By Claudia Boyd-Barrett
For the past eight years, Sonia Melo of Santa Clarita lived in a constant state of worry about her oldest daughter’s health.
Due to her immigration status, 11-year-old Mariana didn’t qualify for Medi-Cal, the state’s health insurance plan for the poor.
Whenever the usually healthy child came down with an illness — such as with the recurring eye infection she’s been battling for more than a year — her mom couldn’t easily take her to a doctor or optometrist.
Mariana moved from Colombia to the United States with her parents at age 2. While her younger sister, a U.S. citizen, qualified for comprehensive medical services through Medi-Cal, Mariana couldn’t get the same care. Instead, her mother made do with home remedies or over-the counter medicine, and some limited health services available through the county’s health department.
“I felt a lot of frustration,” Melo said. “I tried to take good care of (Mariana), gave her good food, tried to make sure she didn’t get sick, because if she did there was nothing I could do. She couldn’t get sick.”
That changed in May when Mariana became one of hundreds of thousands of California children to qualify for full Medi-Cal benefits under a new law that extends coverage to undocumented kids under age 19. So far, about half of the 250,000 children eligible to enroll in the plan have done so, although some applications are still pending, said California Department of Health Care Services spokesman Anthony Cava. Another 65,000 children are expected to sign up for Medi-Cal over the next year, he said.
The state is working with health care providers and Medi-Cal managed health plans to prepare for the influx of new patients, Cava said.
However, many clinics contacted by the California Health Report said it’s too soon to tell what the impact of the expansion will be on their patient numbers.
Expansion broadens care for families
Many of the new Medi-Cal enrollees had visited the clinics contacted by the California Health Report before they had full benefits, clinic workers said. That might be because families paid for the visits themselves, because the children qualified for limited services through a partial Medi-Cal program called “restricted scope,” or because they live in a county that offers a basic health care program for undocumented immigrants, such as My Health LA in Los Angeles County.
“For us, (the expansion) is just allowing us to provide better care,” said Karen Lauterbach, community health insurance program manager for Venice Family Clinic, a 10-clinic system serving west Los Angeles County. Before, “it would not be uncommon for us to have a family with four kids, and two of them had regular Medi-Cal and can get access to all of these things, but the other two couldn’t. So the doctor is having to make different decisions about their care based on their coverage, and that’s not the way you want to provide medical care.”
With full Medi-Cal coverage, kids can get dental, vision and specialty care not available under restricted scope Medi-Cal and programs like My Health LA.
“There’s a huge difference,” said Susie Ramirez, patient relations supervisor for Eisner Pediatric and Family Medical Center, serving downtown and south Los Angeles. “My Health LA is just a program, it’s not insurance. With Medi-Cal they have the full benefits of what an insurance is, so they’re able to have specialty care, they’re able to have a provider as their medical home, the medications are covered, they have full dental benefits.”
Jodi Kopke, vice president of communications with Eisner, said the health center expects to add new patients at “a slow trickle” rather than a sudden onslaught. So far, Eisner and other clinics and outreach organizations in the area have focused on transitioning existing undocumented patients already enrolled in My Health LA into full Medi-Cal. Eisner has a team of nine outreach workers who have been helping families fill out the Medi-Cal paperwork for their children and deal with any questions or problems that come up, she said.
Some children still waiting for benefits
As of late June, some families were still waiting for the county to transition their children to full Medi-Cal. However, clinics and advocates expected the process to be completed soon. Kopke said the next phase of outreach is focused on finding harder-to-reach families, those whose children were not enrolled in My Health LA and who may be wary of the Medi-Cal expansion or not have heard of it.
Eisner is working with a coalition of health clinics — the Southside Coalition of Community Health Centers — to find those families and get them enrolled, Kopke said. Many are fearful about signing on to a government program and providing information on their immigration status, she said.
Nina Vaccaro, executive director of the Southside Coalition of Community Health Centers, said her organization is working with public schools in south L.A. to spread the word to families. A community outreach coordinator has been visiting schools that have many undocumented youths and giving presentations on the Medi-Cal expansion to students and parents, she said.
“It’s been difficult. It’s a really challenging population to reach and there’s a lot of trust issues,” she said. “People have a lot of fear about sharing their information and acknowledging to anyone that they are undocumented, so it takes a lot of trust-building.”
Clinics gear up for more patients
Meanwhile, in Santa Barbara County, where there had been no health care program for undocumented immigrants, the increase in new patients has been more noticeable, said Dr. Charles Fenzi, chief executive officer and chief medical officer for Santa Barbara Neighborhood Clinics. The organization operates four medical clinics and two dental clinics for low-income and undocumented people in southern Santa Barbara County.
Fenzi said the organization has seen an uptick in new patients since the expansion and expects to see more, although the change is too recent to quantify. He said it’s likely that families who already used the clinics when their children got sick and paid for the visits themselves will now start accessing more services — particularly preventative care — now that their kids qualify for Medi-Cal. As a result, the organization has hired a new pediatric nurse practitioner, and is looking to add another family physician, he said.
“I think it’s going to make a really big difference,” Fenzi said of the expansion. “There may be children who walk around who have subclinical asthma for instance, so they only find out they’re in trouble when they try to do sports. Or the children who are overweight and that’s not identified if they don’t come in for some kind of a visit.”
With the expansion, “we’re more likely to get them in for things that are preventative, things that allow us to detect problems before they become big problems,” he said.