By JULIE MINDA
California has passed a state budget that allows for expanded access to health care coverage for undocumented immigrants under age 19; and advocates representing ministry providers in the state applaud the expansion as a way to improve young immigrants' health. Advocates from St. Joseph Health of Irvine, Calif., told Catholic Health World they are continuing to push for even broader access to health insurance — including for adult undocumented immigrants — as well as for other benefits that will improve immigrants' lives, such as housing help and legal aid.
Efforts to improve health care access for the undocumented are "part of a bigger puzzle," said Christopher Leo, Southern California regional director of government relations and advocacy for St. Joseph. He said St. Joseph advocates on behalf of immigrants on a wide range of issues to improve their health and to ensure they are treated with dignity.
"The theme is: What services can we advocate for or establish to create a healthier community?" said Leo's colleague Christopher Manson, who is Northern California regional director of government relations and advocacy for St. Joseph Health.
New avenues for access
Immigrant laborers are among those served by St. Joseph Health’s Open Door, a Latino health promotion program in Humboldt County, Calif.
St. Joseph is among California Catholic health care providers that have been following and generally supporting a state bill to cover undocumented immigrants' health care — a bill that inspired the recently approved state budget that in part funds expanded health care access for undocumented youth. Authored by state Sen. Ricardo Lara of California's 33rd district, which is in the greater Los Angeles area, the "Health for All Act" (SB 4) originally aimed to provide all undocumented immigrants in California access to health care insurance coverage. But, Leo said, the bill went through the government "sausage maker," and benefits and cost projections changed, limiting its scope.
As Catholic Health World went to press SB 4 was slated to be the subject of a hearing on Aug. 19 by the California Senate Standing Committee on Appropriations, which Lara chairs; go to a floor vote and then potentially go to the governor for signature.
Leo said the legislature and Gov. Jerry Brown wanted to preserve some of the original intent of SB 4, and so they passed a 2015-16 state budget with provisions allotting $40 million to provide health care coverage to undocumented immigrants under age 19, effective in May 2016. The coverage expansion is to happen under Medi-Cal, the state's Medicaid program — the funds will be used to reimburse care providers for treating the newly covered beneficiaries. California's fiscal year runs July 1 to June 30; and so the $40 million covers the Medi-Cal expanded coverage for only two months, from May 2016 through June 2016. It is estimated that a full year of full funding for the roughly 170,000 children and teens expected to sign up for the benefit will cost $132 million. The budget item would have to be reauthorized each year.
On a separate track, SB 4 has been completely revamped. It now centers on allowing all Californians access to the health insurance marketplace established under the Affordable Care Act, regardless of their citizenship status. Undocumented immigrants would not be able to receive federal subsidies for use on the exchange, but SB 4 calls for a board connected with the California exchange to create a state fund for subsidizing immigrants' purchases on the exchange. Money for the fund would come from a charge assessed on other qualified health plans. SB 4 also provides some implementation language for the state's approved budget.
Currently, the federal act prohibits undocumented immigrants from purchasing health insurance on the marketplace. SB 4 directs California to seek permission from the federal government to allow undocumented Californians to purchase their own health coverage through the Covered California health insurance exchange.
Manson and Leo explained that the budget and proposed SB 4 are important measures because they could address some very significant gaps in health care access and services for immigrants. While uninsured, undocumented people can access care in emergency departments and some of that care is reimbursed by the government, in general other types of health care access have only been addressed piecemeal. This includes extremely limited provisions for undocumented people to receive some care through Medi-Cal and through the State Children's Health Insurance Program. The undocumented have few options for preventive care, when it comes to formal coverage programs from the government.
Manson said California localities have various strategies in place for providing health care to undocumented immigrants; the new and proposed measures promise more uniform coverage across the state and significantly improved access to preventive and basic health care for undocumented immigrants.
Leo added that under the state budget provision, more of the care provided to undocumented immigrant youths will be reimbursed by Medi-Cal rather than categorized as unpaid charity care. Leo said the revenue will enable St. Joseph facilities to expand services to the uninsured, including adult undocumented immigrants.
And, there is great need for such expansion. The Public Policy Institute of California, a nonprofit, nonpartisan think tank, has said that in 2013 California was home to an estimated 2.67 million undocumented immigrants. That organization said almost a quarter of the nation's undocumented immigrants reside in California, where they make up slightly more than 6 percent of the state's population.
Manson and Leo said St. Joseph's advocacy work at the local, state and federal levels on undocumented immigrant health care is done in concert with advocacy work promoting comprehensive immigration reform, strengthened funding for the federally qualified health centers that serve many undocumented people, improved housing options for this population, expanded services for them and many other provisions. St. Joseph also invests its own dollars, in the form of foundation and community benefit funding, in many of these priorities as well.
Manson noted that St. Joseph is seeing progress in its areas of focus for its advocacy work in part because of ongoing efforts to educate government officials. The system and its hospitals invite elected officials to visit St. Joseph ministries and witness firsthand how St. Joseph treats all who come for care, regardless of their immigration status — and regardless of the limited resources available to care for the undocumented.
Manson said, "At the end of the day, we hear back that the government officials appreciate the work of our ministry, to provide care in keeping with the (Sisters of St. Joseph's) vision. It resonates with them that we are there to serve everyone. And, even if some of the government officials disagree with us on some of our positions, we are still well-respected in their eyes."
Decisions on Obama orders could impact California provisions
The fate of some executive actions issued in 2014 by President Barack Obama could have an impact on the expanded Medi-Cal coverage provisions related to immigrants in California, according to Christopher Leo, Southern California regional director of government relations and advocacy for St. Joseph Health of Irvine, Calif.
Last November, the president issued executive orders enabling Dreamers, or undocumented students who had received temporary, two-year legal status and work permits in 2012, to apply for three-year permits in late 2014. For the first time, Dreamers' parents, too, could apply for work permits under the 2014 executive actions. Essentially the 2012 and 2014 orders removed the threat of deportation for qualified undocumented people and allowed them to work legally in the U.S.
Texas Gov. Greg Abbott filed suit in December on behalf of Texas and 26 other states opposed to the 2014 executive action. That case is State of Texas, et. al. vs. the United States of America, et. al. It is civil case number B-14-254 in the U.S. District Court for the Southern District of Texas, Brownsville Division.
Leo noted that if the Obama administration prevails, more undocumented immigrants will gain temporary legal immigration status, and that would increase the number of undocumented people positioned to benefit from expanded access to health insurance under Medi-Cal in California. That is because California state law provides for such health care insurance benefits for undocumented immigrants eligible for Obama's deferred action on undocumented immigration status.
U.S. District Judge Andrew Hanen in February issued a temporary injunction blocking the administration's 2014 action to authorize work permits for parents of Dreamers who have legal immigration status and its effort to increase extensions of Deferred Action for Childhood Arrivals status to three years from two. However, according to documents filed on the case, the government continued to issue permits. (Dreamers can still apply for initial status under the 2012 Deferred Action for Childhood Arrivals program, or to extend their status for two years.)
At an Aug. 19 hearing in the suit, government lawyers apologized to Hanen about the granting of the work permits in violation of the temporary restraining order, and they documented efforts to retrieve the permits from immigrants, including through door-to-door visits. The judge said that by Sept. 4, parties in the case must suggest penalties in the event Hanen determines the government deliberately misled him about the issuance of work permits. This is according to a Bloomberg report.
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