Bill could provide Medi-Cal to undocumented children

Undocumented children under the age of 18 may soon qualify for full Medi-Cal coverage if Governor Jerry Brown signs Senate Bill 4 before the October 11 deadline.

The bill, written by State Senator Ricardo Lara (D-Bell Gardens) would implement the state’s approved budget to cover undocumented children under Medi-Cal. The budget includes $40 million to implement an extended Medi-Cal program, with $132 million for every subsequent year. The bill would also guarantee full Medi-Cal coverage to financially-qualifying undocumented children and to transfer those in restricted scope coverage, which limits patients to emergency and pregnancy services, to full coverage at the start of the program on May 1, 2016.

An estimated 17,000 undocumented children would be covered under SB 4. “The Affordable Care Act is successful, but it left out a big portion of the population,” said Jesse Melgar, communications director for Lara.

If SB 4 is not adopted, undocumented children in Alameda County can still qualify for HealthPac, which covers Alameda County and only gives patients access to a limited network of community clinics; the Kaiser Child Health Program, a Kaiser Permanente program that does not require U.S. citizenship; and partial coverage under Medi-Cal, which only covers emergency visits.

Health service providers in Oakland said the bill would facilitate ongoing medical care for undocumented children. “We are very excited about SB 4 because that would really allow us to serve these children in a more comprehensive way and be able to be reimbursed for it,” said Amy Blackshaw, clinic supervisor for Fremont Tiger Clinic at Fremont High School. Tiger Clinic is one of 16 Oakland Unified School District (OUSD) school health centers. School health centers work in partnership with the district, the Alameda County Health Care Services Agency and community-based organizations to provide health care to any student in the district.

“While we are able to meet some of those needs, there are limitations,” Blackshaw said. “We can’t refer them to specialty care appointments,” such as those for mental health care, dental, optical, cardiology, endocrinology or urology. Some specialty care doctors are not in the network of health care programs available for undocumented children, such as HealthPac.

“When I think about the impact [the bill] could have, I think about the trauma that a lot of kids in these communities have suffered and are suffering, and what a huge limit there has been to be able to extend mental health services to them,” said Eliza Schiffrin, program coordinator for the school district’s Central Family Resource Center, who helps enroll families in health insurance. Schiffrin said many undocumented children immigrated alone to the United States, have been through traumatic experiences and need individualized mental health care.

Mara Larsen-Fleming, the OUSD school based health centers coordinator, said no student is turned away from school health centers. But if the bill passes, centers would be able to bill the state for undocumented children under Medi-Cal, which in return would provide financial support to the clinics. “It definitely will be helpful to have more students enrolled in Medi-Cal,” said Larsen-Fleming. “The services that are provided to the student health centers will be more sustainable.”

Blackshaw said that although her clinic can bill insurance companies for reimbursements, large numbers of their patients are either under-insured or not insured. “The extension of medical services for the undocumented will allow us to do our work better and more broadly,” she said.

Some health center directors also said SB 4 would help convince undocumented immigrants to come in for medical help. Thu Quach, director of Community Health and Research at Asian Health Services, said the undocumented Asian community is often scared of being deported or ostracized if they seek medical care. This often prevents undocumented people from reaching out to their services. If SB 4 passes, that could change, she said. “We see it as an opportunity that once we bring in the students, we can also bring in the parents,” she said.

Some however, do not think SB 4 should be adopted. State Senator Jeff Stone (R-Temecula) said he opposes the bill because there are not enough doctors accepting Medi-Cal to meet patient demand. “We have an underfunded healthcare system where physicians won’t even participate,” Stone said. He said many doctors do not take in Medi-Cal patients because they cannot afford to accept the state’s reduced medical fees.

Instead, Stone said the state should focus on funding group homes for the elderly and those in need of 24-hour care, which the government has cut funding for over the past seven years. “After that, if we want to do humanitarian work, I am open to it,” he said.

Schiffrin said that since the Affordable Care Act passed, she has heard from community members that there are not enough providers to treat the high number of Medi-Cal patients. “[SB4] has the potential to make such a positive impact for undocumented kids, but there’s that concern of having incentives for providers to increase their clientele of medical patients,” she said.

Brown, who is the former mayor of Oakland, has until October 11 to sign SB 4.