As Families Drop Health Benefits Over ‘Public Charge’ Rule, Clinics Scramble to Respond
Soon after news broke last week of the Trump administration’s finalized “public charge” rule, benefit enrollers at the Eisner Health community clinic in downtown Los Angeles started getting phone calls.
Patients enrolled in Medi-Cal, the state’s health insurance program for low-income people, and CalFresh, California’s food stamp program, asked to end their family’s coverage. Those with pending applications pleaded to pull out.
Many of these patients were non-permanent residents who, under the new federal immigration rule, could have difficulty obtaining a green card if they’ve received certain government-funded aid, or if immigration officials determine they might need that aid in the future. But they were also cancelling coverage for family members unaffected by the rule, including their U.S.-citizen children, said Eisner Health enrollment specialist Gilbert Soto.
“Our patients are confused and fearful,” he said. “We’re letting them know and we’re reassuring them that the children are not impacted by the new public charge rule,” but they’re still pulling out, Soto said.
This exodus from health and food benefit programs—even of people who should have nothing to worry about under the new regulation—is expected to amplify across California and the nation as fear and misinformation about the rule spreads. Even before the “public charge” rule was finalized Aug. 12, organizations working with immigrants reported an uptick in clients dropping out of benefits and forgoing medical care, including for their children.
Many people are reportedly withdrawing from programs that aren’t even under the scope of the regulation, such as emergency medical assistance, Medi-Cal for pregnant women and children, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). At the Venice Family Clinic in Los Angeles last week, a young, pregnant student told the doctor she didn’t want to enroll in Medi-Cal for her prenatal care, recounted Anita Zamora, deputy director and chief operations officer.
“Obviously that’s incredibly concerning to have somebody who’s pregnant and potentially have that baby not getting the care that they need,” Zamora said. “What if she develops a high-risk condition and she doesn’t have the coverage to access those services?”
Researchers say the rule is having a “chilling effect.” While the regulation affects about 500,000 people already living in the United States who apply for green cards each year, about 13.5 million people—including 7.6 million children—could be at risk of un-enrolling in Medicaid (the federal name for the MediCal program), according to the Kaiser Family Foundation.
A study by UCLA and UC Berkeley last year estimated that, in California alone, up to 765,000 immigrants could drop nutrition assistance and health insurance because of fear, confusion and misinformation about the rule. Almost 70 percent of those losing benefits would be children, said Riti Shimkhada, an analyst with UCLA’s Center for Health Policy Research. Many of these children live in mixed-status families where some members are legal residents or U.S. citizens, and others are undocumented.
“It has huge ripple effects,” said Shimkhada. “Disruption in health and wellbeing coverage really impacts communities and public health as a whole, especially if kids and families aren’t getting needed preventive care (or) immunizations.”
Not having adequate health coverage can also affect children’s educations, Shimkhada said. “If you don’t have enough food you’re not able to perform well in school.”
California will need to launch informational campaigns to counter misinformation about the rule and prevent families from needlessly un-enrolling from benefits, said Shimkhada. Otherwise, the state could potentially lose millions of dollars in federal funding for safety-net programs, which could in turn negatively impact California’s economy as a whole, the researchers predicted.
The state is suing the federal government over the rule, and two of California’s most populous counties—San Francisco and Santa Clara—have filed a separate lawsuit.
Meanwhile, health clinics are scrambling to reassure immigrant community members that it’s still safe to go to the doctor and to get health insurance for their kids.
Venice Family Clinic is drafting talking points for medical employees and creating patient pamphlets to help answer questions about “public charge,” Zamora said. At Eisner Health, officials are planning to hold workshops to inform patients and address the stress they’re feeling because of the new rule, Director of Development Emily Bush said.
“We just want to be able to provide our patients with as much accurate information as possible to make sure they can still get the care they need,” she said. “We want everybody to be able to access health care, and this (rule) really prohibits that.”
Cedars-Sinai Is More Than Doubling Its Commitment to Assist 108 Community-Based Organizations That Serve Vulnerable Populations
Cedars-Sinai is deepening its commitment to the health and wellbeing of underserved populations in Los Angeles County by significantly increasing its financial support for safety-net organizations that serve people experiencing homelessness and others who are vulnerable.
The institution is contributing $15 million to 108 nonprofit programs and organizations that foster housing stability, provide sustainable programs for homeless residents and build clinical and financial capacity at community clinics. The grants, announced this month, also will support mental health training, services for LGBTQ+ and veterans’ groups, as well as a range of social services provided by several Jewish organizations.
Cedars-Sinai contributed $5.9 million last year to safety-net organizations in the Los Angeles region.
The effort to address homelessness and housing stability comes at a critical time for the region. The 2019 Greater Los Angeles Homeless Count found a 12% increase in homelessness across the county compared to a year ago, pushing the numbers of homeless residents in the area to nearly 59,000. The count also showed that 600,000 people countywide face critical housing stability issues because they spend more than 90% of their income on shelter.
“We take our role in the community as seriously as we take patient care, research and education,” said Cedars-Sinai President and CEO Thomas M. Priselac. “We are driven by a strategic focus on improving access to care and addressing social determinants of health. Ultimately, we are working to break down barriers that affect tens of thousands of people within the safety net.”
More than 20 of the Cedars-Sinai grants are going to organizations that work directly with people experiencing homelessness or strive to improve housing stability. In total, Cedars-Sinai is contributing $2.5 million to these dual priorities. Among the recipients:
- The City of Santa Monica is receiving $100,000 for a feasibility study about comprehensive healthcare for homeless residents in the seaside city.
- Home for Good, a public-private partnership that invests in solutions to homelessness in Los Angeles County, will receive $100,000 to support its work.
- The Los Angeles LGBT Center will have $160,000 to develop vocational training for youth who are transitioning out of homelessness.
- The People Concern is receiving $100,000 to expand a “navigator” program that connects homeless patients at Cedars-Sinai Marina del Rey Hospital with community resources and services. The Los Angeles nonprofit received a $100,000 Cedars-Sinai grant last year to launch the program.
- St. Joseph Center is receiving $100,000 to train first responders in Culver City to meet the needs of the city’s homeless population and to teach members of the business community how to connect those who are homeless to social services.
Cedars-Sinai also is distributing several major grants to assist community clinics to reduce disparities in health and healthcare. More than 1.6 million Angelenos receive their healthcare from community clinics, making these organizations the backbone of the region’s safety net. The Cedars-Sinai Community Clinic Initiative is contributing $1.5 million over two years to help 17 Los Angeles County community clinics build greater capacity to address food insecurity and transportation issues for those who need the support. The contribution is among more than $10 million Cedars-Sinai has devoted to community clinics over the last four years.
Planned Parenthood also is receiving $500,000 over three years to help develop wellbeing centers on school campuses across the county. Other community clinic grantees include Saban Community Clinic, APLA Health, Eisner Health, Venice Family Clinic, and Korean Health Education Information and Research Clinic.
Behavioral health is another priority area. Cedars-Sinai is providing funds for training and partnerships with clinics and social service agencies.
Martin Luther King, Jr. Community Hospital is receiving more than $1 million to develop a self-sustaining behavioral health program for its local community, which significantly lacks access to care. Other behavioral health grantees include Beit T’Shuvah, Korean American Family Services, The Maple Counseling Center, Didi Hirsch Mental Health Services and Para Los Niños.
Several grants also are going to institutions and programs in alignment with Cedars-Sinai’s Judaic values of welcoming and treating all people with dignity and respect. Grants are going to Jewish Family Services, Sharsheret and Bet Tzedek to serve a range of social, education, homeless and legal needs.
The Jewish Free Loan Association will receive $500,000 over five years to establish the Cedars-Sinai Housing Stability Loan Fund, designed to provide immediate housing assistance to stabilize those on the verge of homelessness.
Cedars-Sinai also is making significant investments in workforce development to train healthcare workers in the community. Charles Drew University Medical School is receiving a grant of nearly $1.4 million to help develop a medical education program and a community health worker training program focused on serving people in vulnerable communities. Other workforce grantees include the Southside Coalition of Community Health Centers and the Los Angeles Urban League.
California Health Report
By Warren J. Brodine • Jun 26, 2019
Photo credit: iStock.
Julia is a patient at Eisner Health in Los Angeles who has diabetes and is uninsured. Prior to finding Eisner’s clinic, Julia, whose name has been changed to protect her privacy, was paying cash for insulin, the drug used to treat her high blood sugar, at a local pharmacy. Because she couldn’t afford to take her prescribed dose, her diabetes was out of control, and she was at high risk for disease-related complications.
When Julia came to see us at Eisner, our medical team referred her to our clinical pharmacist who provides personalized medication management and patient education. Because Eisner is a non-profit health center, Julia was able to fill her prescription onsite at a cost she could afford. She is now able to take the correct dose to manage her disease and prevent painful and costly complications.
Julia is not alone. When people are uninsured they are often forced, for financial reasons, to go for extended periods without their medications, increasing the risks associated with untreated chronic diseases, such as diabetes and hypertension. Without organizations like Eisner providing intervention and care to low-income and uninsured patients, patients like Julia will suffer disproportionately from poor health outcomes.
Unfortunately, the program that makes these resources available to underserved patients is in jeopardy. In January, Gov. Gavin Newsom signed an executive order with the ambitious goal of consolidating the state’s drug purchasing to leverage volume-based discounts with manufacturers and lower the state’s drug costs.
While clinics like Eisner support the governor’s goal, the order could have the unintended consequence of eliminating the ability of organizations like Eisner to purchase drugs at a steep discount and reinvest savings into patient care. The order will take effect on Jan. 1, 2021.
Our 43,000 patients benefit from pharmacy savings without even realizing it. The savings enable us to provide supportive services that go beyond the typical doctor’s visit. Our downtown Los Angeles campus has an on-site pharmacy, which makes it easier for our patients who do not have reliable transportation to pick up their prescriptions. Pharmacy savings also enable us to hire our own integrated clinical pharmacist—an expert who plays a vital role in managing the health of our diabetic patients like Julia.
Nearly three-quarters of our patients live at or below 150 percent of the federal poverty level, making access to quality health care a challenge. Pharmacy savings are essential to our ability to provide comprehensive, quality care to low-income patients. Eliminating these savings will jeopardize patient access to critical support services such as dental, optometric and behavioral health; potentially close our in-house pharmacy; disrupt access for our patients, and, in the long run, raise costs. Clinics across L.A. County and the state will face similar challenges.
We must find solutions to mitigate the potential negative impact of the governor’s order.
As a result of advocacy by legislative leaders, the new budget requires the state to provide details regarding how it plans to implement the order and its impact on patients. It also requires safety-net providers like Eisner and patient advocates to have a voice in the analysis and planning process.
This is a critical first step in the right direction. The patients we serve deserve nothing less.
Warren J. Brodine is president and CEO of Eisner Health, which operates community health centers across Los Angeles County.
“Community Health Centers Deliver,” produced by CHroniCles, a special project of the RCHN Community Health Foundation, the Geiger Gibson Program in Community Health Policy at the Milken Institute School of Public Health and Health Services at The George Washington University, and the National Association of Community Health Centers. In this video, health center leaders across the U.S. reflect on the founding and ongoing work of their organizations and the continued importance of the community health center movement.