Contra Costa to Again Offer Health Coverage to Adult Illegal Immigrants

Six years after eliminating health coverage for adult immigrants living in the U.S. illegally during the Great Recession, Contra Costa County has cobbled together enough money to begin insuring them again, although the program could be short-lived.

The Board of Supervisors voted 4-1 Tuesday to launch a $1 million pilot program aimed at providing primary care services for 3,000 such adult immigrants through county-authorized clinics. The county never stopped insuring children living here illegally, who next year will be covered under the state’s Medi-Cal program.

Public health advocates heralded the new effort, called Contra Costa Cares, as an important step, even though the funding will only cover only about one-fifth of the county’s illegal immigrant adults. Several neighboring counties, including Alameda, Santa Clara and San Mateo, cover all such residents and also offer specialty care.

“Contra Costa is an outlier in the Bay Area, and this would go a long way to reducing that gap,” said Anthony Wright, executive director of Health Access, a statewide consumer advocacy coalition. With the federal Affordable Care Act and the expansion of Medi-Cal reducing the ranks of the uninsured, adult illegal immigrants remain one of the state’s largest populations without health coverage.

Contra Costa had insured them under its county plan until it slashed the program in 2009 during a round of budget-cutting. The county continued to help fund clinics that serve them, but the pilot program would create a far more structured system. Enrollees would receive an insurance card, be assigned a clinic for primary care, and have access to immunizations, lab work, drugs and mental health counseling.

The program, which is separate from Contra Costa’s health insurance plan, is intended to save money by cutting down on the overuse of county emergency rooms, while allowing hospitals, clinics and the county health department to further bring down costs by coordinating care for the enrollees.

“This allows us to enroll folks into primary care … monitor their use over a period of time and prove the cost effectiveness of establishing such a program,” Contra Costa Health Services Director William Walker said.

For the program to expand, or even survive into a second year, the county must hope for increased outside funding or find more money of its own — a prospect that several supervisors cautioned was no sure bet.

“Health care for all is important,” Supervisor Karen Mitchoff said, “But, I will tell you that we have other programs that make the exact same plea to us. I will have no problem voting ‘no’ next time if the money is not there.”

Mitchoff’s concerns were echoed by Supervisor Mary Piepho, who also voted to support the pilot program, and Supervisor Candace Andersen, who cast the lone vote against it.

For now, the program, slated to begin in November, is being funded with $500,000 from the county and a $500,000 grant from a consortium of local hospitals that includes Kaiser Permanente, Sutter Health and John Muir Health.

Walker is looking to either Sacramento or Washington to provide key funding in ensuing years. State lawmakers are expected to once again consider legislation allowing illegal immigrant adults to qualify for Medi-Cal, which would end any need for a county program. Also, the Obama administration, Walker said, is likely to consider a waiver to the federal Medicaid program that could make more funding available for this group.

“If we can do this for the next year, hopefully we can provide that bridge to whatever federal or state funding becomes available during the year,” Walker said.

If Walker comes back looking for more money, he definitely will have one reliable vote: Federal Glover, who attended his first board meeting in nearly eight months after heart and kidney transplant surgery, said the program was too important to eliminate.

“Trust me,” he said. “If I didn’t know it before, I definitely know now.”

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