After Missing Target, County Seeks to Ease Immigrants’ Healthcare Enrollment

After months of debate last year, Los Angeles County officials agreed to pay for 146,000 people in the country illegally to receive medical care through the public health system.

More than a year later, however, officials have fallen about 11,000 short of that target, and left more than $20 million of their budget unspent.

County administrators say they feared that resources would be strained if they expanded health services too quickly. But clinic leaders say they went overboard by making it too difficult for people to sign up.

“We have this unique opportunity to create universal access for everyone in L.A. County regardless of immigration status,” said Jim Mangia, chief executive of St. John’s Well Child and Family Center. “There’s absolutely no reason to suppress enrollment…. It’s time to take the handcuffs off.”

People who are in the country illegally are not allowed to sign up for Obamacare, so they make up a growing portion of the nation’s uninsured. In Los Angeles County, more than 300,000 of these immigrants are thought to be eligible to receive county-subsidized care.

Los Angeles County has been providing healthcare to people who are in the country illegally for years, but over the last several months dozens of other counties have started doing the same. Gov. Jerry Brown signed a law last month promising that children in the country illegally could receive healthcare through the state.

As officials begin implementing these new initiatives, however, the current tensions in Los Angeles County are a sign of what they could soon face. In building the health program here, officials have had a variety of challenges: creating and running a parallel health system for those ineligible for Obamacare, dealing with concerns about containing costs and figuring out how to encourage enrollment among a population that may not speak English and may be fearful of the government.

In 2014, the Board of Supervisors pledged $61 million to create the My Health L.A. program and provide care to 146,000 people in the country illegally.

Starting that October, eligible Los Angeles County residents who made less than 138% of the federal poverty level — less than $16,243 annual income for a single person or $21,984 for a couple — could receive free primary care, specialty care and screenings at dozens of clinics across the county.

Advocates warned that the program wasn’t big enough to serve the population in need.

However, only 135,000 people have signed up so far. The first 12 months of the program generated expenses of $37.5 million, or 61% of what was allocated.

“I think we can all be really proud of what we accomplished in the first year,” said Amy Luftig-Viste, program director for My Health L.A, who pointed out that enrollment is more than 90% of its target. “It’s not everybody, but I don’t think you could ever find everybody.”

Louise McCarthy, who heads the Community Clinic Assn. of Los Angeles County, said the numbers fell short in part because patients were allowed to enroll only at community health centers, and not at part-time clinics or other events such as health fairs.

She said she thinks that restricted access, especially among the homeless population, which often gets care at mobile clinics and makes up less than 1% of the program’s total enrollment.

On Tuesday, the Board of Supervisors is scheduled to discuss several recommendations to ease the enrollment process, including allowing patients to sign up at some mobile clinics and part-time clinics.

“Thankfully, after one year of begging for some relief on this, we’re getting these changes made,” McCarthy said.

She also praised a recommendation that would allow one family member to renew membership for the whole family, a shift from the current standard requiring all participants to show up to renew their plan.

Others don’t think the changes are enough. Mangia, whose clinic treats 16% of all My Health L.A. patients, said that the modifications would allow patients to sign up only at mobile clinics that operate on a fixed schedule, which would exclude many of them. “That’s the very antithesis of what a mobile clinic does,” he said.

He and McCarthy agreed that patients should be allowed to sign up at places such as laundromats and grocery stores, and at locations where others can sign up for Medi-Cal, the state’s low-income health plan.

Mangia said that My Health L.A. has been a boon to the clinic’s finances and that he is glad the county is committed to the program. But he thinks that fulfilling the program’s goals means increasing the income eligibility so more people can sign up.

Earlier this year, Supervisors Mark Ridley-Thomas and Hilda Solis asked that the health department look into increasing enrollment to include people who make 150% of the federal poverty level or higher.

“Let’s blow this thing open; let’s really make this thing work,” Mangia said.

Nearly a third of the state’s undocumented population — 814,000 — live in Los Angeles County, according to data from the Public Policy Institute of California. And a recent analysis from nonprofit group Enroll America found that 21 of the 50 California ZIP Codes with the highest rate of uninsured residents were in Los Angeles County.

Luftig-Viste said the county health department is in discussions with the supervisors about loosening the income requirements, but thinks it’s unlikely they would make such a change while the program is new. She said that in the coming year, they want to focus on maximizing enrollment and re-enrollment for those who are already eligible.

“We need to give the program a little time to see how it’s growing,” she said.

Sonya Vasquez, policy director for Community Health Councils, said enrollment in My Health L.A. so far is not bad, but said she thinks the county could do more to advertise the program and quell fears that immigrants without papers could be detained by authorities.

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