HEALTHY FAMILIES: Barriers Ahead In Latino Enrollment
With 29% of California's Latino children lacking health insurance, the state's Latino population is a sure target for Healthy Families, the state's new insurance program for the working poor. However, it is unclear how this largely immigrant population will respond to an unfamiliar, premium-based insurance program specifically aimed at working families. "Latinos haven't historically had access to health insurance," said Carmela Castellano, CEO of the California Primary Care Association. "For many families who live week-to-week, the thought of paying premiums to insure health care is a hard sell," she added. Under the Managed Risk Medical Insurance Board's (MRMIB) administration, Healthy Families designates community provider plans in each county. Healthy Families selects the health plans that contract with a large number of traditional safety net providers -- community clinics and other facilities that traditionally serve uninsured people on a pay-as-you-go basis. Fortunately, many community-based clinics frequented by Latinos have contracted with the designated community provider plans, which will enable this population to obtain health care through familiar providers.
Integration Is Key
MRMIB's 14-member Campaign Advisory Committee has several tasks planned to ensure smooth provider-integration under Healthy Families. According to Patricia Barrera, committee member and policy director for the Latino Coalition for a Healthy California, Healthy Families does not require "cultural linguistic competency" in its contracts with health plans, while Medi-Cal managed care does. Additionally, MRMIB does not maintain the data on the Latino population that the state Department of Health Services collects for Medi-Cal. The advisory committee hopes to network Healthy Families with other safety net providers that have experience in treating the Latino population, and Barrera is urging more cooperation between health plans and community-based providers. "Healthy Families' lack of regional outreach neglects many Latinos," said Barrera. "We need to disseminate more materials to community-based organizations and to place stakeholder groups in different counties and community forums to advocate for Latinos," she said. One solution could be the creation of "rural demonstration projects" through Healthy Families, which would encourage additional rural clinics to participate in the program. One drawback, Barrera noted, is that many of these clinics have no managed care capacity.
Keeping A Low Profile
Distrust of California's health agencies remains a barrier to health care for many Latinos. According to Rudy Diaz, executive director of Los Angeles County's community provider plan, the Latino grassroots must overcome this population's traditional distrust of the California state health agencies that administer public assistance. Immigrant distrust of the California Department of Health Services centers around the agency's previous collaboration with the Immigration and Naturalization Services to reclaim Medi-Cal costs from legal aliens who seek naturalization. In recent years, the INS questioned immigrants seeking citizenship about their use of public benefits, or their "public charge" status. Public charge is only lawfully used to deny U.S. admission to immigrants who would potentially use public benefits without other means of support. The INS told those Medi-Cal recipients that they could voluntarily repay these lawfully received benefits in order to improve their chances of gaining citizenship. "Because of this, Latinos have developed a fear of public assistance, even though Healthy Families is not an entitlement program like welfare-based Medi-Cal," said Martha Jimenez, executive director of the Latino Coalition. "Given the misinformation permeating the Latino community, many fear that information on their Healthy Families application will go to the INS and jeopardize their legal status," she said.
Sending A Positive Message
Assembly Speaker Antonio Villaraigosa (D-Los Angeles) is appearing in Healthy Families PSAs to encourage Latino enrollment. And to help gain the trust of legal resident aliens, Villaraigosa is sponsoring legislation to protect program eligibility for children who lawfully entered the United States after Aug. 22, 1996. President Clinton's 1996 Personal Responsibility and Work Opportunity Reconciliation Act prohibits all immigrants entering the U.S. after this date from receiving federal means-tested public benefits for their first five years in the country. Villaraigosa's bill is currently in committee, but if passed, it would use state funds to supplement the five-year void for these immigrants. Elena Lopez-Eldridge, assistant to the speaker, said, "AB 2171 may not boost the number of Latinos applying to Healthy Families percentage-wise, but the public policy statement it makes will help this group substantially."
Glenda Arellano, Medi-Cal Eligibility Policy section chief, said Healthy Families "should be shaped on the lessons from Medi-Cal," with the clear message that application information will be passed on to the INS only if there is a clear indication of fraud. In the meantime, it is necessary to clarify that legal immigrants' previous reliance on public benefits is not an issue in Healthy Families enrollment, she added. "The effects of California's Props. 187 and 209, as well as welfare reform, have been very polarizing for the Latino population," said MRMIB contract and marketing manager Ernesto Sanchez. "Our best approach is to continue liaisons with community-based organizations and to emphasize that the working poor should take advantage of the program." [Staff writer Laurie Bazemore wrote this story for California Healthline.]