Welcome and Opening Remarks 10:00 am Gil Ojeda, Director, California Program on Access to Care Xóchitl Castañeda, Director, California-Mexico Health Initiative AGENDA UC Center Sacramento 1130 K Street, Lower Level Sacramento, California Wednesday, July 5, 2006 10:00am to 3:00pm Panel 1: Who s doing what: Targeted Programs for Agricultural Workers Moderator: Art Naldoza, Deputy Director, La Cooperativa Campesina 10:15 am The California Endowment s Special Agricultural Workers Initiative Paul Hernández, Public Affairs Director, The California Endowment 10:30 am Public Health Initiatives in Agricultural Counties Carmen Nevárez, MD, Medical Director, Vice President of External Affairs, Public Health Institute 10:45 am Farmworker Targeted Programs: Successes and Limitations Harry Foster, President and CEO, Family Healthcare Network Janet López, Policy Analyst, California Primary Care Association 11:00 am Outreach, Training and Education Through Multi-county CBO Networks Chris Paige, Chief Operating Officer, California Human Development Corporation Panel 2: What s the Message: Communicating to Agricultural Workers Families 11:15 am Role of the Media in Reaching Rural Immigrants Hugo Morales, President/Founder, Radio Bilingüe Graciela Orozco, Assistant Professor, San Francisco State University
11:30 am Mobilizing Communities through Binational Health Week Xóchitl Castañeda, Director, California-Mexico Health Initiative Luis J. Hernández, Community Program Coordinator, California-Mexico Health Initiative 11:45 am Reaching the Most Vulnerable: What Do We Know? Marc Schenker, MD, MPH, Professor, School of Medicine, UC Davis 12:00 pm Discussion and questions from the audience 12:15 pm Lunch will be served Moderator: Xóchitl Castañeda, Director, California-Mexico Health Initiative Luncheon Keynote Speaker The Honorable Denise Ducheny Moreno, Chair of Senate Budget, Sub-Health Committee, California State Senate (San Diego) Panel 3: National Immigration Reform: Implications for Immigrant Health in California Moderator: Gil Ojeda, Director, California Program on Access to Care 1:30 pm Potential Impacts of Immigration Legislation on Access to Health Care Michael Rodríguez, MD, Vice Chair for Research, David Geffen School of Medicine at UCLA* 1:50 pm The Impact of Possible Reform on California Immigrant Demographics Rick Mines, PhD, Agricultural Labor Consultant/Agricultural Workers Survey, Developer, National Department of Labor 2:10 pm Contending Reform Provisions: the Most Pressing Dilemmas Josh Bernstein, Director of Federal Policy, National Immigration Law Center * Tanya Broder, Public Benefits Staff Attorney, National Immigration Law Center 2:30 pm Discussion and questions from the audience 3:00 pm Adjournment Presentation titles are tentative * Participation via videoconference
Community Health Centers and Farmworker Programs in CA Janet Lopez Policy Analyst California Primary Care Association July 5, 2006
Purpose Who are Migrant/Seasonal Farmworkers in California? What services do California s Migrant Health Centers provide to Farmworkers?
Demographics of California MSFW Population California MSFW communities include over 1.3 million people 700,000 farmworkers are adults 400,000 are spouses and kids under the age of 18 34-42% of the state s farmworker population are undocumented workers Farmworkers are young Median age = 30
Demographics of California MSFW Population 65-80% of MSFWs are male 59% of MSFWs are married 45% of MSFWs have children ¾ of MSFW earn an annual income less than $10,000 per year California State Library, California Research Bureau 2002 Report
California Migrant Health Centers (MHC) 135 sites providing health care services under the federal Migrant Health Centers program Services include preventive and primary health care, dental, mental and substance abuse services, transportation assistance and a sliding fee scale for payment Many services are culturally and linguistically appropriate
MHC Patient Demographics In 2004, MHCs reported providing services to 280,295 individuals 47% of patients seen were women of child-bearing age (19-44) 43% of patients are children under the age of 19
Migrant Women and Children s Health Women more likely to visit doctor than male workers In 2004, MHCs reported serving 59.8% women v. 40.2% men More than half of MSFW children have medical insurance Medi-Cal is most prevalent source of health insurance In 2004, 44.6% of MHC patients were enrolled in Medi-Cal
Health Insurance Programs Legal Residents of CA Full-Scope Medicaid (Medi-Cal) SCHIP (Healthy Families) All Residents of CA Pregnancy Only Medi-Cal California Kids & Healthy Kids Insurance program CHDP Family PACT
State Funding for Health Care Services All Residents of CA (cont) Indigent Programs Seasonal Agricultural Migratory Worker Program and Rural Health Service Development Program $6.9 M general fund FY 2006 67 clinic grants Rural Health Demonstration Projects in counties with high numbers of uninsured children $8.2M general fund FY 2006 97 clinic grants
Challenges for MSFW and MHCs Only 20% of total MSFW population in CA seek care at MHCs Funding & Insurance Limited Federal grant funding Eligibility & Funding Reductions to Medi-Cal program Lack of access to Private Insurance coverage Lack of C/L Providers
Innovative Outreach Efforts in CA Oxnard Region Cultural and Linguistic Competency Estimated at 20,000 Mixteco s in region Clinicas del Camino Real CCHC 3 Mixteco translators on staff Provide assistance with WIC, Social Security, Medi-Cal/Healthy Families enrollment Prenatal classes
Innovative Outreach Efforts in CA Las Islas Family Group County Program Provide assistance with enrollment into social service programs and educate population on health care programs. Hold monthly meetings to provide one-on-one assistance as well as a community forum Clinicas del Camino Real staff attend monthly Las Islas Family Group meeting to coordinate efforts
Contact Information Janet Lopez California Primary Care Association 1215 K Street Sacramento, CA 95814 Find A Clinic Database: http://www.cpca.org/resources/findclinic/
Potential Impacts of Immigration Legislation on Access to Health Care Michael A. Rodriguez, MD, MPH Department of Family Medicine University of California, Los Angeles July 5, 2006
Immigrant labor force Immigrants in California make up one-third of the state labor force (Auerhahn and Brownstein, 2004). Immigrants pay over $30 billion annually in federal taxes and about $4.5 billion in California state taxes (California Immigrant Welfare Collaborative, 2006).
Immigrant Health Immigrants live longer compared to native born (Singh and Siahpush, 2001). Immigrants also have significantly lower causespecific mortality risk than native born for a number of diseases including cardiovascular diseases, lung and prostate cancer, chronic obstructive pulmonary diseases, and suicide (Singh and Siahpush, 2001).
Immigrants & health care access Non-citizen immigrants were much less likely than immigrants who became citizens and U.S. born to be insured (Carrasquillo O., Carrasquillo A.I., and Shea S., 2000). In 2001, 60% of low-income non-citizens were uninsured compared to 28% of low-income citizens (Kaiser Commission on Medicaid and the Uninsured, 2003). In 2001, 33% of low-income U.S. born were on Medicaid, compared to 13% of low-income non-citizens (Holanhan and Wang, 2003).
Immigrants & health care access 2000 data indicate that only 26% of immigrants have employer-based health insurance (Ku and Blaney, 2000) Despite high rates of employment by immigrants, immigrant workers tend to work in industries that are less likely to offer health benefits (Kaiser Commission on Medicaid and the Uninsured, 2003). A recent Robert Wood Johnson Foundation report found that more Californians are declining employer-sponsored health benefits due to rising health insurance premium costs (RWJF, 2006).
Immigrants & health care services The average U.S. born Californian receives $1,212 cash per year in public benefits compared with only $474 for non-citizens (Center on Budget and Policy Priorities, 2003). California spends close to $500 million per year on emergency medical services for undocumented immigrants (Center for the Continuing Study of the California Economy, 2005). California spends approximately $300 million on births and pre-natal care for the children of undocumented immigrants (Center for the Continuing Study of the California Economy, 2005).
Immigration Legislation 1994: Proposition 187- California law that denied social services to undocumented immigrants (was later ruled unconstitutional). 1996: Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA)- As part of welfare reform legal immigrants cannot access Medicaid for their first five years in the U.S. 2006: Deficit Reduction Act (DRA)- New documentation requirement for people applying for or renewing Medicaid eligibility (went into effect on July 1, 2006)
Impacts of immigration legislation In California there was a steep decline in participation of public assistance programs after changes in welfare (PRWORA) and immigration (187) policies (Fix and Passel, 2002; Park et al, 2000; Zimmerman and Fix, 1998). Many illegal immigrants are afraid to seek medical care due to their undocumented status (Berk and Schur, 2001). Many legal immigrants are confused or scared about enrolling for public benefits for fear of being labeled a public charge (Johnson, 1995). The number of U.S. citizen children of non-citizen parents applying for Medi-Cal declined between 1996-1998 (Zimmerman and Fix, 1998). Avoiding treatment can exacerbate communicable diseases like tuberculosis (Asch et al, 1994).
Pending immigration legislation: Comprehensive Immigration Reform Senate Bill (S.2611): Comprehensive Immigration Reform Act (CIR) CITIZENSHIP Path to permanent legal status- different residence and work requirements. Backlog reduction- reduce the immigration backlogs; increases in family and employment-based permanent visas. More guest workers- temporary worker program; agricultural worker program; high-skilled immigration program reforms. DREAM Act- relief for undocumented high school graduates. ENFORCEMET Border enforcement- construction of fence, increase number of border patrol agents, etc. Interior enforcement- increase enforcements and penalties for immigration violations. English as the national language- not entitled to services or materials in any other language.
Pending immigration legislation: Border Protection, Antiterrorism, and Illegal Immigration Control Act House of Representatives bill (H.R. 4437): Border Protection, Antiterrorism, and Illegal Immigration Control Act of 2005 introduced by Sensenbrenner. Focuses on enforcement construction of 700 mile fence along U.S.-Mexico border Mandates employers to verify workers' legal status Increases penalties for employing undocumented workers Housing of undocumented immigrants will be a felony and subject to 3 years in prison.
Analysis of S.2611 legislation Although eligible many may still face logistical barriers to citizenship (NILC, 2006): Costs about $4,000 in fines and fees English language ability Minor past crimes Confusion over new provisions
Analysis of S.2611 legislation: Potential impacts on health care access Financial costs of increased number of newly legal immigrants- the Congressional Budget Office estimates that S. 2611 would add $16.9 billion in federal spending on Medicaid and Medicare (CBO, 2006). Increased tax payments by newly legal immigrants. Newly legal immigrants as a result of S. 2611 will not be able to access federal benefits like Medicaid for another five years due to PRWORA. Opportunity for better jobs means immigrant workers may have greater access to private health insurance and potentially more employer-based coverage.
Analysis of S.2611: Potential impacts on health care access English only provision- health care materials and services would not be offered in a language other than English. Enforcement aspect of bill may cause some to avoid seeking healthcare due to concerns over deportation, fines, and/or jail. Leading to impacts on public health through increased risk for complications from delayed treatment and reliance on emergency rooms.
Questions and future directions How is S.2611 different from 187? What is the best strategy to address health care concerns and advocate for immigrant health issues? What are the public health concerns of the current legislation? What are the hidden costs of the legislation in its current form? Delays in diagnosis, extra costs for unneeded tests, preventive measures