Healthcare bound­ary falls in 35 coun­ties

Pro­gram serv­ing mostly north­ern ar­eas of state will of­fer care to those here il­le­gally.

Los Angeles Times - - THE STATE - By Soumya Kar­la­mangla soumya.kar­la­mangla@latimes.com Twit­ter: @skar­la­mangla Kar­la­mangla re­ported on the re­main­ing unin­sured as a Cal­i­for­nia Health Jour­nal­ism Fel­low at USC’s An­nen­berg School of Jour­nal­ism.

In the latest wave of such de­ci­sions, a group of 35 mostly ru­ral coun­ties in Cal­i­for­nia agreed this week to grant healthcare to im­mi­grants in the coun­try il­le­gally.

For sev­eral years, just 11 of the state’s 58 coun­ties pro­vided some form of low­cost med­i­cal care to these unin­sured im­mi­grants. But as of this month, 47 of the state’s coun­ties have promised to do so.

Healthcare ser­vices in 35 of the small­est coun­ties are man­aged by a state out­fit known as the County Med­i­cal Ser­vices Pro­gram. Mostly clus­tered in the north­ern part of the state, these coun­ties in­clude Sonoma, Solano and Marin, but also Im­pe­rial, at the Mexico bor­der.

For the first time in its more than 30-year history, the panel that gov­erns the pro­gram voted Thurs­day to of­fer pri­mary med­i­cal care to peo­ple who have en­tered the coun­try il­le­gally.

“Even if these are not the most pop­u­lated coun­ties, for this to be avail­able in nearly half of the ge­og­ra­phy of Cal­i­for­nia is an im­por­tant step,” said An­thony Wright, ex­ec­u­tive di­rec­tor of Health Ac­cess Cal­i­for­nia. Of­fi­cials say a few thou­sand peo­ple could en­roll in the pro­gram across the mem­ber coun­ties.

Don Say­lor, a su­per­vi­sor in Yolo County— which par­tic­i­pates in the pro­gram — said that of­fer­ing health cov­er­age will stop peo­ple from turn­ing to costly emer­gency rooms for rou­tine care. He also said that it is vi­tal for pre­vent­ing the spread of com­mu­ni­ca­ble dis­eases.

“Frankly, it’s just the right thing to do,” Say­lor said in an in­ter­view Fri­day. “For us to have an un­der­class that is left out is un­con­scionable.”

How to pro­vide healthcare to the state’s 2.7-mil­lion im­mi­grants here il­le­gally has been a re­cur­ring pol­icy de­bate across the state this year. The pop­u­la­tion is barred from sign­ing up for in­sur­ance un­der the Af­ford­able Care Act and now makes up the sin­gle big­gest group of Cal­i­for­ni­ans with­out in­sur­ance.

State leg­is­la­tors this year con­sid­ered a bill that would have pro­vided healthcare to more than a mil­lion im­mi­grants in the coun­try il­le­gally. But when Gov. Jerry Brown signed the new state bud­get this week, it was pared down to cover only chil­dren here il­le­gally.

Un­der a 1930s state law, coun­ties are re­quired to “re­lieve and sup­port all in­com­pe­tent, poor, in­di­gent per­sons.” While many large, ur­ban coun­ties, in­clud­ing Los An­ge­les, Ven­tura, San Fran­cisco and eight oth­ers, have in­ter­preted that man­date to in­clude peo­ple in the coun­try il­le­gally, the vast ma­jor­ity of the state’s coun­ties his­tor­i­cally have not.

But with most other Cal­i­for­ni­ans now in­sured un­der the Af­ford­able Care Act, many county of­fi­cials have been re­think­ing those de­ci­sions.

This month, Sacra­mento County su­per­vi­sors unan­i­mously de­cided to ex­pand healthcare cov­er­age to un­doc­u­mented im­mi­grants who live in their county. Ad­vo­cates in Con­tra Costa and Monterey coun­ties are push­ing for their of­fi­cials to make a sim­i­lar de­ci­sion.

The County Med­i­cal Ser­vices Pro­gram panel’s vote, along with other changes it made Thurs­day, are ex­pected to cost be­tween $6 mil­lion and $9 mil­lion over two years. The new­pro­gram prob­a­bly will be­gin next year.

Wright said what hap­pened this week could spur of­fi­cials in other coun­ties to take a sec­ond look at their poli­cies af­fect­ing those in the coun­try il­le­gally.

“These are de­ci­sions that both will have a real, ben­e­fi­cial im­pact on spe­cific Cal­i­for­nia fam­i­lies, and will also im­prove our health sys­tem as a whole, and are sym­bol­i­cally im­por­tant,” he said.

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