Fresno County should keep medical care for undocumented immigrants, advocates say

The Fresno BeeJanuary 13, 2014 

Health-care advocates Tuesday will urge Fresno County supervisors to oppose ending their medically indigent services program for undocumented immigrants because state-run Medicaid expansion will leave about 5,000 of them without health-care options.

Through the federal Affordable Care Act, about 14,000 of 19,000 residents considered medically indigent would qualify for Medi-Cal. For the rest, there will be no mechanism to pay for their medical costs, advocates said.

Supervisors on Tuesday are being asked to choose a funding formula that redirects revenues based on costs, assumed revenues and medical care savings to meet a state deadline. The advocates will use the discussion as an opportunity to repeat their calls against the county's plan to end funding of indigent health care.

Fresno County is also in court trying to end a 1984 injunction that required it to care for the undocumented immigrants. Its next court hearing is Feb. 26.

Fresno County could have set up a low-income health program for indigent health care, but was California's largest county declining to set up such a program.

With California operating a state-run Medicaid expansion through the federal Affordable Care Act, the state anticipates that counties' costs and responsibilities for the health care services for the indigent population will decrease. That's because most of that population becomes eligible for coverage through Medi-Cal or through the health care exchange.

But, for undocumented immigrants who were previously covered through a county contract with Community Medical Centers in , the medically indigent services program, there is no funding to pay for medical services.

County officials say about 4,500 to 5,000 undocumented people remain uninsured. Health care for the indigent program costs about $5,000 per patient and to continue care for the undocumented would cost about $25 million annually, the county estimates.

It's not too late for the county to ensure care for the undocumented, said Bud Kaicher, health justice organizer for Fresno Faith In Community.

He suggests formation of a local task force to create a safety net for indigent immigrants.

"There has not been a real attempt to include the community, health clinics and community-based organizations that are working with these populations to figure out what to do with these medically indigent populations," Kaicher said.

Community Medical Centers provided care to 17,000 medically indigent patients, according to its annual report ending in August 2013. Community's estimated unaudited costs were $103.7 million. That included $4 million for jail inmates and juvenile offenders. The county's payment to Community Medical Centers was $21.1 million, leaving an estimated shortfall to Community of $82.6 million, the report said.

The reporter can be reached at (559) 441-6166, or @beebenjamin on Twitter.

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