A Fresno County Superior Court judge has ruled that the county does not have to follow a 30-year-old court order requiring it to pay for medical services for undocumented workers.
But Judge Donald S. Black stayed his decision for 60 days, saying it likely will be appealed.
The judge stopped short of dissolving the entire injunction that requires health care services be provided to the indigent -- people considered to be living in poverty.
The judge said the county had proven a change in law no longer required it to pay for medical care for undocumented immigrants, but his motion stopped there.
Black said he could not find that "dissolving the injunction is in the interests of justice," citing arguments by Clinica Sierra Vista that ending the injunction would harm the health and well-being not only of undocumented people, but also the public at large.
The case is not over, said Mona Tawatao, a lawyer with the nonprofit Western Center on Law & Poverty, which represents Clinica Sierra Vista in the case. Clinica operates federally qualified health centers in Fresno and Bakersfield that primarily serve low-income patients.
"At this point we are looking at all options to continue to enforce the county's obligation to ensure the public's health," Tawatao said. "Certainly an appeal is one of those options."
And it's critical that the public understands care for the undocumented population will continue during the 60-day stay imposed by the judge, she said.
John Navarrette, Fresno County's administrative officer, said supervisors have not decided to discontinue the Medically Indigent Services Program for the undocumented.
But under changes in state funding resulting from the Affordable Care Act, the county has said it will receive $14 million less in realignment funds for public health. To continue paying for undocumented health care would mean cutting other essential public health services, such as immunizations and tuberculosis control.
Navarrette said Friday that the county has appealed to the state to provide funds to continue a $20 million contract with Community Medical Centers for medical services for the indigent population. He is waiting to hear back before a recommendation can be made to the board. "We're hopeful that maybe we can continue that practice of providing health care to the undocumented," he said.
Juan Arambula, a former Fresno County supervisor and member of the state Assembly, said Friday afternoon that the county should look for funds to continue the health services.
"It's a little hypocritical to say we need water for farmers and farmworkers and to say that farmworkers shouldn't have health care," Arambula said after a noon rally outside the county Hall of Records in support of continuing health services for the undocumented.
Navarrette said the county's undocumented population will continue to get primary medical care from federally qualified health clinics regardless of any decision by supervisors. "It's not as if they will get no coverage," he said.
But Clinica CEO Stephen Schilling said federally qualified health centers are limited in what they can provide to undocumented immigrants. The clinics do not have funding for speciality care, such as orthopedic surgeons to set broken bones, he said. And without the county's Medically Indigent Services Program there would be no reimbursement to hospitals when patients need to be admitted.
Schilling said Clinica has not yet decided whether to appeal Black's ruling. But to leave undocumented workers without health care creates a public health issue that has to be addressed either by the county, state or federal government: "Something has to be done. We have a huge, treacherous gap in coverage and care for undocumented people in this country."
A bill by state Sen. Ricardo Lara, D-Long Beach, to allow access to health care coverage for undocumented immigrants is set for a hearing Wednesday before the Senate health committee. But it could be at least two months before the bill could make it through the Senate.
At the noon downtown rally, members of Building Healthy Communities Fresno, an organization to improve health funded by The California Endowment, called on supervisors to continue the Medically Indigent Services Program for the undocumented population.
"We believe we cannot have one healthy Fresno without all people having access to basic preventive care and disease management care," said Sandra Celedón, the Building Healthy Communities manager.
The group, along with Health Access, the California Immigrant Policy Center and Service Employees International Union-United Health Workers West, is organizing a community forum on health access from 6-8 p.m. Monday at the Fresno Center for New Americans at Kings Canyon Road and Winery Avenue.
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