Fresno County will provide specialty health care for undocumented immigrants

Undocumented immigrants will be able to get care in Fresno County under a plan approved by supervisors.

Deferring $5.6 million repayment of road funds to the state will pay for specialty care for indigent population.

Supervisors s plit 3-2 on providing specialty health care to undocumented immigrants.


Fresno County supervisors voted Tuesday to provide specialty medical care for undocumented immigrants and the poor by deferring repayment of road funds to the state.

Supervisors Brian Pacheco, Buddy Mendes and Henry R. Perea voted to spend $5.6 million from the deferred payment for specialty medical care.

“This is the right thing to do,” Pacheco said.

Board Chairwoman Debbie Poochigian and Andreas Borgeas opposed the motion made by Pacheco. And the decision came after a testy exchange among board members, with Borgeas calling the county’s plan a “social experiment” and Perea saying that Borgeas’ comment made “his blood boil.”

The county has been negotiating for more than 18 months with Community Regional Medical Center and specialty providers to provide the care. Supporters of health care for undocumented immigrants have followed the issue and on Tuesday applauded the board’s decision.

Under the decision, people in the county who are not eligible for Medi-Cal, have no insurance and can’t pay for care can get specialty care, such as cancer treatment, gallstone surgery and broken bones. The county will pay providers for the care at Medi-Cal rates. The state has agreed to reimburse the county at those rates. Undocumented immigrants and the poor will continue to get primary care at local clinics.

Supporters filled the board chambers, including Victor Lopez, mayor of Orange Cove, who said children of undocumented immigrants one day will be the county’s teachers, doctors and soldiers.

Marco Ocano, 20, implored supervisors to provide specialty care to undocumented immigrants, saying, “I call them Fresnans.”

The supervisors’ decision to provide specialty care was lauded by Sarah Reyes, a former state Assembly member and now regional program manager for the California Endowment’s Building Healthy Communities initiative in the central San Joaquin Valley. “Residents and community partners, the county administrative office, Community hospital representatives have all been working a year and a half to two years trying to provide care for a segment of our population that works so hard to make us the No. 1 agricultural community in the world,” she said. “Today our efforts paid off.”

The board’s decision gives the county time to find funding for the long term, Reyes said, but “at the same time not have people suffer because they can’t get specialty care.”

County officials estimate the $5.6 million for specialty care could be spent before the end of three years. They are basing that on reports that Community has been providing $250,000 a month in care for the uninsured and undocumented immigrants since supervisors ended a 20-year contract with the hospital for those services at the end of November.

In their opposition to the county’s plan for specialty care, Borgeas and Poochigian said they couldn’t support a funding source that wasn’t sustainable. Poochigian scolded the state, President Barack Obama and Congress for not solving the problem and people in the community for not demanding that a long-term solution be found.

County Administrative Officer John Navarrette said the county’s plan is not the fix. “It is something that keeps us going down the road.” But he said there’s no guarantee of a permanent solution. The county is keeping its eye on legislation, including Senate Bill 4, introduced by Ricardo Lara, D-Bell Gardens, which would extend Medi-Cal to undocumented immigrant families. But a similar bill died last year.

Poochigian and Borgeas also questioned whether Community hospital was being asked to contribute enough toward the cost of providing specialty care and whether the hospital would continue providing $250,000 worth of care monthly. No one from Community was at the meeting, which the two supervisors also questioned.

Reached after the meeting, a Community spokeswoman said in an email that “we appreciate the collaborative relationship we’ve had with the county over the past several months and today’s decision will help us move forward with discussions already in progress.”

Pacheco, who served nine years on the Community Medical Centers board, said Community has provided the care at the lowest possible reimbursement. The county got $90 million of indigent health-care services for the $20 million it paid to Community in a contract supervisors’ terminated in November, Pacheco said.

“I believe Community is a good partner and I believe it’s time for us to be a good partner,” he said.

Community can’t be asked to shoulder a lot more of the burden, Pacheco said. Fresno County needs strong hospitals, he said. “We all need a place to go to have adequate care.”

In voting to spend the $5.6 million for specialty care, Mendes said he was in Community’s emergency department last month at the time of of the board meeting. “I was glad I was taken care of,” he said.

Pacheco, Perea and Mendes had opposed an earlier motion by Borgeas and seconded by Poochigian to repay $2.8 million of the road fund debt and use $1.5 million for specialty care for six months. Another $1.3 million would be left in reserve while the county worked toward a sustainable funding source. The motion failed, with Pacheco, Perea and Mendes voting against it.

Perea questioned whether the county even could use some of the money to pay down the road fund debt. Navarrette said the county could only use the deferred payment for health care as outlined under Assembly Bill 2731, which was sponsored for the county by the supervisor’s son, Henry T. Perea. “You’re either all in or you are all out,” Navarrette said.

But Borgeas and Poochigian remained opposed to spending the $5.6 million. Borgeas said no other county was considering such a plan and Fresno County’s use of the road funds for indigent care. “This is a social experiment,” he said. “We’re being asked to do something for the very first time.”

A clearly emotional Perea said to call providing specialty health care “a social experiment, like it’s a strange thing we’re doing,” was offensive. “That just makes my blood boil.”