By Augie G. Blancas
On April 7, thanks to the hard work of community leaders, health advocates and residents, the Fresno County Board of Supervisors (BOS) agreed to provide care to undocumented Fresnans through a limited, short-term specialty care program in a 3-2 vote, with Supervisors Andreas Borgeas and Debbie Poochigian voting no. The agreement includes a partnership between Fresno County and local healthcare providers, including Clinica Sierra Vista and the Community Regional Medical Center, which will provide limited specialty healthcare to undocumented Fresnans from April 20, 2015, through April 19, 2016, or until funds for the specialty care program are depleted.
For more than a year, leaders and health advocates, in partnership with Fresno Building Healthy Communities— a local health coalition made up of residents, young people and community-based organizations—have been leading the effort to save Fresno’s healthcare safety net to ensure all residents have access to healthcare, regardless of immigration status.
“We’re excited to tell you that our hard work has paid off,” announced Amparo Cid, who is the local director for California Rural Legal Assistance Foundation and lead organizer for Fresno Building Healthy Communities’ #Health4AllFresnans Action Team, to a hallway of more than a dozen residents wearing black #Health4All t-shirts. “It’s been a long road, but rest assured undocumented Fresnans will be able to get the care they need.”
In December 2013, the BOS filed for relief from a permanent injunction requiring them to provide healthcare to all Fresnans since 1983. In its attempt to eliminate the Medically Indigent Services Program (MISP), the county argued that the Affordable Care Act and the state’s expansion of the Medi-Cal program would care for those Fresnans who rely on the county program. However, the Affordable Care Act excludes undocumented individuals from Medi-Cal eligibility and bars them from purchasing health insurance through the exchange. More than 15,000 people have used the MISP at one-time.
After a lengthy court battle, a Fresno Superior Court judge ruled the BOS had the obligation to continue to provide healthcare for the medically indigent—but not for the undocumented.
In November 2014, the BOS voted to remove eligibility for the MISP for undocumented Fresnans, which went into effect Dec. 1, 2014. For more than three months, undocumented Fresnans lost their only source of disease management care, forcing patients to rely on emergency rooms.
“To refuse to provide routine care and provide treatment only on an emergency basis, county leaders are disregarding the time-tested saying, ‘an ounce of prevention equals a pound of cure.’ Primary care physicians do not have the capacity to care for patients with an advanced illness,” said Sandra Celedon-Castro, hub manager for Fresno Building Healthy Communities. “Patients need to see a specialist to care for their chronic medical condition, like heart disease, diabetes, stroke or asthma.”
According to a 2008 study from the Trust for America’s Health, every dollar invested in prevention yields $5.60 in savings.
Last summer, Assembly Member Henry T. Perea (D–Fresno) helped secure $5.5 million to provide short-term specialty healthcare to Fresno County’s undocumented. The budget flexibility came from Assembly Bill (AB) 2731, which delayed a repayment of transportation funds the county owes to the state only if the county continues to provide healthcare to Fresno’s indigent and undocumented members. The BOS accepted the deal on Nov. 4, 2014.
“For many residents living in Fresno County, this is the only means of getting the care they need to stay healthy, and in many instances alive,” added Celedon-Castro. “Whether residents have legal status or not, everyone should be able to see the doctor.”
“We know that the $5.5 million won’t last forever, but it buys Fresno County some time to come up with a long-term solution to keep providing healthcare to residents and neighbors that need it most,” said Cid. “Our advocacy work will continue until we have a permanent solution that will ensure the health for all Fresnans is maintained.”
Fresno Building Healthy Communities has been organizing community residents in support of #Health4AllFresnans for more than a year since the BOS attempted to decimate the MISP altogether. “Our goal as a coalition is to create One Healthy Fresno—and we cannot have a healthy city or county when elected officials treat groups of people as second-class citizens,” added Celedon- Castro. “We know that this is just a Band- Aid to a much larger problem.”
The coalition is working to identify long-term solutions including proposed statewide legislation that will expand eligibility for health coverage to all Californians and revamping the community benefits model, which requires not-for-profit hospitals to invest in the communities they serve in exchange for not paying taxes. They say that a viable solution will require everyone at the table, including the county, healthcare providers, advocates and residents.
Augie G. Blancas is the communications specialist with Building Healthy Communities. For more information about Fresno Building Healthy Communities, visit www. fresnobhc.org.