‘Health navigators’ connect undocumented to Calif.’s expanding health network

With health care leading much of California’s legislative agenda, a state program that connects people to health services has become a vital gateway for millions of uninsured residents to California’s often complicated but expanding public health system.

The mission of the “health navigators” program is to guide, inform and support individuals in need of health coverage. At the same time, health navigators clarify often incorrect information that reaches patients, such as which services immigrants can access without putting their visa applications at risk.

The future of the program, which until recently was uncertain, became clearer last month after Gov. Gavin Newsom dedicated funding for it in the state budget. That budget allocated $60 million for the health navigators program over two years, about the same amount as its last allocation.

“Health navigation and advocacy centers are necessary,” said Lynn Kersey, executive director of Maternal and Child Health Access (MCHA) in Los Angeles, an advocacy, education, training and health services organization for women and their families. “We help not only pregnant or undocumented women, but also homeless pregnant women, men and the elderly. We need people to fight for them.”

One of MCHA’s clients, Maria Lopez, left her native Guatemala 13 years ago. Both she and her husband are still undocumented. When Lopez was pregnant with her daughter Magali more than three years ago, Lopez received full-scope Medi-Cal health services.

When that coverage expired after her daughter’s birth, Lopez retained emergency Medi-Cal — a service that pays medical costs only for hospital emergencies — although she prefers not to use it for fear that she’ll be deported for using a government benefit.

Like many immigrants, Lopez fears being declared a “public charge” to the federal government, which could hurt her chances of adjusting their immigration status. Her daughter Magali receives full-scope Medi-Cal benefits since she’s a U.S. citizen.

The 44-year-old mother said she also refuses to ask for food stamps — a program her daughter could benefit from — or apply for My Health LA, which helps undocumented people access primary care doctors.

“We’ve heard a lot of things, and many of them that aren’t true in the end,” Lopez said.

Her situation is common among the thousands of undocumented Latina women in the United States who postpone and neglect their reproductive health.

“Many immigrant women don’t visit the doctor until they’re pregnant, so it’s important to take advantage of that moment,” Kersey said.

 “When women are pregnant, they get comprehensive health coverage, everything they need, regardless of their immigration status,” she said. “Many things can be discovered during pregnancy that could have been unknown to the woman.”

 Health navigators open doors to health services that many immigrants feared were closed, said Celia Valdez, director of enrollment and outreach at MCHA. The group ended up helping Lopez access the care she was entitled to. 

MCHA also made sure Lopez understood that proposed federal rules to limit green cards to those who accessed public benefits like Medi-Cal are not in effect, and cannot be applied retroactively.

“Although reluctant to apply for Medi-Cal at any given time, Maria Lopez did so,” Valdez said.

“Maria said she didn’t want to apply for CalFresh even though she knew her family was eligible. She said her husband was against it.”

In addition to fears about the consequences of using government benefits, some undocumented patients must overcome language barriers, including some who cannot read or write, Valdez said.

“Oftentimes people lose their Medi-Cal simply because they don’t renew it or make mistakes when filling out the application,” she said.

Connecting to health services

Each month, MCHA connects about 950 people to health services, mainly enrollment for insurance, with guidance from health navigators.

Roxana Gaspar arrived from Guatemala 25 years ago and has been getting help from MCHA for 23 years. She not only visits the center to renew her emergency Medi-Cal benefits, but also attends classes and information workshops there. Gaspar has two children, ages 22 and 23.

Her social worker, Debbie Winski, has offered information and assistance to Gaspar since her baby was 20 days old. “God put her in my path,” Gaspar said.

“Debbie saw me giving soda to my baby and she came up to me to talk. ... I wasn’t aware of what I was doing,” she said.

Gaspar, who suffers from type 2 diabetes, has emergency Medi-Cal and is in the process of getting My Health LA so she can access primary care. MCHA helps her apply for a range of benefits.

“For example, they helped me get the insulin pen because I didn’t qualify for it, but I didn’t know how to use needles (insulin) either. My medication changes all the time. I don’t know how to read and many times I don’t even know what I have to take,” Gaspar said. “I don't have anything. I live alone with my puppies and sometimes I can only eat once a day.”

Margarita Valdez, who arrived from Hidalgo, Mexico in 1994, continues to take classes at MCHA.

“I came (to MCHA) when my older children were young, more than 15 years ago,” recalled Valdez, whose children are now 20 and 23 years old.

She visits the center now with her younger daughters, ages 5 and 7. They participate in informational workshops, personal development classes and even theater classes. MCHA also offers activities and child care while their mothers attend the workshops.

“When I arrived, I was afraid of everything, but thanks to these classes, I learned the language. Here I receive permanent support. My children have very good memories of the center,” Valdez said. 

Health Navigators extended

In March, a coalition of statewide health organizations, including MCHA, submitted a proposal to the Assembly Budget Subcommittee on Health and Human Services, requesting $15 million from the state’s general fund for two years — equivalent to $30 million. That would be matched by federal funding for a total of $60 million to “restore and continue disclosure, enrollment, retention and use of Medi-Cal assistance.”

A UC Berkeley Labor Center study revealed that, since the implementation of the Affordable Care Act in 2014, the state’s uninsured rate has fallen dramatically from 17.6% to 7.2%. However, California is now seeing a substantial decline in Medi-Cal and Covered California enrollment for the first time in years, partly due to immigrants’ fear of using services, rising health care costs and the repeal of the individual mandate.

Newsom’s budget expands health coverage to an estimated 90,000 low-income undocumented individuals from 19 to 26 years old. In 2016, California had already expanded Medi-Cal to all undocumented children from income-eligible families.

Celia Valdez acknowledged that enrolling in health plans can be complex. Health navigators take the time to fill out the paperwork, coordinate services for the sick and find care for those who need special treatment.

Most importantly, however, health navigators help people feel safe in their communities — in health clinics, local agencies and even in schools.

“In our center, people don’t have to visit a government agency,” Valdez said. “We focus on the whole family, documented or undocumented.”

Follow the USC Center for Health Journalism Collaborative series "Uncovered California" here.