A plan to cover immigrants would divert public health dollars

Reviewed by James Ives, M.Psych. (Editor)May 8 2019

California Gov. Gavin Newsom wants the state to provide health coverage to low-income young adults who are in the country illegally, but his plan would siphon public health dollars from several counties battling surging rates of sexually transmitted diseases and, in some cases, measles outbreaks.

Public health officials describe the proposed reallocation of state dollars as a well-meaning initiative that nonetheless would have "dire consequences" to core public health services.

There have been 764 confirmed cases of measles this year through May 3 in 23 states, including California, the highest number since 1994, the Centers for Disease Control and Prevention reported Monday. State public health officials also are struggling to address record rates of sexually transmitted diseases, with more than 300,000 cases of gonorrhea, chlamydia and syphilis reported in 2017.

The reallocation of state money "would exacerbate our already limited capacity to respond to outbreaks and public health emergencies," said Jeff Brown, director of Placer County's Health and Human Services Department, which has responded to three measles cases so far this year.

California already allows eligible immigrant children up to age 19 to participate in Medi-Cal, the state's Medicaid program for low-income residents, regardless of their immigration status. The current budget sets aside $365.2 million to pay for the coverage.

In his 2019-20 budget plan, Newsom proposes expanding eligibility to unauthorized young adult immigrants from age 19 through 25.

His office estimates it would cost nearly $260 million to cover them in 2019-20. While state and federal governments usually share Medicaid costs, California would have to bear the full cost of covering this population.

To help pay for it, Newsom proposes to redirect about $63 million in state funds from 39 counties, arguing they would no longer need to provide health benefits to low-income young adults covered by the state.

"As the state takes on responsibility for providing health care to undocumented adults, counties' costs and responsibilities on indigent health care are expected to decrease," Jenny Nguyen, a budget analyst at the state Department of Finance, told lawmakers at a recent legislative hearing.

Under the governor's 2019-20 budget plan, which requires legislative approval, 35 mostly small and rural counties expect to lose about $45 million in state money that funds health services for uninsured residents, including undocumented immigrants. Those counties — which participate in something called the County Medical Services Program — aren't expected to feel an immediate financial impact because the program has a budget surplus.

But four counties — Placer, Sacramento, Santa Barbara and Stanislaus — would take big and immediate hits to their public health budgets, officials say.

The amount of money the governor wants to divert from them to cover unauthorized immigrants under Medi-Cal is far more than the counties now spend on comprehensive health services for those immigrants, local health officials said.

"The idea that these dollars would be offset is just not accurate," said Mary Ann Lee, managing director of Stanislaus County Health Services Agency, who described the governor's budget proposal as "alarming."

For example, Stanislaus County estimates it would lose $2.5 million under the governor's budget plan. When officials studied the population served by their health centers, they found only 18 individuals were young adults who might not have legal immigration status. The total cost to provide care to them: just $1,700 a year.

Sacramento County, which reported a 300% increase in syphilis cases in the past four years, would have to shutter its newly opened STD clinic if the county loses an estimated $7.5 million in state funding, Dr. Peter Beilenson, the county Health Services Director, told lawmakers.

And while Sacramento County provides primary health care to an estimated 4,000 undocumented immigrant adults, just 100 are ages 19 to 25, and they are the least expensive to cover, Beilenson said.

"We agree with the idea behind this, increasing coverage for [those who are] undocumented," Beilenson said. But losing those funds would force the county to close its STD clinic and terminate some communicable disease investigators "at a time when we now have measles cases in the region and we don't want to be shutting those services down."

The 40 confirmed cases of measles reported in California as of May 1 include three in Sacramento County.

As a result of the reduced funding, Sacramento County also would have to slash health services to its unauthorized immigrant residents — the very people Newsom aims to help — by an estimated 75%, Beilenson added.

Whether lawmakers will approve the governor's proposal is unclear.

Several already have expressed concern, including state Assemblywoman Eloise Reyes (D-Grand Terrace), who said, "I think it is clear that this would be terrible for those counties."

Officials with the Department of Finance told lawmakers at the hearing that they were aware of counties' concerns but that the "governor's budget stands as it is."

The governor is scheduled to release a revised budget proposal by May 14, before the legislature votes on it this summer.

"I hope there will be some reconsideration," said state Sen. Richard Pan (D-Sacramento), chairman of the Senate Health Committee. "There's a disconnect there."

This KHN story first published on California Healthline, a service of the California Health Care Foundation.