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© 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
Providing Access for the Undocumented and Families with Mixed Immigration Status
Immigrants and Health Care Reform
Steven P. Wallace UCLA Center for Health Policy Research
http://dornsife.usc.edu/csii
http://healthpolicy.ucla.edu
Acknowledgements
Funding for my research on this topic has
been provided by The Commonwealth Foundation, The California Endowment, The UC Global Health Institute, and the
Health Initiative of the Americas.
A few key points ! Immigrants are part of
all communities ! ACA will benefit
immigrants but not undocumented
! Access to health care for all improves the health of workers, families, and communities
http://migrationpolicy.org/sites/default/files/datahub/State_Metro_ACS2010_Total_FB.pdf
41.3 million immigrants in U.S.
Population without Health Insurance, by region of birth and race/ethnicity,US 2013
52.3% 49.2%
19.6% 12.0%
17.3%
Mexican immigrants Central American immigrants
Immigrants from other regions
US-born nonHispanic whites
African Americans
Leite, Paula, Xochitl Castaneda, Steven P. Wallace, et al. Migration & Health. Mexican immigrants in the US: A 10 year perspective. Mexico, DF: Secretaría de Gobernación/Consejo Nacional de Población, October 2014. http://healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=1341.
Mexican Immigrants w/ no Medical Insurance by Occupation, U.S. 2013
33.9%
38.6%
48.2%
65.5%
65.5%
71.5%
Executive, professional
Sales, admin, office
Skilled laborers
Service
Agriculture
Construction
Source: Migration and Health 2014. Mexican Immigrants in the U.S. 10 years of perspective
Undocumented immigrants w/ no insurance 2012 & estimated 2016
undocumented immigrants, %
w/ no insurance, 2012
undocumented immigrants, %
w/ no insurance, 2016
% uninsured who are un-‐documented
2012
% uninsured who are un-‐documented
2016
US Ave. 61.0 61.5 9.8 24.5
California 57.0 58.5 19.5 40.8
Florida 68.3 69.2 12.3 33.8
Georgia 72.9 72.8 10.2 28.1
Illinois 67.0 67.5 7.5 18.4
New York 50.1 52.1 11.0 16.0
Texas 74.0 74.3 16.1 37.8
Source: Undocumented and Uninsured: Barriers to Affordable Care for Immigrant Populations . http://healthpolicy.ucla.edu/publications/Documents/PDF/undocumentedbrief-aug2013.pdf
Deportation fears
150,000
200,000
250,000
300,000
350,000
400,000
450,000
2002 2007 2013
Photo Courtesy of ICE
www.dhs.gov/yearbook-immigration-statistics-2013-enforcement-actions
http://www.migrationpolicy.org/data/unauthorized-immigrant-population/state/US
Evolving “status” of undocumented immigrants
! California, Washington, Massachusetts, Minnesota, New York, and Washington, D.C. extend state-funded insurance to DACA recipients.
Executive Action for California
971,000
377,000
77,000
-‐
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
Parents that will be eligible underdeferred action because of citizen
and LPR children
Previously immediately DACA-‐eligible
Newly DACA-‐eligible withdifferent age and year of arrival
benchmarks
Who Might Benefit in California From Deferred Action for Parents (DAPA) and Deferred Action for Childhood Arrivals (DACA & DACA-‐Plus)
Preliminary Estimates
Center for the Study of Immigrant Integration
http://dornsife.usc.edu/csii
Average = -2.5
http://healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=1373
State Policies that Affect the Health of Undocumented Immigrants &Their Families
Example of a health policy
http://www.nilc.org/healthcoveragemaps.html
California Population Ages 18 -64: Immigration Status and Health Insurance
California Health Interview Survey, 2009
16.7 17.8
33.6
51.3
Uninsured
U.S. Born Naturalized Citizen LPR Undocumented Immigrant
Wallace, Steven P., Jacqueline Torres, Tabashir Sadegh-Nobari, Nadereh Pourat, Undocumented and Uninsured: Barriers to Affordable Care for Immigrant Population. Los Angeles, CA: UCLA Center for Health Policy Research and The Commonwealth Fund. August 2013. http://healthpolicy.ucla.edu/publications/Documents/PDF/undocumentedbrief-aug2013.pdf
California Population Ages 18 -64: Immigration Status and Diabetes
California Health Interview Survey, 2009
6.7%
9.0%
15.7%
4.4%
9.2%
U.S. Born Naturalized Citizen* LPR* Undocumented Immigrant unadj Undoc.Immigrant age adjusted*
* Age adjusted to US-born population
Implications
Adopt a human rights frame Universal Declaration of
Human Rights, Article 25 • Everyone has the right to a
standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services …
Conclusion ! America, and
especially California, benefits from immigration
! Health and health care needs of all immigrants merit rational attention
Thank you
http://healthpolicy.ucla.edu/about/staff/pages/detail.aspx?StaffID=163
Community Outreach Strategies For Mixed Status Families and Undocumented Populations
Presented by: Lupe Delgado
2015 National Conference State of Enrollment: Getting America Covered
Renaissance Washington Hotel Washington DC
� What to consider when engaging families.
� Who are the important partners?
� Learn how to engage and outreach to individual and undocumented population.
� Assess your current understanding of engaging undocumented population.
� Role of individuals and undocumented population.
� Best practices for meaningful engagement.
Goals and Objectives
� Experience in working with Outreach, Enrollment and Community Residents:
¢ Over 10 years experience in outreach, grassroots organizing and working with community residents.
¢ 10 years experience in Public Benefit Programs (State and local); CalFresh (SNAP Ed), Healthy Families, Medi-Cal, and Covered California. Both new enrollments and re-enrollments.
¢ Worked in community based clinical settings, hospitals, non profit organizations and public events such as health fairs and forums.
¢ Currently one of ten community partners in Merced’s Prevention Action Team (PAT) funded by The California Endowment’s Building Healthy Communities Initiative.
Outreaching Principles
� What Does Community Outreach Mean: ¡ Building Trust ¡ Engage Your Residents in Change ¡ Let Them Lead the Advocacy Work ¡ Collaboration
÷ Human Services Agency ÷ Certified Enrollment Agencies ÷ Immigration Legal Services ÷ Schools ÷ Public Health Department ÷ Food Bank
� Know Your Community: ¡ Demographic ¡ Accessibility ¡ Language Spoken ¡ Education ¡ Culture
� Community Outreach ¡ Provide information and post
announcements about the Get Covered at local schools, local faith-based institutions, community centers, businesses, health centers, libraries, etc. ÷ Identify existing meetings/events
� Education Forums/Workshops/Presentations ¡ Educating community members about the
Health Insurance Marketplace (CoveredCA) ÷ Partners
Outreaching Principles
EFFECTIVE OUTREACH
� Setting-up resource table to share information
� School fairs/events � Creating video by target population
about getting health insurance � Outreach & Enrollment events � Townhalls/Forums � Door-to-door � Phone bank � Robo Calls � Public Service Announcements (PSA) � Advocacy #Health4All
Outreaching Principles
AVOID THESE STRATEGIES
� Not targeted population on Social Media
� Not going into the community ¡ Example Schools, community organization.
� Not leaving anything for the community to follow-up
Outreaching Principles
• Get them INVOLVED! ¡ LISTEN to their interest/concerns/needs ¡ IDENTIFY who else is interested/concerned - undocumented ¡ FIND out who are the allies/partners ¡ CREATE access and opportunities for enrollment
Engaging Community Resident Principles
� Provide effective messaging to individuals and families to empower them and actively engage and participate in the enrollment process.
� Provide leadership training to individuals and families by promoting education, health, leadership, cultural, and generational connections so they can lead the advocacy work.
� Develop a connection by becoming a resource where individuals and families can get the information they need to make effective decisions on health insurance options.
Engaging Principles
Example of Grassroots Training and Empowerment Leaders provide real life examples of health care costs:
¡ For example: A doctor’s visit for preventive care runs for about $145.00
A hospital visit averages about $1,349.00
� Empower community residents to spread the word in their community to ensure community residents have access to affordable health care.
� This type of education is relative to everyone. That’s why they emphasize the
preventative care vs. emergency care.
2014 Outcomes of Effective Outreaching
Education 1369
Outreach 7405
Presentations 15
In coming calls 407
Phone Bank 296
Referrals 1452
2015 Current Outreach Efforts
Education 421
Outreach 16,542
Presentations 5
In coming calls 189
Community Leaders Phone Bank 146 Door to door 128
Town hall 56 Forum 263
Referrals 281
Most Impactful Outreach
City of Merced Rating 8,000 Merced County overall 150,000
Health4All Advocacy
� Deferred Action Childhood Arrivers (DACA)
� Deferred Action for Parental Accountability (DAPA)
� Undocumented
Leading the Advocacy
� Community residents
Collaboration
Lupe Delgado ACA Health Outreach Worker
PARENT INSTITUTE FOR QUALITY EDUCATION
[email protected] Phone: 209-230-6371
1124 11th Street Modesto, CA 95354 Phone: 209-238-9496 Fax: 209-238-9495 www.piqe.org
Contact Information
Thank You!!!
SERVING THE REMAINING UNINSURED – MY HEALTH L.A. STATE OF ENROLLMENT: GETTING AMERICA COVERED CONFERENCE PROVIDING ACCESS FOR THE UNDOCUMENTED AND
FAMILIES WITH MIXED IMMIGRATION STATUS JUNE 11, 2015
Tangerine Brigham Los Angeles County Department of Health Services
Context – Health Care to Uninsured Episodic California • Mandates counties provide life-threatening treatment to indigent persons • Two funding sources: (1) county and (2) State [decreased after ACA] • Proposition 187 prohibits undocumented from receiving range of services
Los Angeles • ≈10 million residents; 4,083 sq. miles; 88 cities and many unincorp. areas • Estimated 300-400,000 residually uninsured residents • County direct provider with 4 hospitals and 20 ambulatory care sites • Since 1990s, County has funded community clinics to care for uninsured
43
Los Angeles County Goals
Preserve access to care for uninsured patients
Encourage coordinated, whole-person care
Payment reform
Improve efficiency and reduce duplication
Simplify administrative systems
44
My Health LA (MHLA) is Health Access ¨ Provides health care for uninsured residents regardless of
¤ Employment status ¤ Immigration status ¤ Pre-existing conditions
¨ Not a health insurance plan
¨ Promotes a primary care medical home model
¨ Voluntary program – remaining uninsured not require to enroll
¨ Does not include uninsured patients who seek primary care services at County clinics
45
MHLA Program Features
Features Los Angeles County
Implementation Date October 1, 2014
Enrollment Process Web-based (One-e-App)
Insurance Status Uninsured; ineligible for public coverage
Income Threshold At or below 138% FPL
Age Eligibility 6 and over
Services Primary, preventive, diagnostics, prescription drugs; specialty, emergency urgent care, hospitalization, behavioral health referrals
Provider Network Over 180 primary care community clinics (primary care medical home); DHS for other services (e.g., hospital, specialty, etc.)
Medical Homes Over 180 primary care community clinics
Participant Costs None
County Agency Department of Health Services
46
MHLA Web-Based Eligibility & Enrollment (One-e-App)
47
Clinical Visit Leads to MHLA Enrollment
48
Enrolled!
Dental is not a MHLA benefit
MHLA Designed to be Organized Health Care ¨ A common eligibility and enrollment system (One-e-App)
¨ Medical home model of care
¨ Broad-based network of community-based primary care providers
¨ Participants can get services immediately after enrolling
¨ Centralized customer service
¨ After enrollment participants get: ¤ ID card with medical home ¤ Participant handbook ¤ Program newsletters
49
Participant Demographics (109,000) – Age, Gender, Housing and Income (5/2015)
50
8% 2%
49%
25%
11% 5%
0%
10%
20%
30%
40%
50%
60%
6 - 18 19 - 24 25 - 44 45 - 55 55 - 64 65+
% o
f Pa
rtic
ipan
ts
Age
[CATEGORY NAME],
61%
Male, [VALUE]
Gender
8% 16%
23% 21%
22% 10%
0% 5% 10% 15% 20% 25%
125.01-138% 100.01-125%
75.01-100% 50.01-75% 25.01-50%
0-25%
% of Participants
% o
f FP
L
Income (Expressed as % of Federal Poverty Level)
Note: 314 participants indicated “Other” for Gender
[VALUE]
Housed
[VALUE]
Homeless
Housing Status
Participant Demographics (5/2015) - Ethnicity and Language
Ethnicity Top 5 Languages Spoken (99.4%):
51
Ethnicity Percent
Hispanic 94.30%
Asian/Pacific Islander 2.90%
Declined to State 1.38%
White 1.03%
Other or Mixed Race 0.32%
Black/African American 0.18%
Language Percent
Spanish 92.11%
English 6.40%
Thai 0.37%
Armenian 0.28%
Korean 0.23%
q Note that MHLA does not ask applicants their citizenship or immigration status
Strategies
¨ Had clarity of purpose/goals
¨ Created public/private partnership
¨ Used existing delivery system
¨ Engaged community partners/leads on program design and kept informed
¨ Worked closely with local social services agency (intersection with Medicaid)
52
Challenges
¨ Manage expectations with respect to what program is (health access) and is not (health insurance)
¨ Selection of included and excluded services
¨ Change in health care delivery system for providers serving the remaining uninsured
¨ Understand financing mechanism (estimated costs, funding and provider reimbursement)
¨ Ensure appropriate administrative and clinical infrastructure
53
Replicability
¨ Relevant to and feasible for communities with multiple safety-net providers that want to replace the complex, uncoordinated system of care for the uninsured
¨ Health access model may be more financially feasible than offering health insurance
¨ Features ripe for replication ¤ Primary care medical home to reduce service duplication and improve care
coordination
¤ Centralized eligibility system to maximize public entitlement and reduce barriers to entry
¤ Public-private partnership to maximize available resources
¤ Establishment of predictable and affordable participant fee structure
54
Implementation Factors
Patient Centered
Delivery System
Provider Payment
Coverage Expansion
Local Level Reforms Contributing Factors
55
Political
Leadership
Financial Support
Existing Health Care Providers
Admin. Structure
Learn More About MHLA
¨ Website: dhs.lacounty.gov/MHLA
¨ Contacts: ¤ Amy Luftig-Viste ([email protected]) ¤ Tangerine Brigham ([email protected])
56
Questions 57
