Tagged Immigrants

Some Immigrants, Fearful Of Political Climate, Shy Away From Medi-Cal

Some foreign-born Californians are canceling their Medi-Cal coverage or declining to enroll in the first place, citing fears of a Trump administration crackdown on immigrants.

Among those dropping coverage are people in the country legally but concerned about jeopardizing family members who lack permanent legal status, according to government officials, immigration attorneys and health care advocates.

Others worry they will be penalized in the future for using public benefits such as Medi-Cal, the state’s version of the federal Medicaid program that provides health coverage to low-income residents.

“We’re hearing from a lot of counties that they’re getting calls from immigrant families who are receiving benefits, or whose children are citizens and may be receiving benefits, asking to be disenrolled,” said Cathy Senderling-McDonald, deputy executive director of the County Welfare Directors Association of California in Sacramento, which represents human services directors from the state’s 58 counties.

Senderling-McDonald stressed that the reports are anecdotal but are coming from across the state. “It’s not just one or two counties,” she said.

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Many immigrants are dropping out even though they are legally entitled to and eligible for the benefits they’re receiving, she said.

In reality, experts say, terminating benefits might not help since the immigrants’ names are already in the system.

The Community Health Initiative of Orange County, a nonprofit group that helps local residents apply for health coverage, has worked in the past month with two immigrant families that have withdrawn applications for Medi-Cal coverage.

In one case, a Santa Ana mother had applied in January for full Medi-Cal benefits for her daughter, an unauthorized immigrant, said Aaron Reyes, the group’s director of programs and policy.

But the mother called back about a week later and told them to scrap the application, even though California provides full Medi-Cal coverage to all low-income children, regardless of immigration status.

“She said she heard that Trump was going to deport people, and that they’re going to use the names of people who are getting services,” he said. “We told her there was currently nothing like that going on, but she didn’t want to take any chances.”

In the other case, a Buena Park mom submitted an application last month for Medi-Cal and food stamps for her daughter, a green-card holder. A few weeks later, she called back to cancel the application.

“The parent said she was afraid of Donald Trump and didn’t want any problems,” Reyes said.

President Trump has made cracking down on unlawful immigration a focal point of his presidency. In addition to fraying relations with Mexico over his plans to build a wall along the southern border, he has vowed to get tough on unauthorized immigrants already here. Two weeks ago, immigration authorities rounded up hundreds of people in deportation raids across the country, including in California.

Trump’s administration also has drafted an executive order that would, if implemented, exclude potential immigrants likely to need certain types of aid and deport those already in the United States who have used social services, according to a Washington Post analysis of the order. It also would require social service agencies to report immigrants receiving benefits to federal authorities.

“The overall climate has been terrifying for immigrant families,” said Tanya Broder, senior attorney at the Los Angeles-based National Immigration Law Center. “We have literally heard from people who don’t know whether to continue cancer treatment. I encourage them to continue getting the care they need while they can get it.”

Broder wants immigrants to know that “at this point, the rules have not changed. The executive order has not been filed.”

Melissa Rodgers, director of programs for the San Francisco-based Immigrant Legal Resource Center, emphasized that immigrants who are currently receiving health care and nutrition benefits for which they’re eligible “are not breaking the law in any way.”

The most recent statistically credible statewide enrollment data from California’s Department of Health Care Services (DHCS) are about four months old, so they don’t yet show any possible Trump effect on enrollment.

Department spokesman Adam Weintraub said the federal government hasn’t imposed any significant changes on Medi-Cal since Trump’s inauguration.

But, he said, “DHCS cannot speculate as to any potential changes to the Medicaid program that may occur under a new administration.”

Weintraub added that the department “takes its responsibility to safeguard personal health information seriously” and shares only details about an applicant’s immigration status with the federal Centers for Medicare & Medicaid Services, and only “for the purposes of administering the Medicaid program.”

Two weeks ago, Ale Ricardez, program manager for San Diegans for Healthcare Coverage, spoke with a woman who had taken the first steps to rescind her family’s Medi-Cal application.

Everyone in the family is a citizen except the woman’s husband, who has work authorization and is in the process of getting his green card, Ricardez said.

“She was concerned that they would risk the immigration process for her husband if they continued with the application,” she said.

Ricardez told the woman that her family is legally entitled to the benefits as long as they qualify, but that didn’t change her mind, Ricardez said.

While some immigrants are canceling their coverage, others aren’t even signing up.

Alice Ting, an enrollment worker at Asian Pacific Health Care Venture, a group of clinics in Los Angeles and El Monte, received two calls in the past two weeks from nervous immigrants asking if they should cancel their Medi-Cal. Ultimately, they decided to remain enrolled after she explained they qualified, she said.

Another trend has grabbed her attention even more: She used to get daily phone calls from Chinese immigrants inquiring about how to apply for Medi-Cal. “I’ve noticed recently it’s decreased,” she said.

Jan Spencley, executive director of San Diegans for Healthcare Coverage, has witnessed a similar trend.

“We are seeing people who are not enrolling who are eligible, and people ending coverage who have it,” Spencley said. “People are not enrolling unless they have to.”

Advocates and immigration experts warn that dropping health coverage — or not signing up — might compromise public health, let alone an individual or family’s health.

“Letting fear lead to actual serious bodily harm, that’s really not the way to go,” Rodgers said. “If people need health care, they should get it.”

At the same time, Rodgers and others aren’t making promises about the future, because they don’t know what it holds.

“We don’t want to say, ‘This isn’t going to happen, don’t worry,’ and then have something bad happen,” Reyes said. “For us, it’s important to be as accurate as possible, which is really challenging right now.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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Travel Ban Spotlights U.S. Dependence On Foreign-Born Doctors

Patients in Alexandria, La., were the friendliest people Dr. Muhammad Tauseef ever treated. They’d drive long distances to see him, and often brought gifts.

“It’s a small town, so they will sometimes bring you chickens, bring you eggs, bring you homemade cakes,” he said. One woman even gave him a puppy. “That was really nice.”

Tauseef was born and raised in Pakistan. After going to medical school there, he applied to come to the U.S. to train as a pediatrician.

It’s a path thousands of foreign-born medical students follow every year — a path that’s been around for more than half a century. And, like most foreign-born physicians, Tauseef came on a J1 visa. That meant after training he had two options: return to Pakistan or work for three years in an area the U.S. government has identified as having a provider shortage. He chose to work with mostly uninsured kids at a pediatric practice in Alexandria, La.

“That was a challenge,” he said, “but it was rewarding as well, because you are taking care of people who there aren’t many to take care for.”

The U.S. medical system depends on doctors like Tauseef, said Andrew Gurman, president of the American Medical Association. He worries that President Donald Trump’s executive order on immigration, which is now on hold after a federal appeals court ruling.

“International medical graduates have been a resource to provide medical care to areas that don’t otherwise have access to physicians,” he said. “With the current uncertainty about those physicians’ immigration status, we don’t know whether or not these areas are going to receive care.”

According to the AMA, about 280,000 international medical graduates practice in the U.S. today — that’s about one in four doctors. Some are U.S. citizens who’ve gone abroad for medical school, but most aren’t.

“They don’t all have permanent visas and so a lot of them are concerned about what their status is going to be, whether they can stay, whether they can go home to visit family and still come back, and the communities they serve have similar questions,” he said.

And the care is top-notch. A study just published in the journal BMJ shows Medicare patients treated by doctors from foreign medical schools get just as good care — and sometimes better — than those treated by U.S. medical graduates.

The uncertainty is hitting medical schools at a tough time of the year. Dr. Salahuddin Kazi is in charge of recruiting top students from across the world for the University of Texas Southwestern residency program.

“Typically we have 3,000 people applying for our 61 positions — of those 3,000, at least half of them are international medical graduates,” he said.

Applicants find out their program match in March and usually start working in June. That gives them about 90 days to get a visa. Kazi worries this year that won’t be long enough, and that students from countries included in the travel ban won’t be let in.

“That would create hardship for the hospital, for us, and for our remaining residents,” he said. “They’ll have to pick up more shifts or give up vacation.”

Two-hundred and sixty people have applied for residency in the U.S. from the seven countries included in the travel ban, according to the Association of American Medical Colleges.

Tauseef left Louisiana two years ago but continues to care for low-income patients at Los Barrios Unidos Community Clinic in Dallas. Six of the 30 physicians who work at this clinic are from other countries. Tauseef said they’re all educated to do the same thing.

“As a physician, being a foreign medical graduate, U.S. medical graduate, a Muslim doctor, a non-Muslim, we are trained to look for signs and symptoms,” he said, “We do not look at anybody’s color, we are not trained to look at anybody’s religion or ethnicity.”

Tauseef, who has been in this country for 13 years, will apply for U.S. citizenship next month.

This story is part of a partnership that includes KERA, NPR and Kaiser Health News.

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