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While Valley Children’s Executives Earn Millions, Community Benefits Lag

March 22, 2024

As news comes out about Valley Children’s Hospital’s high rate of executive pay, an examination of public records reveals the hospital’s community benefit fund lags other children’s hospitals.

The IRS and hospitals have an understanding. In 2020, an estimated $28 billion in taxes were exempted from nonprofit hospitals, according to Kaiser Family Foundation.

Instead of paying millions of dollars in taxes, state and federal governments require nonprofit hospitals to keep a community benefit fund.

The government knows that hospitals take major losses from patients who can’t pay for their services. Hospitals also provide other services pro bono such as education courses and research.

That can cover anything from health education to scholarships to research grants. Most traditional hospitals send a lion’s share of their community benefits to cover hospital bills for those who can’t pay — called charity care and unreimbursed care.

Valley Children Had a 2% Community Benefit Fund in 2022

In 2022, Valley Children’s entire community benefit fund came in just under $17 million, according to its report filed with the California Department of Health Care Access and Information. That was only 2% of the hospital’s expenses.

That same year, Children’s Hospital Los Angeles spent $440 million on its community benefit fund, or 31% of its expenses. Children’s Hospital Orange County’s $143 million community benefit made up 18% of its expenses.

Rady Children’s Hospital in San Diego spent $85.6 million on its 2022 community benefit fund, or 8.8% of expenses.

For comparison purposes, in 2021, Valley Children’s administrative pay exceeded $20 million and CEO Todd Suntrapak made $5.1 million. That same year, Valley Children’s community benefit fell more in line with other hospitals — its $80 million CBF making up 10.32% of expenses.

But in 2020 the CBF was $12.6 million, or 1.83% of expenses.

Vintage Foster, president of AMF Media Group, a third-party representative for Valley Children’s, said the hospital’s benefit fund was in line with other hospitals.

Foster provided community benefit numbers showing the net community benefit was 13.87% of expenses in fiscal 2021 and 9.88% in fiscal 2020. However, those figures didn’t line up with IRS 990 reports or the hospital’s reported community benefit fund.

Questions to Valley Children’s and Foster to clarify these discrepancies were not answered.

Affordable Care Act Doesn’t Cover Everyone: Western Center for Poverty and Law

A majority of hospital community benefits typically go toward unpaid medical debts.

Of the $269 million community benefit fund from Fresno-based Community Health Systems in 2022, $213 million covered what government-funded insurance didn’t, according to the medical group’s report. The hospital system that year also provided $15 million in charity care.

Children’s hospitals operate differently.

“For Children’s Hospitals, Charity Care trend lower than other hospitals because the percentage of children without health insurance is significantly less than it is for adults,” Foster said.

In contrast, unpaid Medi-Cal costs for Valley Children’s in fiscal year 2022 totaled $85.4 million. Revenue from the California Department of Health Care Service covered the entirety of that cost that year. Charity care totaled $181,952.

But even with the Affordable Care Act, some patients don’t have adequate insurance, said David Kane, an attorney with the Western Center for Poverty and Law.

Western Center and its partners often find patients who should have qualified for charity care.

A Look at Valley Children’s 2022 Community Benefits

Valley Children’s Hospital reported nearly $17 million in community benefit money in fiscal year 2022. (Valley Children’s)
Valley Children’s Hospital reported nearly $17 million in community benefit money in fiscal year 2022. (Valley Children’s)

California law requires access to discounted or even complete coverage for patients making up to 400% of the federal poverty level. In California, that is $4,530 a month for a single person or $9,250 a month for a family of four.

In 2016, St. Agnes requested the amount of required charity care be lessened as more people received insurance and therefore didn’t need the assistance.

Then-Attorney General Xavier Becerra didn’t buy that argument, saying California hospitals’ reported unpaid debt showed an unfilled need in the community. St. Agnes was required to pay out to nonprofits to make up the difference.

Becerra’s office used the hospital-reported “bad debt” as evidence that even federally mandated insurance wasn’t enough to provide for the needs of the community.

In fiscal 2021, Valley Children’s reported $3.7 million in unpaid medical debt, issuing only $181,952 in charity care, or 5% of unpaid medical debt.

Rady Children’s Hospital reported $17.6 million in unpaid debt on its IRS Form 990. But the charity care it reported topped $3.2 million, or 18%.

Of the four California children’s hospitals examined by GV Wire, Valley Children’s was second in charity care.

In 2021, Children’s Hospital of Orange County reported only $52,716 in charity care and $28.8 million in bad debt.

Children’s Hospital of Los Angeles reported $175,661 in charity care and $36.3 million in bad debt.

Hospitals Don’t Receive Much Oversight Into Charity Care: Kaiser Family Foundation

State and federal governments give nonprofit hospitals a lot of leniency for how they spend the money they would otherwise pay to the IRS. But not total leniency.

Kaiser Family Foundation in 2022 reported that “it is possible that some nonprofit hospitals may not expect significant oversight of their charity care practices from government regulators.”

When patients receive their medical bills, hospitals are supposed to inform patients of applications for charity care, said Kane, the attorney with Western Center Poverty and Law. Kane did not speak about Valley Children’s specifically.

He says charity care programs break down because hospitals aren’t incentivized to inform people of their options.

“It’s not because they don’t have the funding available to provide assistance to people who need it. It’s simply because they haven’t implemented the rules properly to screen people, evaluate them, tell them about, those sorts of things,” Kane said.

And hospitals will actively pursue debt collection on patients who may qualify for charity care. Questions about how many Valley Children’s bills have been sold to debt collection agencies went unanswered by the hospital.

A court search in Fresno and Madera counties for two known local medical debt collection agencies did not show legal action on medical bills originating from Valley Children’s.

“There is still a problem with some hospitals not providing this assistance to people who still need it today,” Kane said.

How Does Valley Children’s Spend Its Community Benefit?

Valley Children’s Community Health Needs Assessment identified access to health care and economic insecurity as two of the greatest barriers to healthy living for the community it serves.

Valley Children’s put $11.2 million toward education and research and $5.4 million toward health education, community health improvement, and other non-billing expenditures.

Valley Children’s spokesperson Zara Arboleda said the money for education supports significant training and education to more than 900 physician residents, medical students, and other health profession students —including nurses, pharmacists, social workers, physical therapists, speech therapists, and others.

The hospital also provides education to community-based providers including private practice physicians and school nurses.

“A significant portion of those funds are needed to have the personnel in place to teach future workforce members and to conduct research,” Arboleda said.

Valley Children’s staff and doctors provide education.

Using cumulative IRS 990 data from 2019 to 2021, Valley Children’s spent the least amount on benefits compared to Rady Children’s and the L.A. and Orange County children’s hospitals.

The $38.9 million spent on benefits such as community health improvement services, education for health professionals, and research only accounted for 1.82% of Valley Children’s expenses for those three years.

Valley Children’s did spend the most of the four hospitals in one area — donations to eligible nonprofits. The two biggest donations were $2.8 million to Valley Children’s Medical Group and $1 million to Valley Children’s Healthcare in 2021.

New eligibility rules mean nearly 2 million on Medi-Cal can now save for a rainy day.

FEB. 14, 2024 3 AM PT

Millions of Medi-Cal beneficiaries can now save for a rainy day, keep an inheritance, or hold on to a modest nest egg without losing coverage, thanks to an eligibility change phased in over the past year and a half.

The change also has opened the door for thousands who previously did not qualify for Medi-Cal, the health insurance program for low-income residents that covers over one-third of California’s population.

Until Jan. 1, 3 million Medi-Cal beneficiaries — mainly those who are aged, blind, disabled, in long-term care or in the federal Supplemental Security Income program — faced limits on the value of financial accounts and personal property they could hold and still qualify for coverage. Now, nearly 2 million of them will no longer face these restrictions, putting them on par with the roughly 12 million other Medi-Cal beneficiaries who don’t have asset limits.

They still must be below Medi-Cal’s income threshold, which for most enrollees is currently $1,677 a month for a single adult and $3,450 for a family of four. However, the change will eliminate a lot of paperwork for applicants and the county workers who verify their eligibility.

For a long time, this group of Medi-Cal beneficiaries could have no more than $2,000 in the bank — $3,000 for a married couple — though the home they lived in, as well as one car and certain types of other personal property, were exempt.

“If you had $5,000 in assets, you would have to spend $3,000 on something to prove that you were beneath the limit to qualify,” said Tiffany Huyenh-Cho, a senior attorney at the advocacy group Justice in Aging. “We had people who prepaid rent, spent money on car repairs, bought a new couch or appliances — things to reduce their assets in order to get to the $2,000 limit.”

Now, Huyenh-Cho adds, “you don’t have to remain in deep poverty. You can save for an emergency; you can save for retirement or for a security deposit if you want to move.”

And those who have hoped to leave a little something for their children when they die can now do so, even if they need expensive long-term care.

The first phase of the rule change was implemented in July 2022, when the threshold was raised dramatically to $130,000 for an individual and $195,000 for a two-person household. That was a nonfactor for the vast majority of those concerned; after all, most people with incomes low enough to qualify for Medi-Cal would not have that much saved. For this reason, the total elimination of the so-called asset test ushered in this year is expected to help fewer people financially than the first change did.

Still, there are some people with more than $130,000 in the bank whose savings would have been wiped out in shockingly short order had they needed long-term care in a nursing facility or at home. Now, they can qualify to have Medi-Cal pick up that cost.

Dr. Joanne Shinozaki, a resident of Granada Hills, hired private full-time caregiving last year for her mother, Fujiko, who has dementia. But it cost nearly $11,000 a month, which Shinozaki quickly realized would burn fast through the roughly $200,000 in savings her father had left when he died early last year. Reluctantly, she put her mom in a memory care home, which was less expensive. But after a 10% increase in January, it is now costing $9,000 a month, although that includes food and utilities.

Fujiko Shinozaki, who has dementia, at a memory care home in Agoura Hills.
Fujiko Shinozaki, who has dementia, is currently in a memory care home in Agoura Hills. Thanks to a change in eligibility rules that took effect Jan. 1, she may now qualify for Medi-Cal despite a nest egg her husband left when he died last year.
(Joanne Shinozaki)

Because of the money Shinozaki’s dad left, her mom did not qualify for Medi-Cal under the old rules. Now that money no longer counts against her.

Shinozaki, a veterinarian who quit her job to coordinate her mother’s care, needs to return to work soon. She has applied for Medi-Cal for her mom and is waiting for it to be approved.

“It would mean being able to bring her back to the house where she’s lived since 1988, if she’s well enough to come home,” Shinozaki says. To do that, she will need to get her mom access to caregivers via Medi-Cal’s In-Home Supportive Services program.

Indeed, another benefit of the change in eligibility rules is that it supports the caregiver economy, says Kim Selfon, a Medi-Cal and IHSS policy specialist at Bet Tzedek Legal Services, which provides free legal assistance to people in Los Angeles County.

Advocates who work with Medi-Cal enrollees and applicants say they often have to explain the difference between assets and income.

“I think a lot of people are confused,” says Stephanie Fajuri, program director at the Center for Health Care Rights, an L.A.-based nonprofit that helps people navigate Medi-Cal and Medicare. “They say, ‘What do you mean? I could be making $1 million a year?’ And we say, ‘No, that’s income.’”

So, let’s be clear: Under the new rules, yes, you can have a second house. But if you are renting it out, that’s income — and given today’s rental prices, it will probably disqualify you from full Medi-Cal benefits. You can also keep an investment account regardless of the balance, but distributions from it as well as any interest, dividends and capital gains it generates are also income.

Again, most beneficiaries are unlikely to have a large pool of assets and still have income low enough to qualify for Medi-Cal. But if you suddenly inherit a modest sum — or even a large one — now you can keep it, though it may briefly affect your coverage.

Unfortunately, the 1.1 million Medi-Cal beneficiaries receiving Supplemental Security Income are still subject to an asset test, because different rules apply to them.

Western Center Roundup – February 2024

Honoring Black History Month and the Critical Work Ahead of Us
As Black History Month comes to a close, we honor the life and legacy of Professor Derrick Bell, one of Western Center’s founding members, past executive director, and a leading voice in the school of thought that would become critical race theory. We honor WCLP’s rich history, standing on the shoulders of giants, as we continue the critical work of eliminating anti-Blackness in Health, Housing, Public Benefits, and Access to Justice. We continue to expand our team to even more effectively tackle issues that disproportionately impact the Black community like the housing crisis, the burden of medical debt, and birthing justice and equity.

Blog Post: Black Midwifery and Birthing Justice
In a recent blog post, Senior Health Advocate Etecia Burrell delves into the racist roots of “professionalized” medicine as it relates to obstetrics and gynecology, Black Americans’ long history as birthing guides, and the current state of the centuries old practice of midwifery in America today.  Read the full blog post here.

 

READ MORE

Blog Post: Anaheim City Council Stiffens Penalties for Street Vendors

Western Center Outreach & Advocacy Associate Abe Zavala-Rodriguez recently wrote a blog post that highlights recent changes to Anaheim’s harsh vending policies.

This month Anaheim City Council voted to impound street vendor equipment and codify into law non-vending zones, moves he says are fueled by stereotypes that suggest street vendors deter customers from visiting brick and mortar businesses in the city. Read the full blog post here.

READ MORE

Join Us for the Next “Meet the Advocates”
March 12th at 12:30-1:30PM
Join Western Center on Law and Poverty’s policy advocates for a deep dive into our 2024 legislative agenda, including our bills on medical debt protections, increasing housing voucher utilization, reducing Black maternal mortality, fighting for Medi-Cal continuous coverage, housing as a human right, and much, much more! The presentation will be followed by a Q&A.
REGISTER

Last Chance:  Apply for Reimbursement of Electronically Stolen Benefits
If you had cash aid or CalFresh benefits stolen without losing custody of your EBT card, you may have been a victim of electronic theft. This training tells you how to ask for reimbursement if your benefits were electronically stolen. It includes links to the claim form and resources.  If the benefits were stolen between October 1, 2022 and September 30, 2023, you must file a claim form by February 29, 2024.
LEARN MORE


Justice, USA Documentary To Premiere on MAX

Marshall Goldberg’s documentary Justice, USA is set to premiere March 14, 2024, on MAX. The movie puts viewers in the shoes of indigent defendants, offering an inside, 360-degree look at the criminal justice system in some of the most racially-divided cities in the United States.

Shot over seven months in Nashville with almost no restrictions, this six-part series for MAX bears witness to everyday life in the men’s jail, the women’s jail, juvenile court, and the courthouse. There are no narrators and no experts. Justice, USA simply lets the cameras roll so we see and hear directly from the people who make up the system – inmates, lawyers, deputies, administrators – in their own voices.

To learn more about this groundbreaking documentary, click here.

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Join our Team
As Western Center continues to position itself for greater reach and impact in 2024, we currently have three positions open: Policy Advocate – HousingSenior Health Attorney or Health Attorney, and Senior Communications Strategist.

Please share these opportunities widely with your networks!

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California becomes first state to offer health insurance to all eligible undocumented adults But many remain uninsured because of a range of enrollment barriers

California became the first state to offer full health insurance to undocumented immigrants. (Getty Images)

By: Brenda Verano
Jan 8, 2024

On Monday, California became the first state in the nation to offer health insurance to all eligible undocumented immigrants. Beginning January 1, immigrants of all ages will be eligible for the state’s health insurance program for low-income people, known as Medi-Cal.

Throughout the years, Granados has developed a list of chronic and degenerative diseases.

Full-scope Medi-Cal will allow immigrants like Granados, living in the Golden State to seek free dental, vision (eye) care, specialist appointments, mental health care, substance use disorder services, prescription drugs and medical supplies, and in-home care if they meet all Medi-Cal eligibility rules, including income limits.

Immigrants ages 26-49 are the last group to join the ongoing Medi-Cal program expansion, which is part of the “Healthy California for All” initiative, which took effect in 2015. Nine years ago, former Gov. Jerry Brown signed a law making undocumented children (1-18 years old) eligible for state insurance.

What followed was the Young Adult Expansion, which was signed into law in 2019 and provided full-scope Medi-Cal to young adults 19 through 25. In 2023, the Older Adult Expansion, which provided full-scope Medi-Cal to adults 50 or older, was signed into law.

Adults can apply to Medi-Cal online, in person through Medi-Cal enrollment centers and thousands of certified enrollers and over the phone. For California immigrants to qualify for Medi-Cal, adults must submit proof of income that proves their household earns less than 138% of the federal poverty level (FPL), along with additional details like age, marital status, tax information and identification.

Granado’s first health issue began as a kid in Mexico when she was diagnosed with epilepsy, a neurological condition involving the brain that makes people more susceptible to having recurrent, unprovoked seizures. “We didn’t grow up with much, but my mom always cared for me, even when she didn’t know what exactly was wrong,” she said.

Granados grew up in a small town in Guanajuato, Mexico, where her parents and grandparents lived off the land as farmers. “My parents taught me to value everything—every meal, every day that we get to wake up and although my health has not been the best in the last few years, I remain grateful,” she said.

She immigrated to the United States in 1998 and shortly after she was diagnosed with Sjögren’s syndrome, a chronic (long-lasting) autoimmune disorder caused when the immune system attacks the glands, which causes the eyes, mouth, and other parts of the body to retain moisture. Granados said that for her, it causes her mouth to feel very dry, a symptom that has required her to visit the dentist more frequently than most people.

She began noticing the ways that not having insurance played a key role in the type of care she would receive. “When I first started going to the clinic because of my severe migraines, they would prescribe me Tylenol and other people would be offered medical tests and examinations to find the exact cause of the headaches,” Granados said.

But the chronic disease that first sent Granados to the hospital for days was fibromyalgia, a chronic (long-lasting) disorder that causes pain and tenderness throughout the body, as well as fatigue and trouble sleeping. “It’s the type of pain that you cannot control or get rid of; it’s very scary,” Granados said.

She was first diagnosed with fibromyalgia about 5 years ago when the pain was so severe that her husband decided to take her to the emergency room and ask for her to be admitted to the hospital, a decision that would leave them financially struggling. “The doctors explained that they did not know what caused it, but that it explained my heightened sensitivity to pain in my back. I could not walk,” she said. “ We spent all of our savings on being in the hospital and seeing a specialist. “

After years of experiencing severe symptoms of fibromyalgia, Granado’s feet and entire body are not as strong. She uses a cane to support herself; she cannot walk or stand for long periods or carry heavy equipment; and she gets very cold easily, all of which affect her daily life, her job and her ability to perform regular tasks.

For those like Granados who already have an active restricted or emergency Medi-Cal insurance plan, they will not need to submit their application or apply again. “Those people will be automatically switched over to full-scope coverage beginning January 1st, 2024,” Jose Torres Casillas, Policy and Legislative Advocate at Health Access California, said.

He said that Health Access California had been actively recommending community members and other community organizations to enroll qualified immigrants into emergency-scope Medi-Cal before the beginning of the year, so the transition would be seamless.

Medi-Cal will cover an additional 700,000 Californians

In the United States, one in five (20%) immigrant adults reported having problems when it came to paying for health care in the past year and (22%) said they skipped or postponed care in the past year because of their inability to pay, according to a  2023 survey by the LA Times and the Kaiser Family Foundation (KFF).

meical photo 4

Timeline of the Medi-Cal expansions that took effect throughout the year. Graph by Brenda Verano

Previously, many undocumented immigrants like Granados only qualified for restricted Medi-Cal, which allowed immigrants to receive emergency and pregnancy-related services as long as they met eligibility criteria like economic requirements and had proof of California residency in 2014.

Medi-Cal provides services to over 13 million Californians (or one in three who rely on the program for health coverage). Granados is excited to begin receiving full-scope comprehensive health insurance, which will help her see a doctor for her chronic pain regularly and can ultimately cover at-home assistance and care, all while not having to worry about the cost.

The California Department of Health Care Services (DHCS), which administers Medi-Cal, estimates that with this new expansion, an additional 700,000 Californians will now be enrolled, but Torres Casillas, said the number of new enrollees will most likely be a lot greater.

“When the 50-year adult expansion was approved, our original estimates were that about 250, 000 people were going to enroll. We’re now over 300,000 people over the age of 50 who have enrolled,“ he said. “We’re expecting a similar situation with that of the 26 to 49, where we are currently estimating 700,000 people will be eligible, but we’re expecting a lot more people to enroll.”

#Health4All campaign

Torres Casillas has become a policy expert at Health Access California, which serves as the co-chair, along with the California Immigrant Policy Center, of the #Health4All campaign, which has driven the efforts of all the Medi-Cal expansions throughout the years. The Health4All campaign began in 2013 when immigrant rights activists, healthcare advocates, and community members came together to call for expanding health care to all immigrants living in California.

“We’re ensuring that we, along with other organizations advocating for immigrants, are at the decision-making table to be able to speak on and address a lot of the issues that exist within the implementation of these Medi-Cal expansions,“ he said. “We want to make sure that the state is able to use a lot of the lessons learned from our prior expansions and apply those to the new expansions.”

The January 1 expansion will cost the California Health and Human Services Agency $835.6 million in funding between 2023 and 2024 and $2.6 billion annually, but Torres Casillas believes these costs are worth the well-being of immigrants. “We need to invest in our immigrant community’s well being, and this is a huge step for them to feel supported and part of our country’s health care system,” he said.

Existing flaws in Medi-Cal’s Application Process

However, according to David Kane, senior attorney at Westen Center for Law and Poverty, an organization that has worked closely with DHCS to ensure the implementation of the expansion, the Medi-Cal applications and the application process still have flaws.

“We convene meetings with partners, advocates, stakeholders and the Department of Healthcare Services to make sure that they are implementing this in a way that will meet the needs of the community,“ he said.

For Kane, aside from complaints of Medi-Cal applications that take long to process, adults not being able to reach the county by phone or not being able to get help in their language, one of the biggest flaws in the Medi-Cal application is the section that asks people for their social security number. Although skiing for an SSN is something that is a federal requirement, it is not something undocumented immigrants do not have.

“That’s something that should have been fixed a long time ago. We do not want people to feel discouraged when they see this in the application. We need to find a way to let people know they can still get full-scope care even if they don’t have a social security number,” Kane said.

Enrollment barriers

The KFF also found that among immigrants who are eligible for health coverage, many remain uninsured because of a range of enrollment barriers, including fear, confusion about eligibility policies, difficulty navigating the enrollment process, and language and literacy challenges.

For Maria Hernandez, 23, who has had Medi-Cal insurance for over 5 years and speaks fluent English, navigating Medi-Cal is still a challenge. She was born in Puebla, Mexico and immigrated to the U.S. when she was only six months old. “We never really got any assistance or help [from the government] before. My mom was scared of telling people she was an immigrant,” she said.

Hernandez got severely ill during the COVID-19 pandemic, and being able to go to the hospital or clinic to get the appropriate care made her appreciate having health insurance. “It has helped me a lot, just by the fact that I was able to be seen,” she said.

As a former personal translator for her mom, she realized the way language plays a part in health coverage. “I did not live too far from a hospital and being able to go without having to think of the cost or if [doctors] were going to speak English is something I did not have to worry about, but many did,” Hernandez said.

Andrew Kazakes, senior attorney at the Legal Aid Foundation of Los Angeles (LAFLA), has provided free, high-quality legal services to those seeking government benefits, including Medi-Cal.  “Part of our work at LAFLA is that we hold clinics set up in L.A. County hospitals, where social workers will refer patients to our clinic if they have any legal issues that might have prevented them from getting approved for the services they need, such as Medi-Cal.”

 Although federal funding restrictions limit the assistance LAFLA can provide to undocumented immigrants, with exceptions that depend on individual circumstances, the organization aims to assist uncovered Californians who are eligible for their services, and to provide high-quality referrals to those who they cannot serve directly.

During his time hosting legal aid clinics at Rancho Los Amigos National Rehabilitation Center, located in Downey, he worked with many patients who were unfamiliar with the healthcare system of California and who wrestled with navigating Medi-Cal and the application process.

“There was definitely a high volume of undocumented folks who got referred our way. It’s really confusing for a lot of people to navigate these different administrative systems and it’s not their fault,” Kazakes said. “The system itself is really confusing. Doctors will struggle, social workers will struggle, and even attorneys will have to struggle to figure out, based on somebody’s status, what sort of assistance they can get.”

According to Kazakes, because a hospital does not turn away anyone who does not have health insurance or cannot pay, the patient would often obtain presumptive eligibility for Medi-Cal.

“If you have someone who’s showing up from a car crash, the hospital doesn’t want to pause care; therefore, the patient would get presumptive eligibility, but after the patient receives the care needed, like, for example, a surgery, they are left to transition off Medi-Cal unless they can establish their eligibility,” he said. “It creates this situation where people have already been through trauma, and now they’re put in this position of not knowing if the care is going to be there to help them with the aftermath of the accident and fully recover beyond the immediate emergency.”

Kane and Torres believe that the hardest part, other than implementing the Medical 26-49 Adult Expansion, will be modifying the Medi-Cal health system to make immigrants feel welcomed and seen. “It’s not as simple as saying: “OK, immigration status doesn’t matter anymore.” That’s what the law says. It’s super clear; it’s super simple, but the Department of Health Care Services has historically excluded this group of people. The State Department of Health Care Services needs to break down the systemic barriers that they have had in the design of their program,” Kane said.

Supporting New Medi-Cal Patients

Katie Rodriguez, vice president of Policy and Government Relations at the California Association of Public Hospitals and Health Systems (CAPH), said their members are excited to welcome new full-scope Medi-Cal patients and wants them to feel supported in the clinics and hospitals where they will be seeking care.

According to Rodriguez, 21 public hospitals and their clinics in the state, such as Los Angeles General Medical Center and  UCLA Medical Center, already see many of the patients that have recently become eligible for full-scope Medi-Cal. “The majority of our patient population at our public hospitals and healthcare systems are already Medi-Cal or Medicare patients or uninsured,“ she said. “We are very proud of this.”

Rodriguez said public hospitals and clinics do not turn anyone away because of a lack of insurance and are excited to continue to foster the patient-relationship practices that make new full-scope MediCal-eligible patients feel included and seen. “Public hospitals and their clinics regularly communicate with any new and existing patients. that come in and make sure that they’re aware of all coverage options, in case they’re eligible for full-scope Medi-Cal or other services as well,” Rodriguez said.

Rodriguez said she is aware of how filling out new applications can be overwhelming and difficult for people who are doing this for the first time. One of the things that the public hospitals and their clinics have done to ease some of these nerves and assist new Medi-Cal patients is to have people solely designated to help fill out applications and determine eligibility. “Many of our hospitals and clinics have what we call enrollment counselors onsite that help individuals apply,” she said. “Most importantly, the enrollment counselors, tell them what Medi-Cal is, the documentation they need, and what the application looks like. Whenever possible, they go through it with them in the language they feel most comfortable with,” she said.

Public Charge

In August 2019, former president Donald Trump announced a public charge policy that, at that time, could result in the rejection of many immigrants applying for an immigrant visa (e.g. green card) if they had previously accessed or were deemed likely to rely on certain forms of public assistance, such as Medi-Cal. The unenrollment and decreased participation in government assistance programs contributed to more uninsured individuals and negatively affected the health and financial stability of families.

Even as the former public charge rule is no longer in effect and the government has stopped following the Trump-era rule on March 9, 2021, the narrative continues, and according to Torres Casillas, immigrants continue to be afraid of taking advantage of programs like Medi-Cal.

“That rule is no longer in effect, but we’re still dealing with the remnants in the sense that people may not know that it’s no longer in effect. And if that information spreads, then other people are confused and therefore hesitant to apply to Medi-Cal” he said.

Kane said that the Western Center for Law and Poverty and other immigrant rights advocates, including the Health4All Coalition, continue to push DHCS to educate people on the way public charge is not something they should worry about.

 “For some time, DHCS would not want to say anything about public charge because they said it was like giving immigration legal advice, but it’s not if you are just educating people,” Kane said. “We’ve been pushing DHCS to tell people very basic things about public charge, and we’ve made some great progress.”

Today, DHCS’s website contains basic information on public charge and assures people that the U.S. Department of Homeland Security (DHS) and U.S. Citizenship and Immigration Services (USCIS) do not consider health, food, and housing services as part of the public charge determination. “DHS strongly encourages these populations to access any and all services and benefits available to them without fear of a future negative impact,” states the DHCS website.

For Granados, a flawed Medi-Cal program is better than not having any insurance at all. “I’m still grateful and even if flawed, I’m excited to be able to have Medi-Cal,” she said.

Torres Casillas believes outreach, marketing and informing community members of their eligibility are the most crucial steps after January 1. “People may not know that they’re eligible; people may not know that coverage was expanded, and we all need to work hard to make sure the information gets to the right people,” he said.

Kane said it’s important to emphasize the journey that it took for all immigrants in California to be eligible for Medi-Cal. “We know that this is a community-led, community-driven effort. That’s the only reason we’re doing this because people stood up and advocated for their family members and themselves,” Kane said.

You can apply for Medi-Cal at any time of the year. To learn when you can apply, go to www.coveredca.com or call 1-800-300-1506 (TTY 1-888-889-4500).

Black Midwifery in the US

Since the inception of the United States, midwifery has been the most customary practice for pregnancy care and childbirth. Today, the primary care for pregnant people in most developed European countries is facilitated by midwives. However, in the United States a divide began to take root in the 1800’s, when white male physicians began to explore childbirth with greater interest. Their approach was based on a patriarchal and colonial framework that was highly experimental and racist, often times using enslaved African to test explicit drug therapies, shock treatments, and surgeries without any anesthesia.

Prior to the creation of formalized medical education in obstetrics and gynecology, midwives were the sole experts in birth work and medicine relied heavily on Native American and African American knowledge of plants and indigenous healing modalities. For millennia, birth work was considered a female occupation or “woman’s work” (Hoch-Smith and Spring, 1978; Leavitt, 1983; Rooks, 1997; Donegan, 1978; Litoff, 1990). The midwifery model of education was a indigenous model of apprenticeship under more experienced midwives that were often grandmothers who also learned from their grandmothers. In the United States midwifery was largely practiced by enslaved Africans who were responsible for women’s healthcare of all enslaved women on the plantation as well as the white women who owned them. A large part of midwifery apprenticeship on the plantation included various forms of training such as herbalism, procedures for dealing with birth complications, perinatal care, and serving as traditional healing.

Once the field of medicine became “professionalized” and legitimized by the legal system with the invention of the American Board of Obstetrics and Gynecology in 1927, physicians sought to dominate the field of birth work as its primary practitioners. Their claim to jurisdiction spurred racist propaganda campaigns depicting Black midwives as caricatures falsely accusing midwives of being “incompetent”, “witches”, “unclean”, “savages”, and “untrustworthy”. These physicians also lured white women to trust them because they offered “innovative” pain relief options such as opioid tampons, and mercury. In addition to the propaganda, because pregnancy began to be viewed as a pathological condition beginning in the late 1800s and continuing into the 1900s, physicians claimed that only legally trained individuals could “treat” this “condition”. Such assertions/claims served as manipulative tools that “pushed the scales” in favor of physician-assisted births versus granny midwife assisted births.

The public perception of midwives began to shift as the midwives who had for centuries in the Americas served as the primary maternal and infant healthcare providers were essentially deemed illegitimate. These smear campaigns were supported by the white male physicians who were founders and members of State Boards of Health which controlled who was able to care for and treat women in childbirth. By the 1900s white male physicians attended approximately half of births, despite having little to no training in obstetrics.

In rural America, however, Black midwives continued to attend births especially for Black folks who lived in the segregated south and had no access to hospitals in their communities. In the Southern states, Black midwives, sometimes called “granny” midwives, attended up to 75% of births until the 1940’s.

Racist laws, educational restrictions, and campaigns against midwifery care led to the dismantling of the practice especially for Black women, for example:

  • The 1910 Flexner Report recommended hospital deliveries and the abolition of midwifery. The study has since been recognized for its racist, sexist, and classist approach to medical education.
  • “Twilight sleep” was introduced in 1914, an amnesiac given to women by white physicians preventing any memories of giving birth.
  • In 1915, Dr. Joseph DeLee – a prominent obstetrician – called pregnancy and childbirth “dangerous” and “evil.” Dr. DeLee promoted the use of forceps, sedatives, ether, and other interventions that needed hospital-level care. He argued that midwives were incompetent.
  • The Department of Indian Affairs passed legislation that moved births from the home to the hospital.
  • The Shepphard-Tower Infancy and Protection Act became a federal law in 1921. It encouraged states to develop their own maternal and child health legislation. Before these changes, lay midwives practiced mostly without restrictions. The new laws severely reduced their practice in many states. For example, Alabama began requiring all midwives to obtain a license, then later required nurse-midwives to practice only in hospitals. These changes prevented 150 “granny midwives” from practicing across the state practically overnight.
  • Public health nurse Mary Breckenridge founded Frontier Nursing Service (FNS) in rural Kentucky in 1925 which led to the more formalized field of nurse-midwifery also developed at this time. Breckenridge’s racist rhetoric impacted Black midwives’ entry into the nurse midwifery route though Breckenridge has been for “creating a pathway for midwifery education and certification.”

The formalization of education and certification ultimately delegitimized apprentice-trained midwives in every community. Today, less than 5% of midwives in the United States are people of color. Disparities in maternal morbidity and mortality rates are striking; Black mothers are 2-3 times more likely to die in childbirth than white mothers. This impact reflects the powers and forces that disconnected midwives from their communities.

Black Midwives that Birthed Communities

Mary Coley was born in Baker County, Georgia. She began training as a midwife under the tutelage of Onnie Lee Logan. She became an advocate for the health of Georgia’s black population and was known for her willingness to work with women regardless of race in a time of segregation. It is estimated that she delivered over 3,000 babies in her career.

Ms. Arilla Smiley was trained by the local Health Department in Brunswick Georgia and apprenticed with her mother-in-law. She received her license to perform midwifery in 1963 and retired in 1987. During her career as a midwife, Ms. Smiley delivered over 1,000 babies in Mitchell County.

Maude Callen was a nurse-midwife in the South Carolina Low country for over 60 years. Her work was brought to national attention in W. Eugene Smith’s photo essay, “Nurse Midwife,” published in Life on December 3, 1951.

Margaret Charles Smith delivered more than 3,000 babies. In 1949, she became one of the first official midwives in Green County, Alabama, and she was still practicing in 1976 when the state passed a law outlawing traditional midwifery. In the 1990s, she cowrote a book about her career, Listen to Me Good: The Life Story of an Alabama Midwife, and in 2010 she was inducted into the Alabama Women’s Hall of Fame.

Bibliography
Abbott, Andrew. 1988 The System of Professions. Chicago: University of Chicago Press.
Donnegan, Jane B. 1978 Women and Men Midwives: Medicine, Morality, and Misogyny in Early America. Westport: Greenwood Press.
Fraser, Gertrude Jacinta. 1998 African American Midwifery in the South: Dialogues of Birth, Race, and Memory. Cambridge: Harvard University Press.
Hoch-Smith, Judith and Anita Spring. 1978 Women in Ritual and Symbolic Roles. New York: Plenum Press.
Leavitt, Judith Walzer. 1987 “The Growth of Medical Authority: Technology and Morals in Turn-of-the-Century Obstetrics.” Medical Anthropology Quarterly 1(3). September. 230-255.
Leavitt, Judith Walzer. 1983 “Science Enters the Birthing Room: Obstetrics in America Since the Eighteenth Century.” The Journal of American History. 70(2). 281-304.
Litoff, Judy Barrett. 1996 “Forgotten Women: American Midwives at the Turn of the Twentieth Century.” Pp. 425-441 in Childbirth: Changing Ideas and Practices in Britain and America 1600 to the Present, edited by Phillip K. Wilson, Ann Dally, and Charles R. King. New York: Garland Publishing.
Pringle, Rosemary 1998 Sex and Medicine: Gender, Power, and Authority in the Medical Profession. Cambridge: Cambridge University Press.
Radcliffe, Walter. 1989 Milestones in Midwifery and the Secret Instrument: The Birth of the Midwifery Forceps. San Francisco: Norman Publishing.
Rooks, Judith Pence. 1985 Midwifery and Childbirth in America. Philadelphia: Temple University Press.

Western Center Roundup – January 2024


Western Center’s Analysis of Gov. Newsom’s Budget Proposal

In response to Gov. Gavin Newsom’s 2024-2025 budget proposal, Western Center issued an analysis on the impact his proposed funding priorities would have in several key areas of concern. These include: access to housing, health care, and public benefits for Californians. Note that this analysis is the first in a series of communications Western Center will distribute this session as we advocate for just budget priorities. Read the full analysis here.
READ MORE

WCLP Blog: Making Food Prescriptions a Reality in California

Western Center Outreach & Advocacy Associate Abe Zavala-Rodriguez recently wrote a blog post uplifting California’s innovative food prescription pilot programs. Food and nutrition supports have been proven to be successful at helping people to treat, manage, or even prevent chronic health conditions as seen in pilots and studies not only across California but also nationally. These programs are an especially critical tool towards achieving health equity goals since BIPOC communities are disproportionately impacted by health issues and poverty. Read the full blog post here.
READ MORE

Western Center’s Newest Team Members
Western Center continues to grow to meet the needs of Californians with low incomes. Please join us in welcoming our newest team members, Etecia Burrell, Senior Health Advocate; Rebecca Gonzales, Policy Advocate, and Danny Sternberg, Attorney. We are overjoyed to have them on the Western Center team!

Join our Team
As Western Center continues to position itself for greater reach and impact in 2024, we currently have two positions open: Policy Advocate – Housing; and Senior Communications Strategist.

Please share these opportunities widely with your networks!

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Western Center Roundup – December 2023


Settlement Finalized in Katie A. v. LA County Mental Health Lawsuit
After more than 20 years of litigation, the U.S. District Court for the Central District of California, Western Division, has given final approval to a settlement in the longstanding case Katie A. v. Los Angeles County. The Court’s action ends a federal class action lawsuit that, over time, led to significantly improved mental health services for children and young adults in foster care or who face imminent risk of placement in foster care.

Filed in 2002, the suit alleged the county and state agencies failed to provide legally mandated health care services to youth in its custody. The lack of mental health services harmed foster youth by increasing the likelihood they would be removed from their homes.  Removals compound trauma for foster youth, making the lack of appropriate care even harder for children already struggling with mental illness.

“In the beginning of this lawsuit, we saw many youth have multiple moves due to behaviors that weren’t being addressed with treatment, and they were losing important connections to family and community,” said Antionette Dozier, one of Western Center’s lead attorneys on the case.


Tis the Season to Donate (Unspoiled) Food
One in five Californians suffers from chronic hunger, but a growing food rescue effort is poised to shrink that number.

About two years ago, one of the most significant waste reduction mandates went into effect across the state. SB 1383 ambitiously seeks to reduce organic waste  by 75% by 2025.  This means that around 20 million tons of potential waste may soon be diverted from landfills to kitchen tables.

Throughout California, municipalities  are setting up  programs to  ensure that grocery stores, produce marts, corporate kitchens, schools,  and other commercial food generators  set protocols to inspect leftover food before it spoils and see that it reaches those who are hungry as fresh as possible. For years prior to SB 1383, many food generators resisted donating food. Now with legislation, a robust network of waste reduction programs and streamlined donation processes,  support is growing.

For example, Food Finders, which has a network of over 470 partners across five counties in Southern California, has been helping food generators comply with the mandate. In particular, they facilitate same-day, donor-to-recipient delivery of edible foods.

FULL BLOG

Western Center Roundup – October 2023


Hunger Persists but So Do We
A new report from the United States Department of Agriculture shows a sharp rise in food insecurity in 2022, the latest numbers available. A staggering 17 million households struggled to get enough food in 2022, a jump from 13.5 million households who were food insecure in 2021. Hunger, like poverty, is a policy choice and is not inevitable. Our Public Benefits and Access to Justice team continues to monitor the Supplemental Nutrition Assistance Program (SNAP) at the federal level, including suing the United States Department of Agriculture (USDA) to protect food benefits in the face of Congressional inaction and winning guaranteed October benefits for over 40 million Americans. Our plaintiff, Jacqueline, spoke with CalMatters about struggling to make ends meet. Just this month, Chris Sanchez, policy advocate, was featured in Food Research & Action Center’s list of 12 Latinx advocates “who are leading the charge to end hunger and poverty.”

2023 Legislative Successes

This year, Governor Newsom signed four of our co-sponsored bills into law:

SB 567 (Senator María Elena Durazo), the Homelessness Prevention Act will close the loopholes in the AB 1482 (Chiu), the Tenant Protection Act, another WCLP co-sponsored bill in 2019 that established the first statewide just cause eviction protections and rent stabilization ordinance in CA. SB 567 will provide both a private and public right of action for violations of AB 1482 and will close loopholes in owner-move-in and substantial rehabilitations evictions. These are the two most common protections that unscrupulous landlords violate. Co-Sponsored with Alliance of Californians for Community Empowerment (ACCE), California Rural Legal Assistance Foundation, Leadership Counsel for Justice and Accountability, PICO California, and Public Advocates.

AB 1418 (Assemblymember Tina McKinnor), Limiting Racially Motivated Crime-Free Housing Programs and Nuisance Ordinances ends predatory local laws that have unfairly increased evictions and further exacerbated California’s housing crisis. This bill will prohibit a local government from, among other things from requiring or encouraging a landlord to evict or penalize a tenant because of the tenant’s previous history with law enforcement, their association with another tenant or household member who has had contact with a law enforcement agency or has a criminal conviction, or to perform a criminal background check of a tenant or a prospective tenant. Co-Sponsored with California Rural Legal Assistance Foundation, Disability Rights California, National Housing Law Project, and Root & Rebound.

SB595 (Senator Richard Roth), Minimizing Gaps in Health Care Coverage clears up language in another WCLP co-sponsored bill from 2022, SB 644 (Leyva) requiring Employment Development Department (EDD) to share information about those who applied for income-replacing benefits administered by EDD with Covered California to allow Covered California to outreach and help enroll these individuals in Medi-Cal or Covered California. SB595 prevents insurance agents and enrollment brokers from cold-calling individuals to offer healthcare coverage and allows Covered California to conduct timely and targeted outreach to individuals. Co-sponsored with the California Pan-Ethnic Health Network and Health Access.

SB 727 (Senator Monique Limón), Forgiveness of Coerced Debt for Survivors of Human Trafficking will provide a pathway for survivors of human trafficking to have coerced debt accrued during the time they were trafficked forgiven. Co-Sponsored with Coalition to Abolish Slavery and Trafficking (CAST) and Los Angeles Center for Law and Justice.

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A Night to Remember – Reflections from Garden Party 2023
Over 300 people gathered at the Ebell of Los Angeles last week in celebration of Garden Party 2023, our annual fundraiser and night to honor anti-poverty trailblazers. Read about this spectacular night!
FULL BLOG

Thousands dropped from Medi-Cal in first eligibility check since the start of the pandemic

New data shows Sacramento County disenrolled 9,650 people from Medi-Cal in June. It was the first time in three years it and all other California counties have checked for eligibility.

The majority of people who were dropped did not return the renewal packets that were sent to the last address the county had on file. The same is true on the state level. Of the 225,000 California residents who were disenrolled in June, almost 9 in 10 were dropped because they didn’t complete the renewal paperwork.

“It’s extremely troubling,” said David Kane, senior attorney at Western Center on Law and Poverty. “Nobody looked at their cases and said, ‘you’re over income or you no longer qualify.’ They were cut off merely for paperwork reasons.”

Kane said many people have changed their addresses in the past three years, and may have never received the packet. Meanwhile, in Sacramento, community health workers say long wait times and a lack of communication from the county make it difficult to help people renew their coverage.

Medi-Cal, California’s low-to-no-cost insurance program for people with very low incomes, is in the first month of a yearlong renewal process.

Throughout the COVID-19 public health emergency, a federal policy called “continuous coverage” ensured that people could join Medi-Cal but could not be taken off. When the public health emergency ended this spring, counties began checking whether people were still eligible for the first time since 2020.

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‘A disaster waiting to happen’: Do staff shortages threaten Medi-Cal plans for renewing recipients

In one report after another earlier this year, counties from Los Angeles to Sacramento warned Medi-Cal officials that they don’t have enough trained staff — or simply don’t know whether they do — to process the millions of Californians whose cases come up for renewal starting in June.

For three years now, ever since federal officials declared a public health emergency in March 2020, U.S. law has prohibited Medi-Cal from kicking millions of Californians off its rolls, even if their incomes pushed past eligibility limits.

The end of so-called continuous coverage will come over a rolling 12-month period, based on the last date when a Medi-Cal enrollee’s eligibility was determined. If enrollees don’t submit the proper documentation by time their eligibility month ends, they will lose their benefits.

State officials estimate that 2 million to 3 million Medi-Cal enrollees could lose coverage because counties can’t manage the volume of cases or they don’t have the right addresses for enrollees or they can’t get critical information in time.

Read more