For Reyna Flores, nothing is more important than keeping herself and family happy and healthy.
“There comes a time in life when you realize that being well is the most important thing,” Flores said. “I always tell my kids they need to begin caring for themselves now and not wait until they’re older.”
The 50-year-old mother of six has always pushed loved ones to care for their minds and bodies. However, Flores admits that she has struggled to keep her own health a priority, especially as her days are split between work and parenting. Flores’ long days consist of picking up and dropping off her kids at school, cooking meals, cleaning her home and staying atop all of their homework assignments and pending exams. And she works at her community garden several hours each week.
“There’s always something to do around the house,” she said, “whether I’m washing the kids’ clothes or helping them with their homework, there is always something.”
Flores, who is originally from Puebla, Mexico, is among the nearly two-thirds of undocumented immigrants in California younger than 65 who survive without health insurance.
Flores’ age and immigration status have made her ineligible for Medi-Cal insurance. As is the case with many undocumented people in the U.S, she chooses to schedule doctor appointments based on whether she can afford the care that week.
“It can get very expensive,” Flores said. “As much as you want to care for yourself, the costs can be really high. It makes you think twice about going to the doctor.”
Earlier this year, Flores was forced to rush to a local clinic due to severe abdominal pain that she could no longer ignore. “The doctors requested specific lab tests,” she said. “So I got them and they’re not cheap.”
During the last three months of 2021, approximately 30% of Americans skipped medical care due to concerns about the cost, according to a survey from Gallup and West Health. However, as of May 1 medical costs will become less of an impediment for the immigrant community of California. A new law called “Older Adult Expansion,” formerly known as AB 133, expands full-scope Medi-Cal coverage to low-income immigrants 50 and older, despite immigration status.
The law was signed by Gov. Gavin Newsom in July and is expected to expand healthcare coverage to approximately 235,000 undocumented people. The new healthcare law will provide eligible undocumented immigrants access to free preventive services, long-term care and in-home supportive services.
Currently, income-eligible immigrants without legal status qualify for restricted Medi-Cal, which limits treatments to emergency room and pregnancy-related care.
The cost of medical care services in U.S cities increased by an average of 5.3% from February 2021 to February 2022, according to the Bureau of Labor Statistics’ consumer price index.
A fear of racking up high medical costs led Flores to rely many times on alternative medicine, something she refers to as plantas medicinales or medicinal plants.
Flores is a member of the Corazon De La Gente Community Farm, where she dedicates time planting medicinal herbs throughout the garden. The bounty is shared by her and residents of South Central. Because Flores does not always have the capacity or cash to attend medical check ups, so she often relies on teas, tinctures and extracts from plants, such as as chamomile, rosemary, lavender and, her personal favorite, aloe vera, to alleviate muscle pains, migraines and flu symptoms.
“It wasn’t until the pandemic hit that people began to appreciate alternative medicine, teas and medicinal plants,” Flores said.
Until now, Flores was the only person in her immediate family who was uninsured. California’s Medi-Cal system already covers undocumented children and young adults.
The Health4All Coalition, formed in 2013 by the California Immigrant Policy Center (CIPC) and Health Access California, considers AB 133’s passage a big win. The Health4All Coalition advocates for removal of health coverage exclusions based on immigration status and its efforts include community engagement, state-wide lobbying and hosting community meetings. In 2016, the coalition’s “Health4All Kids” campaign secured full-scope Medi-Cal coverage for undocumented children, and in 2020, helped encourage the state to expand coverage to include young adults ages 19 to 25.
The “Older Adult Expansion” law is considered to be a milestone for the undocumented community in California, say health experts and immigrant justice advocates. It now covers more immigrants than Gov. Newsom had initially proposed in his state budget plan in May 2021. He originally intended to provide full-scope Medi-Cal to undocumented seniors 60 and older. The change occurred in June when Democrats, supported by immigrant advocacy organizations, such as CIPC, struck a deal that lowered the age threshold and covered more people.
The “Older Adult Expansion” law is expected to cost $2.1 billion a year to administer, according to the California Legislative Analyst’s Office. Ivan Barragan, Health & Public Benefits Policy Coordinator with CIPC, says that the cost is worth every penny.
“It was and still is a big budget ask,” Barragan said. “Older people can be very expensive to take care of medically, because of chronic illnesses. But excluding someone from healthcare based on where you are born is inhumane. Our healthcare system is stronger when everyone has access to primary and preventative care because it lowers costs for everyone now that we have insurance paying for services. And, folks are not going into debt.”
For undocumented people 50 and older who already have emergency Medi-Cal, the full-scope service changes will automatically begin May 1 and they will not need to fill out new applications. “Those people with restricted or emergency Medi-Cal will use the same insurance card and same account number,” Barragan said. “Their services will be the only thing that changes. They will expand from one day to another.”
In Los Angeles County, My Health LA (MHLA) is a county healthcare program that aids low-income individuals and helps uninsured immigrants set and attend crucial doctor appointments and regular check-ups. MHLA offers its services to patients for free. But unlike Medi-Cal, MHLA does not serve as health insurance and undocumented immigrants are restricted from receiving care outside of the MHLA clinics.
Anna Gorman, Director of My Health LA, said that there are about 132,000 individuals in the MHLA program and nearly 60,000 of them should qualify for the expansion.
“We are grateful that the state has expanded Medi-Cal to this population and we are committed to ensuring a smooth transition from the My Health LA coverage program to Medi-Cal,” Gorman said. “We have been doing a lot of outreach to make sure the participants know they will qualify for Medi-Cal and know how to get signed up.”
Vilma Champion, Director of Managed Care, and Jiovanni Perez, Manage Care Program Manager at the Northeast Valley Health Corporation, lead the efforts to enroll as many eligible members onto restricted Medi-Cal before May 1.
“It has been a major priority to prepare our communities for this historical transition,” Perez said. “This includes calling folks who still do not have emergency medical services and urging them to apply. Full-scope Medi-Cal is going to be a new world for many patients. There will be so many more options and that can be overwhelming.”
Experts say that two major barriers may continue to frighten away immigrants from applying for full-scope Medi-Cal: misinformation and fear.
The trepidation that many undocumented people feel often stems from the Trump Administration’s 2020 “Public Charge” rule, Barragan said. Despite the fact that the Trump law is no longer in effect as written by that administration, the legacy keeps the immigrant community in fear of applying for assistance. Formerly, the rule limited green card access from those deemed likely to apply for public assistance, such as Medicare or Medi-Cal.
“We have been fighting this public charge narrative,” Barragan said. “I know there is still a lot of uncertainty and genuine fear, but Medicaid and Medi-Cal don’t count anymore for public charge tests. As of today, the U.S. Citizenship and Immigration Service no longer considers Medi-Cal or Medicaid as a part of a public charge determination when deciding immigration status.”
The passage of this law hits home for many undocumented Californians, Barragan said. “The Health4All coalition is 9 years old,” he said, “and just last year we had a couple of our organizers lose their lives to Covid-19 because they did not have access to health coverage.”
The pandemic, experts say, revealed the level of urgency at play to insure older adults, the most susceptible among Latinos to the flu and Covid-19, Barragan said.
“The pandemic has exacerbated all historical inequities among our healthcare system,” he said. “It highlighted the risk in our society when we exclude our neighbors and community members from programs they need to survive and live well.”
Flores’ sister is among the Latinos in the U.S who have died due to complications from Covid-19. “The pandemic took something from everyone,” she said. “I know that this law will not help just myself, but also many of the people I know who need that care to be well.”
Still, even with the extra health coverage provided by the “Older Adult Expansion” law, approximately 3.2 million people will remain uninsured in California, according to researchers at the UC Berkeley Labor Center and the UCLA Center for Health Policy Research. The healthcare gap will remain prevalent and affect undocumented adults ages 26 to 49, researchers say.
The new full-scope Medi-Cal plan will cover medical issues surrounding alcohol abuse, drug abuse, family planning, foot care, mental health, laboratory tests and personal attendant care. However, Flores said that she is most excited to have access to dental and vision benefits.
“I will be able to care for the things I haven’t for years,” she said. “This will take a huge weight off my shoulders.”