During Immigrant Heritage Month, Reflections on Creating an Inclusive Health Care System in California

by Mayra E. Alvarez

twenty20_7042d433-e356-4360-856a-57e899685ba5 (1)The American story is inherently one of immigrants. Like so many in our country, my parents came to the United States from Mexico some 40 years ago in search of a better future for their children. Today, my three sisters and I are leading lives our parents once dreamed of—with a career dedicated to making a difference, in a home that is your own, or a schedule that you are able to set for yourself. For many, these are simple things, but to many immigrants, they are what make America special. 

Whether your family came to America decades ago or months ago, faith in the American Dream remains the same, and immigrants continue to come to this country to find a better life for their family and make the country a stronger place. This is particularly true in California, home to more than 10 million immigrants and where half of children have at least one immigrant parent. During this past month, The Children’s Partnership proudly joined the #IAmAnImmigrant movement sweeping the nation for Immigrant Heritage Month, reminding us that America’s strength is reflected in our diversity built over generations.

Immigrants are part of the fabric of our society and their well-being is directly linked to our country’s well-being today and in the future. While many policies increasingly reflect that value, others continue to not. We were deeply disappointed by the recent Supreme Court deadlock that effectively blocked the Obama Administration’s executive actions to expand the Deferred Action for Childhood Arrivals (DACA) program to more DREAMers and implement the Deferred Action for Parents of Americans and Legal Permanent Residents (DAPA) program. The impasse continues a broken immigration system that harms the healthy development of immigrant and citizen children alike. In California, thousands were denied the peace of mind such policies offered and the security of health coverage that could have followed.

While we continue to fight for all families that call this country home, in California, we continue our path of immigrant integration by making important strides for the health and well-being of immigrant families. As of May 16, 2016, low-income undocumented children can enroll in full-scope Medi-Cal (California’s Medicaid program), opening the door to free preventive services and other critical services. With access to the care they need to be healthy, children are on a trajectory to be better prepared for school and life. More recently, Governor Jerry Brown signed legislation authorizing the State to request a waiver from the federal government to allow undocumented immigrants to purchase unsubsidized insurance through Covered California, the state’s health insurance marketplace. While the decision will ultimately rest with the federal government, the “Health4All” movement in California continues on to ensure all members of the family have affordable, comprehensive health coverage.

Creating an equitable health care system that works for everyone, no matter where they were born, will require more than just securing coverage. Helping newly insured families navigate a health care system that may be new to them and creating a culturally appropriate system of care that meets the needs of California’s uniquely diverse residents will help ensure the health of not just immigrant families but all families as well. Here are some ways that can be accomplished:

  1. Tailor outreach materials to better meet the needs of California’s diverse families.As we help families understand their coverage and care, we need to make sure they understand the information shared and that resources created and disseminated by the State, health care entities, and community organizations are personalized to different cultures and are in appropriate languages. Time-intensive, tar­geted, culturally competent, innovative outreach strategies have proven effective in enrollment assistance. Similarly, we can apply these strategies to help families understand the health care system and get the care they need. Linguistically and culturally targeted materials can supplement work to reach families through trusted messengers, including schools, small businesses, reli­gious organizations, and other non-health channels.
  2. Create a system of care that works for families’ needs. While the traditional medical office works for many, there are other ways communities can work to better meet the needs of families. Families often face financial, transportation, and language barriers when seeking traditional, office-based care. Local health centers, schools, and community centers may be more appropriate for some. By supporting efforts to bring health care to the community, we can create mechanisms to better deliver health care to all families. For example, school-based health centers have proven successful in providing critical health care services to children and making sure students who are unable to get health care elsewhere can receive it at school.
  3.  Develop a workforce that families trust. In traditional medical settings, it is often a team of providers that offer community members a health home they trust. In addition to the doctor or dentist, there are others on the team that deliver health information and care and serve as trusted sources for such information and care. Given the number of newly insured, we have an opportunity to look at trained members of the community, such as community health workers and promotores, as well as public health nurses, home visitors, and appropriate school personnel that are responsive to families’ unique needs. Not only is it more effective in reaching the millions of newly insured families, but it is also a smart use of the tremendous resources we have to make up our health care workforce. The State should support community-based education, care coordination, and support models, not only because such models im­prove families’ health literacy and overall health outcomes, but also because such an investment is also an investment in preventive care, which leads to both healthier children and adults and is cost effective in the long run.

Good health is critical to a successful future for everyone. When immigrants come to this country, they come with the highest expectations of what America can do for their families and what they, in return, can do for America. For the millions of immigrants in California, the ability to contribute to this nation goes hand in hand with their health status. This Immigrant Heritage Month, we celebrate our diversity and renew our commitment to doing more to support the health and well-being of every member of our immigrant communities, for their sake and our own. 

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