Families of children with special health care needs are painfully acquainted with the too frequent
difficulty of having access to specialty care. In California, approximately one in six children is diagnosed with a special health care need, which can range from conditions such as asthma, diabetes, and birth defects, as well as developmental disabilities such as autism and cerebral palsy, and mental illness. Children with special health care needs (CSHCN) require healthcare and other services that are either more specialized in nature or must be accessed on a more frequent basis than generally required by children. This pronounced lack of access puts CSHCN at increased risk for chronic physical, developmental, behavioral or emotional conditions. Telehealth, the use of technology to provide and coordinate healthcare at a distance, can vastly improve access and care coordination for vulnerable populations, like CSHCN.
Last month, CaliforniaHealthline shared a story about Kimberly Griffiths’ daughter, Avery, who almost lost her life at just one week of age but the availability of telehealth saved her. Avery was taken to an emergency room in rural Sonora, California, and although the nearest ediatric specialist was 100 miles away, her emergency room doctors were able to connect via online video with a neonatologist at UC Davis. The specialist viewed hi-resolution images of the infant and her vital signs and determined that Avery had a congenital heart condition and prescribed medication to stabilize her breathing. “Without telemedicine, our daughter would have died that night,” Avery’s mother said, “Nobody should be denied the health care they need because of where they live.”
Telehealth provides communities with the option to bring care to children when available providers in a given area are in short supply or difficult to access. Telehealth can also be used to help coordinate care for kids who have multiple needs for health care and support services, as is often the case for CSHCN. Families with CSHCN who utilize telehealth services are able to access the care that they may otherwise go without, while also reducing both the need to travel far distances to see healthcare providers, and the need for school and work absences in order to make these appointments.
Earlier this month, California lawmaker Sharon Quirk-Silva (D- Orange County) joined The Children’s Partnership and the Providence Speech and Hearing Center (PSHC) at an August 16th roundtable to discuss the promise of telehealth as a means of increasing access to vital services for families. The event featured a live tele-speech therapy demonstration by a speech pathologist who provides services to patients from her remote site in Mission Viejo, 20 miles from PSHC. After the demonstration, the panel – which included Assemblymember Quirk-Silva, Linda Smith, PSHC CEO, Isabel Becerra, CEO of the Coalition of Orange County Community Health Centers, and Mayra Alvarez, President of The Children’s Partnership – discussed the critical role that telehealth plays in providing services and care to children and families with access challenges and/or special needs across California.
Assemblymember Quirk-Silva mentioned that she and other state lawmakers are working to increase the resources made available to providers. However, such a task has become even more challenging as a result of attempts at the federal level to dismantle the ACA and Medicaid.
The Children’s Partnership remains committed to working with California policymakers, providers, payers, child health advocates, and families to advance telehealth and other promising solutions that will break down access barriers, improve care coordination and move us closer to achieving health equity in California.
NOTE: The event was broadcast via Facebook live, and can be viewed online at https://www.facebook.com/kidspartnership/.
“Break down boxes!” “Open up new solutions!” “Dream big!” These are some of the expressions heard during last month’s Silicon Valley Hack Foster Care Summit. The hackathon introduced youth, caregivers, social workers, child welfare agencies, advocates, service providers, and funders to “design thinking” – an approach to solving business and social problems that starts and ends with the user – in this case, children and youth in foster care. The hackathon also introduced technology specialists to the foster care experience –creating a real opportunity to understand the foster care system and the ways outdated technology burdens the system and those who are part of it. In doing so, we broke down boxes.
Then came the opportunity to “Open up new solutions!” Participants were divided into more than 20 “tracks” to look at complex child welfare issues in new ways in order to develop tangible models and prototypes to improve the lives of children and youth in care. With the “dream big” theme in mind, these “tracks” bore strong results. For example, teams developed designs for digital tools that would improve placement success by leveraging matching algorithms (a’ la eHarmony.com) and bringing children, youth, and prospective families into the placement process to find better compatibility based on strengths and interests. Another track developed a prototype for a communications platform that would connect youth to trusted peers and resources, enabling them to build their own support structure that would promote mental wellness. Other teams came up with innovative ways to: give children and youth secure input to the dependency court judge through pre-taped videos or audio files created on a phone; help foster youth evaluate and find training and employment opportunities with virtual reality and gaming technology; and, simplify the application process for becoming a foster parent through an online portal that tracks the process and provides online support. During team presentations of these models, developers worked with attendees to incorporate their feedback and really put “design thinking” to work.
At the end of the two-day hackathon, participants walked away with a compelling approach to problem-solving and new ideas for tackling the challenges that pervade the foster care experience. Even before the event was over, improvements in the lives of foster youth were identified and moved forward. Among the follow-up commitments were over 1,200 laptops donated to California’s foster youth, to be distributed by iFoster and TeenForce; Santa Clara County committed to piloting the Think of Us platform with its foster youth; and a number of programs and vendors in attendance pledged to use the input from their tracks to enhance the services and tools that they offer. And there’s more coming! In the weeks following the hackathon, further significant commitments and planning have been made. It is clear that cross-sector collaboration brings new resources and opportunities to foster youth and families.
Technology is one vehicle that can empower and engage youth and enhance the support structure that is necessary for them to thrive. However, the real challenge as we develop digital tools and new processes is to “think different”, change the status quo, and transform the foster care experience. Taking this step requires child welfare agencies and service providers to work closely with those with “lived experience”— foster youth and their caregivers. The Children’s Partnership is committed to supporting hackathon partners and we are currently helping plan the next hackathon, taking place in Los Angeles on April 28-29, which will build on the momentum and exciting progress made during previous hackathons, including the most recent event in Silicon Valley.
There’s an app for that! What was once a witty slogan is now truer than ever before. We have endless options for apps that help us organize our lives, keep track of our workouts, and much more. For many of us, technology eases life planning and connects us to the resources we need to make life a little easier. For foster youth and families, technology can play a vital role to better address their care and support needs—and we are heading in the right direction.
In May 2016, the White House hosted the first-ever Foster Care & Technology Hackathon, ushering in a new era for foster care. Organized by the Pritzker Foster Care Initiative, the US Department of Health and Human Services, and Think of Us, the Hackathon was an opportunity to leverage technology to identify ways to improve health, education, and economic outcomes for youth and families in foster care. Hackathons, as a model, welcome ideas and solutions from the technology sector to previously identified challenges in the child welfare system and invite foster youth and families to weigh in on those ideas and solutions. The events bring together a mix of people—from child welfare experts to software developers, technology leaders to foster youth or foster care alumni—with diverse skills and perspectives, who stimulate one another’s creativity, cross-pollinate ideas, and develop concrete prototypes or proposals that address challenges posed to the group. In doing so, a new partnership between technology and child welfare emerges to tackle real life challenges impacting the lives of children and youth in foster care.
The White House event also inspired further hackathons, including one that will take place next week in Silicon Valley (Feb. 27-28). The Silicon Valley Foster Care Summit will put its unique stamp on this opportunity, with the involvement of a broad set of major technology firms and commitments from partners to provide laptops and tech internship opportunities for foster youth in the community. The Summit—organized by the Silicon Valley Children’s Fund, TeenForce, and Think of Us, and sponsored by the Walter S. Johnson Foundation and others—promises to build on the momentum to make lasting change for children and youth in foster care.
The Children’s Partnership is proud to join our partners at the Silicon Valley hackathon and bring our ten years of experience working on health information technology solutions to improve care and services for children and youth in foster care. Thanks to the infusion of energy and new ideas fostered by the hackathons, these efforts are gaining traction in child welfare. California’s hackathons are tackling head on the need to improve access to laptops, smart phones and low-cost broadband access for foster youth and their caregivers, while simultaneously developing apps and systems for their use.
The time is right in California to leverage technology to support the transformation of child welfare services through the Continuum of Care Reform and to enhance the impact of the Child Welfare Services case management system that is being designed and developed right now. In these and other initiatives, digital tools and features can be deployed to improve care coordination, engage foster parents more effectively, and empower foster youth themselves.
Hackathons, like the one taking place next week in Silicon Valley and one being planned for Los Angeles at the end of April, are an important building block in the evolution of child welfare services. However, the work cannot stop after the events and those of us tackling these issues must share resources and lessons learned to ensure the best results. As partners in the fight to support children and youth in foster care, child welfare advocates, community organizations, technology companies, child welfare agencies, and foster youth themselves must continue the collaboration and press forward to realize the value of this opportunity.
There’s a saying in California: As California goes, so goes the nation. When it comes to coverage for children, we sure hope so. In California, almost 97% of children have health coverage – a 55% decline in uninsured children in the last two years. Last week, Georgetown’s Center for Children and Families released its sixth annual report on children’s health coverage and made clear how the Affordable Care Act (ACA) is working for millions of children and families. Nationally, over 95 percent of children are now covered with quality, affordable health coverage! This historic achievement is a testament of what national and state partnerships can achieve to secure health coverage for every child, and California is leading the way.
California has made the most of the ACA to create a system of coverage that works for kids and their families. This system of coverage is made possible through both Covered California, the state’s marketplace, and the expansion of Medi-Cal. Medi-Cal is the cornerstone of the children’s coverage system in California, covering nearly 6 in 10 children in California, according to recent numbers released by the Department of Health Care Services. Beyond Medi-Cal, Covered California has used all of the tools available through the law to create an exchange with robust competition, competitive premiums, and easy-to-compare options. As a result, more California families are shopping for health coverage in a market that helps families understand for what programs they or their children may qualify – private plans or public programs like Medi-Cal – and secures coverage for more eligible children.
Investing in children’s coverage matters. Research shows significant benefits for children but also for the future of all of us in California and across the country. Studies show that children with coverage show up to school ready to learn. Children with Medi-Cal, for instance, are less likely to drop out of high school and more likely to graduate from college. As a result, they grow up to be healthy, productive adults. They end up with more earning potential as adults, making them less reliant on safety net programs and contributing to a strong government return on investment. Medi-Cal is a proven program that makes a difference in the lives of today’s children and invests in tomorrow’s adults.
As we celebrate the progress made to cover more kids, we also recognize there is still more work to do. With 3.3 percent of children in California uninsured, we have the lowest rate of uninsured children California has seen. However, in a state as large as ours, it means hundreds of thousands of children do not have the security that health insurance provides. California’s recent move to extend Medi-Cal coverage to all income-eligible children – no matter where they were born – will help make further progress. Using state-only funds, California gave undocumented children who otherwise would not have access to coverage the opportunity to enroll, and in less than 6 months, over 135,000 children have already enrolled!
The Children’s Partnership is excited to keep up the momentum because one uninsured child is too many. Whether someone is in a health center, a school, faith organization, or library or even at the dinner table, we each have a role to play to help spread the word about how to enroll in coverage. Open enrollment in Covered California and marketplaces across the country started this week and for Medi-Cal, enrollment is available all year long.
When everyone has the security that health insurance provides, our communities are stronger and our future is brighter. In celebrating this historic high of coverage for children, we celebrate the commitment the program has made to care for our fellow Californians, our communities and our families. We stand ready to work with our local, state and national partners to ensure this promise is protected for our children and grandchildren for years to come.
The theme of this year’s National Hispanic Heritage Month is Honoring our Heritage, Building our Future, and it could not be more appropriate. In just 27 days, the American people, including 13.1 million Latinos expected to cast a ballot, will choose the next President of the United States, as well as officeholders at the national, state, and local levels. It is our vote that will decide the elected officials whose policy choices will shape the opportunities available to our children to build their future. As we celebrate Hispanic Heritage Month, let’s celebrate our opportunity to give voice to the needs of millions of Latino children in our country, a growing share of the country’s population and, in particular, a majority of California’s children.
Investing in children today is key to sustaining our national prosperity and making sure every person can achieve the American dream, on their own terms. Studies have found, for instance, that children who were eligible for Medicaid coverage earned more and paid more in taxes as adults than those who were not. Additionally, safety net programs were responsible for cutting the poverty rate for children last year by 10 percent, supporting children’s present needs and future success. Continuing these investments means voting for candidates who support programs that are proven to work in lifting children and families out of poverty and propelling them to opportunity, programs like Medicaid, CHIP, the Earned Income Tax Credit, and many others. In fact, many of these programs enjoy bipartisan support thanks to their record of success and their adherence to basic American principles like equality of opportunity.
The health and well-being of our Latino children is directly linked to our future as a state and as a nation. Nationally, Latino children face greater barriers to health and opportunity. Despite recent gains in health coverage, Latino children continue to represent a disproportionate share of the uninsured. In many states, undocumented children remain ineligible for publicly funded health coverage, like Medicaid coverage or subsidized health plans through the marketplaces. Health coverage is necessary to ensure access to health care and healthy growth and development, and we must elect officials who support covering all children—including the undocumented. We must also invest in robust, culturally and linguistically competent outreach and enrollment efforts to ensure Latino children who are eligible for coverage are able to enroll.
In states, like California, where Medicaid is available to all children, regardless of immigration status, fear prevents many parents from enrolling their children. Despite assurances from the federal government that information collected to enroll in health coverage is used only to determine eligibility, families understandably worry that giving their information to the government may impact their applications for legal status or, even worse, lead to deportation. This election cycle’s heated rhetoric around immigrants and immigration enforcement actions in many communities has only exacerbated these concerns.
What is more, immigration status has impacts on children’s health beyond their ability to access health coverage and care. Children in mixed status families—those in which some members are legally residing while others are undocumented—are regularly faced with the fear that a parent or loved one could be deported, and undocumented children themselves, many unaccompanied minors, worry what will happen to them and the new life they were hoping to build. Toxic stress caused by this constant fear has a dangerous and detrimental impact on these children. Supporting candidates who are committed to comprehensive immigration reform with a path to citizenship is not just a matter of American fairness and inclusion; it is vital to the health of our children and our communities.
Though National Hispanic Heritage Month ends this Saturday, all of us, both Latinos and non-Latinos alike, must keep the needs of our nation’s growing Latino population in mind as we head into the voting booth—for the sake of our family, friends, and communities, and the future of our nation.
In California, the registration deadline for voting in November’s election is October 24. To learn about voting in your state, or to register, visit Nonprofit VOTE.
Yesterday, the California Department of Social Services (CDSS) reported out to stakeholders and the legislature about the progress made on the State’s new child welfare case management system (the “new system”) project. What is notable, from our children’s advocate perspective, is the State’s effort to design this new system in a manner that uses technology to transform care coordination for children and youth in foster care. To make the most of this moment, The Children’s Partnership wants to hear from you.
This major child welfare tech upgrade offers a tremendous opportunity to improve cross-sector communication and team planning to support children and youth in foster care. Unlike the current child welfare IT system, which is available only to child welfare staff, the new system will connect with and across members of the broader care team, like health providers, education rights holders, and foster youth themselves. If done right, the end product will be a system that directly supports those who have the most at stake—children and youth in foster care. To do this, the State has opened a call for stakeholders to submit “user stories” that lay out the data elements the improved system should capture, how it should handle such data, and explanations of why these changes are necessary. These stories will assist the people developing the data system to better meet the needs of the users.
The Children’s Partnership has been working with a broad set of stakeholders to develop extensive recommendations as to how this “connected” system can make a positive difference in the lives of children and youth in foster care. In response to the new opportunity to provide input through user stories, we will be working with stakeholders to translate these recommendations into user stories that can support the State in its design process and ensure it best responds to the needs of children and youth in foster care and their families.
It’s that time of year where families, educators, and school administrators get back to familiar routines. Families are preparing their children for the first day of school with the right tools, like pencils, notebooks, and even health insurance coverage. Yet there is one thing about this school year that is different from years past—for the very first time, many families have access to quality, affordable health coverage for their children. That’s right! All low-income children in California, regardless of their immigration status, can apply for full-scope Medi-Cal and get needed care—giving them one more tool to stay healthy and be better prepared to learn. Those who qualify will get coverage for free or at very low cost, and they can stay covered up to the age of 19, giving them the opportunity to access comprehensive health services at no cost. Learn more about Health4All Kids.
This back-to-school season provides a great opportunity to make sure families enroll their kids in coverage since parents and guardians are most engaged this time of year. With just over 6.2 million students in public schools, educators and leaders will be interacting with many parents and guardians in the coming weeks. Parents will visit new classrooms and introduce themselves to new teachers. When they walk through the door this year, let’s make sure to tell them about Health4All Kids.
With the Health4All Kids expansion of Medi-Cal, up to 225,000 children will be newly eligible for comprehensive health coverage, including access to preventive care and other critical health services. Students will be able to see a doctor regularly, get routine checkups at the dentist, and get the care they need when they start to feel under the weather. Healthy students make better learners and, with this new opportunity for coverage, more students have the chance to lead healthier lives.
Educators know that healthy students make better learners. Help us publicize this new opportunity by distributing health coverage materials from the ALL IN For Health Back to School Toolkit. It includes easy-to-use materials to share with families, as well as tools to help spread the word, like robocall scripts and sample text for parent newsletters. Together, we can make sure ALL KIDS are ALL IN for health coverage!
Despite this June’s disappointing inaction by the Supreme Court on the Obama Administration’s executive actions on immigration, California continues its leadership as a welcoming environment for immigrant families, especially immigrant children. The Supreme Court’s split ruling has no impact on the historic Health4All Kids Medi-Cal expansion that went into effect this May, meaning that all low-income children can apply for Medi-Cal, regardless of where they were born. Californians who qualify for the original Deferred Action for Childhood Arrivals (DACA) program are also still able to enroll in Medi-Cal.
Thus far, there is cause for celebration. Since earlier this summer, over 135,000 immigrant children have enrolled in full-scope, comprehensive Medi-Cal benefits, giving peace of mind to thousands of families that their children are protected.
However, while we have made important progress, there is more work to do. A recent report from the UC Berkeley Labor Center estimates that there are 225,000 undocumented immigrant children eligible for Medi-Cal, meaning 90,000 eligible undocumented children have yet to be enrolled in coverage in addition to the hundreds of thousands of other eligible but unenrolled children. Though we continue to wait on federal action on immigration, our work in California does not. We are proud to join partners from across the state in reaching out and helping every eligible child to enroll in affordable health coverage. Read our recent blog posted on the California Health Care Foundation website, written in partnership with Clinica Romero, to learn more.
We Can’t Let the Supreme Court’s Latest Ruling on Immigration Hurt Medi-Cal Expansion
Mayra E. Alvarez, President, The Children’s Partnership,
Sandra B. Rossato, Executive Director, Clínica Monseñor Oscar A. Romero
The movement to improve the lives of immigrant families hit a roadblock in June when a deadlocked US Supreme Court prevented, for now, expansion of the Deferred Action for Childhood Arrivals (DACA) program and implementation of the new Deferred Action for Parents of Americans and Legal Permanent Residents (DAPA) program. These programs were designed to protect millions of undocumented children and parents across the country from deportation. This disappointing decision leaves families in fear, with uncertain futures, and further from fulfilling the American promise of life, liberty, and the pursuit of happiness.
California continues to pursue state-level efforts to create an inclusive environment for all aspiring Americans. The expansion of full-scope Medi-Cal to all low-income, undocumented children that took effect in May is another example of California’s clear commitment to inclusivity, which is even more important in the face of this ruling and the lack of movement in Congress on immigration reform.
As we seek to ensure every California child has coverage, it is imperative that the high court’s ruling does not adversely impact enrollment made possible by the state’s historic policy. The Medi-Cal expansion has the potential to help more than 185,000 children statewide, yet there remain multiple barriers to enrollment. Now more than ever, undocumented families may fear providing information to government officials and, as a result, refrain from seeking critical health coverage for their children. More information is needed at the community level to assuage families’ fears and drive home the importance of enrolling their kids.
Advocacy organizations like The Children’s Partnership, community health centers like Clínica Monseñor Oscar A. Romero in Los Angeles, the California Department of Health Care Services (DHCS), county eligibility workers, and a variety of state and local partners are working tirelessly to ensure newly eligible children are signed up. In the coming months, it’s essential that that we clearly explain to immigrant families that:
- The Supreme Court ruling has no impact on the Medi-Cal expansion. All income-eligible children, regardless of immigration status, now have access to full-scope Medi-Cal. Health application information is used only to verify eligibility for health programs and not for immigration enforcement.
- The ruling has no impact on people deemed eligible for the original DACA program, which is still accepting applications and renewals. This has important implications for health coverage of undocumented families. All those accepted into the original DACA program are also eligible for Medi-Cal. An estimated 11,000 Californians (PDF) who qualified for the original DACA program are now covered by full-scope Medi-Cal.
The good news is that the Medi-Cal expansion is off to a strong start. DHCS reports that so far more than 125,000 kids have successfully enrolled in full-scope Medi-Cal since the expansion went into effect in May 2016. Community health centers continue to play a vital role in helping children enroll and providing them with the care they need. Clínica Romero has already seen a huge difference, with newly enrolled kids coming in for long-delayed care, including dental, vision, and mental health services.
Much work remains, as thousands of eligible kids are still not enrolled. For organizations on the front lines of outreach and enrollment, tools and resources related to the expansion of Medi-Cal are available at the Health4AllKids website. For example, the California Welfare Directors Association recently released a list of designated county staff (PDF) with whom partners can work to assist immigrants and mixed-status families (those in which some members are legally present and others are undocumented) having trouble with the Medi-Cal application.
The fight also continues to build a more just and inclusive, and therefore healthier, society. An estimated 1.1 million Californians (PDF) could have gained health coverage through Medi-Cal and Covered California with the expanded DACA and DAPA programs. Parents living under the threat of deportation are less likely to get the health services they need and frequently are too scared to enroll their children in vital public programs. Children in constant fear that a parent or loved one will be deported are more likely to suffer depression and anxiety (PDF), which can have a tangible effect on brain development, performance in school, and long-term life outcomes. As advocates and health care providers in the community, we see this reality every day.
California has led the way with policies for expanding Medi-Cal, providing in-state tuition and state educational grants to undocumented students, and allowing undocumented immigrants to apply for driver licenses. Immigrants are part of the fabric of society, and we must keep pushing the envelope. The immigrant community’s health, well-being, and ability to realize its full potential are directly linked to the future success of our state and nation.
Providing a young child with oral health care helps ensure long-term oral health for the future. But today, California’s children are facing an oral health care crisis. In 2013, over half of the children enrolled in Medi-Cal did not receive an oral health visit through the program and, at 57 percent, the numbers were no better for the program’s youngest enrollees, aged zero to three. For pregnant women, one study found that over half of all pregnant women had experienced a dental problem and, of them, six in ten were not receiving oral health care. The need for urgent action to address the interconnected needs of both generations is evident.
As we explore ways to better meet the oral health care needs of children and families, early childhood home visiting programs can be a critical resource in reaching families with information about good oral health practices early in their child’s life. The strategies used by home visiting programs to achieve results—like the frequency and duration of visits to the family, early intervention, anticipatory guidance, and education—can be effective in improving children’s oral health.
There is also a growing recognition that the dentist is not the only provider that can address children’s oral health needs. A team approach is necessary to provide the comprehensive oral health education, preventive services, and care management families need. Home visitors can be an integral part of the team, especially given the severe lack of oral health providers available to treat children and the systemic barriers that pregnant women and young children face in getting care.
Therefore, it only makes sense to build a stronger connection between home visiting and oral health in a way that maintains the fidelity to the home visiting model and does not overburden home visitors with onerous requirements.
Our recommendations for next steps:
- Provide home visitors with the training and resources they need to incorporate oral health practices into their activities.
- Collect oral health data from home visiting programs so that we can better understand the impact of home visiting on the oral health of children and families, and develop the evidence base for funding to include oral health practices in home visiting programs.
- Create stable funding streams to support home visiting overall so that it is a viable avenue to bring preventive services to children and families, including preventive oral health services.
These next steps create an opportunity to give home visitors the tools they need to better serve the oral health needs of children and families. They also give advocates the opportunity to increase awareness in both the home visiting and oral health communities on the importance of this strategic connection. Together, we can create a system of oral health care in which early childhood home visitors are a key part.
You can read more details about each of our recommendations in “Healthy Mouth, Healthy Start: Improving Oral Health for Young Children and Families Through Early Childhood Home Visiting.”
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:
- 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.
- 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.
- 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.