Fresno residents demonstrate their support for a county health program that covers care for undocumented immigrants (Courtesy: Fresno Building Healthy Communities)
Fresno residents demonstrate their support for a county health program that covers care for undocumented immigrants (Courtesy: Fresno Building Healthy Communities)

Update: Fresno County’s Board of Supervisors voted 4-1 to end the contract providing care to the poor and to undocumented immigrants. 

Original Post:

Brandon Hauk’s job is about to get a lot harder. The health of about 7,000 patients he helps at Clinica Sierra Vista in Fresno is in the hands of the county board of supervisors – they are set to vote Tuesday whether or not to shut down a program that covers specialty care for the undocumented.

Hauk doesn’t want to think about how he’s going to explain that to people when their primary care doctor says they need to see a cardiologist, pulmonologist, or endocrinologist.

“What do you say to somebody that has chronic illness and we can’t refer them out? Sorry?” says Hauk. “I mean, how can you tell someone that has abdominal bleeds, I’m sorry, but we can’t help you.”

Fresno’s Medically Indigent Services Program was set up decades ago to provide health coverage for the poor, and later, the undocumented. But now that the Affordable Care Act has gone into effect, the county says it doesn’t need the program anymore. Now tens of thousands of uninsured Fresnans have health coverage through Obamacare. More than that, the county says it can’t afford to keep the program going.

“With the reduction in the number of individuals who need to seek services in the Medically Indigent Services Program, there’s also a reduction in funding used to support that program,” says David Pomaville, director of Fresno county’s department of public health.

Closing or restricting the program could leave 6,000 undocumented Fresnans without care. The Affordable Care Act does not cover the undocumented. And, after a recent court battle, the county no longer has a legal obligation to cover them.

Pomaville says it would cost the county up to $21 million to continue coverage for the undocumented, but the county is short about $10 million. He says his department has already trimmed everywhere else possible.

“It is a balancing act,” he says. “The communicable disease investigators that are out investigating cases and trying to identify sources, we are stretched. The public health laboratory that we operate here; the sexually transmitted disease programs are really stretched as far as we can stretch them.”

Most counties in California do not provide health care services to the undocumented. Only about half a dozen do, mainly in urban areas like the Bay Area and Los Angeles. When the recession hit in 2008, Sacramento and Yolo counties dropped their coverage for the undocumented, and Contra Costa discontinued it for undocumented adults.

“In Fresno county, we’ve been able to hold on and deliver those services for longer than most counties have been able to,” Pomaville says.

But health care advocates say Fresno isn’t like most other counties. The economy depends on undocumented farm workers. Advocates say canceling the program ignores the contributions farm workers have made to the community.

“The question has become, does Fresno County value their farm workers?” says Sandra Celedon-Castro, manager of the advocacy group Fresno Building Healthy Communities. “Disease does not know immigration status. We’re going to be left with a population of folks in our community that are really sick, that are left to fend for themselves. What kind of community are we if we’re okay with that happening?”

The group organized a “Health4All” event earlier this month, where two hundred people gathered to protest the closure of the health program to undocumented immigrants.

“It would be really, really bad news,” says Grisanti Valencia. Her mother, who is undocumented, has terrible pain and numbness in her leg from a series of work injuries. Her neighbor is recovering from leukemia. “My mother, she’s already scared. She knows a lot of people, and those people are scared.”

Undocumented people can still get some care at Fresno’s community clinics, or the Emergency Room. But it’s the specialty care that gets lost if this program shuts down. That means no neurological consults, no cancer treatment.

“To me, it’s committing murder – getting rid of this program,” Valencia says. “Because you’re just letting these people die.”

The final decision rests with the county’s five supervisors. Most of them do not see it as the county’s responsibility to pay for care for the undocumented.

“If we are having a difficult time providing social services and a safety net for individuals that are documented American citizens, what allows individuals who are here illegally to derive and obtain that benefit?” says Andreas Borgeas, chairman of the board.

He asks why Fresno should do what Congress refused to.

“The onus seems to be on the county to provide undocumented coverage when the Affordable Care Act does not. It specifically does not,” he says.

He acknowledged that health care for farm workers is a good idea, in theory. It makes economic sense for Fresno. But farmers and lawmakers at every level point at each other when it comes down to who should pay for it.

Borgeas says community clinics that receive federal funding, like Clinica Sierra Vista, should be the ones to pick up the slack.

“I would be willing to explore that,” says Schilling, Sierra’s CEO. “It’s an issue of who would work for the kind of compensation I can offer?”

Fresno, like many other rural counties, has a shortage of specialist doctors in the area. Getting them to work for the reimbursement rates provided by state and federal programs is an even bigger challenge, Schilling says.

“If $125 or $150 buys a surgical consult, or a neurological consult, I’m game. Come on over,” he says. “The problem is, no one’s going to come work for me for that kind of money. They want substantially more than that.”

Fresno Considers Ending Health Services for the Undocumented 20 August,2014April Dembosky

  • elldogg

    Get the money from Mexico, or the countries that are sending their poor here that depend on Citizen’s taxpayer dollars.

  • jurgispilis

    I’m surprised the undocumented are able to get health coverage. What insurance company would take the risk?

  • Lizeth Lopez, CSV

    Fresno County should care for all residents. If we exclude anyone from health care we are endangering all of Fresno as a whole. Disease is not only present in the lives of documented people! Disease does not know status. These hard working people have been here for years and years, and they are not going anywhere. For all their hard work the least Fresno County could do is providing specialty care. Clinica Sierra Vista has been providing Primary and Ambulatory Care to this community for 43 years, and it will continue to do so. The shortcoming is the specialty care. Access to health care is a HUMAN RIGHT!!

  • Maria Santillan

    Californians pay more than $2.6 billion
    annually in taxes. They contribute to our economy in various ways. When they buy cars, clothes, food etc. No one tells them they shouldn’t pay taxes because of their status. When they work they contribute into unemployment fund EDD and workers compensation, however they are never allowed to access these services. That’s why is so critical to have a safety net for these individuals. Regardless of the fact that they are contributing into their employers workers compensation, if they get hurt on the job they do not receive any type of support. If anything their work related injuries now become a financial burden for them on top of being hurt. We need to remember that if everyone in our community isn’t healthy our community isn’t healthy.

  • Alejandra Tovar

    Fresno County should care for all fresnans, we need to come together to fight for the families, neighbors and friends who will suffer for not having access to medical care. We all know that the farm workers are the backbone of the Central Valley economy, they are productive people, they deserve to have better health. And if anyone thinks that I won’t be impacted, think again, because without agriculture Fresno County would crumble. The agricultural economy plays such a strong role in overall economic health of our community. Cutting the MISP directly threatens the physical health of thousands of residents. Cutting the program indirectly threatens the health of ALL of us, the whole County. Cutting the program could impact our economic health. We need to make sure that the Fresno County residents have access to health. HEALTH IS A HUMAN RIGHT!

  • Steven Barcelos

    Not only is cutting the MISP an incredible violation of basic human rights, it sends a message to the undocumented folks who work so hard for so little: your lives don’t matter. That is not the kind of message we should be sending to members of the community who contribute so much to our community (and economy).

  • jskdn

    Illegal immigrants can go to a Federally Qualified Health Clinic like Clinica Sierra Vista and be treated at a sliding scale cost. Such clinics receive grants and enhanced reimbursement in federal programs to offset the costs of reduced or free care they give. Illegal immigrants are also eligible for emergency Medi-Cal.

  • Oday Guerrero

    I know from FIRSTHAND EXPERIENCE what it’s like to not have health care and be undocumented. Recently I was able to obtain a DACA work permit so now I am able to work and have health coverage that way, but thousands of undocumented people like my mom living in Fresno County are still barred from access to Medi-Cal and other forms of health services, which leave MISP as their only option to paying for specialty care. We need to stop evaluating human lives based on birthplace and value ALL humans because we all breathe and get sick as much as anyone else. Borders aren’t going to stop people from seeking better and healthier lives here, because we all deserve to SURVIVE!

  • Advisor_37years

    No county or even state government should pay for the health, education or general welfare needs of an illegal alien. If we as a country decided that the benefits of mass immigration outweigh the costs, then the entire country should pay the costs associated with illegals. Those costs and benefits must be analyzed in hard numbers and then we vote. Citizens of other countries have absolutely no right to demand that American citizens pay for their health, education and welfare. I would argue that we don’t have the resources to pay for huge numbers of illegals. Forty cents of every dollar spent by the US is borrowed. I feel sorry for the person in poor health who needs care, but medical care, beyond basic lifesaving, is not a right.

  • Pingback: Fresno Considers Ending Health Services for Illegals | News()


April Dembosky

April Dembosky is the health reporter for The California Report and KQED News. She covers health policy and public health, and has reported extensively on the economics of health care, the roll-out of the Affordable Care Act in California, mental health and end-of-life issues.

Her work is regularly rebroadcast on NPR and has been recognized with awards from the Society for Professional Journalists (for sports reporting), and the Association of Health Care Journalists (for a story about pediatric hospice). Her hour-long radio documentary about home funerals won the Best New Artist award from the Third Coast International Audio Festival in 2009.

April occasionally moonlights on the arts beat, covering music and dance. Her story about the first symphony orchestra at Burning Man won the award for Best Use of Sound from the Public Radio News Directors Inc.

Before joining KQED in 2013, April covered technology and Silicon Valley for The Financial Times, and freelanced for Marketplace and The New York Times. She is a graduate of the University of California at Berkeley Graduate School of Journalism and Smith College.

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