Many of our low-income community members have healthcare coverage through the State’s Medi-Cal program, but how can we help them use these benefits to get the care they need? Often times our families tell us they need help getting dental care or seeing a mental health professional. Other times our families tell us they have had a horrible experience and don’t want to return to the doctor. How do we respond to these experiences? Healthcare coverage can be difficult to manage for anyone. Among our low-income California residents it’s even more difficult to manage as Medi-Cal coverage can be different for each household member. In this workshop we will be discussing healthcare coverage eligibility for all members of the family that may include immigrant household members. We will be reviewing the benefits available to adults, children, and undocumented family members and the rights people have to request timely, accessible, and quality care. Our session will provide guidance to SBHC staff who work with community members with multiple healthcare needs. The goal is to help attendees identify what types of concerns families are having and how to appropriately guide and refer them to the healthcare resources they need. In addition, during this session participants will explore existing laws, such as The California Values Act (SB 54) and Safe Schools for Immigrant Students (AB 699) that have the potential to safeguard children and their parents from immigration enforcement. Participants will also get to hear about and engage in a conversation about public charge and the potential changes that can affect immigrant families and access to key services such as health care. Lastly, through the findings of a recent report called Healthy Mind, Healthy Future the group will discuss how immigration related policy changes impact the mental health of children in immigrant families and highlight the important role that schools have on ensuring children can overcome barriers and secure the support they need to thrive.

1. “I Have a Question”:
Introduction to Health Care Access
for Immigrant Families
Mayra E Alvarez Susan Flores Marianna Yamamoto
2019 California School Based Health Conference
May 9, 2019

2. AGENDA
● California’s Children
● Policy Changes Impacting California Immigrant Families and their Children
● Health Benefits 101
● Importance of Language Access
● Beyond Clinic Walls – How Immigrant Families are Faring Today
● Moving Forward: Policy & Programmatic Recommendations
● Q&A

3. California’s Children

4. Who are we?
The Children’s Partnership (TCP)
is a children’s policy and advocacy
organization committed to
improving the lives of underserved
children where they live, learn, and
play. We identify breakthrough
solutions at the intersection of
research, policy, and community
engagement.

5. California’s Children
Source: Kidsdata.org (Lucile Packard Foundation for
Children's Health)

6. Children in Immigrant Families

7. Policy Changes Affecting
Immigrant Families and their
Children

8. Federal Actions: Impact on Immigrant Families
▪ Multiple Anti-Immigration Executive
Orders
▪ Rescission of the Deferred Action for
Childhood Arrivals (DACA) Program &
Temporary Protected Status (TPS)
▪ Shift in enforcement priorities
▪ Pending changes to “Public Charge”

9. Public Charge: Background
● What is public charge?
○ Public charge is a term used by U.S.
immigration officials to refer to a person
who is considered likely to become
primarily dependent on the government
for subsistence.
○ An immigrant who is found to become a
“public charge” may be denied admission
to the U.S. or lawful permanent
residency.
Source: National Immigration Law Center

10. Pending Federal Actions: Changes to “Public
Charge”
▪ New benefits under consideration for implicating
public charge include:
▪ Medicaid
▪ SNAP (CalFresh)
▪ Housing assistance (Section 8 & affordable housing)
▪ Medicare – Low Income Subsidy
Released in October 2018, the draft proposed rule would authorize
agents to consider additional benefits used by the immigrant, or a
dependent family member, including a citizen.
Source: National Immigration Law Center

11. State Response: California
▪ Attorney General Xavier Becerra Lawsuits
▪ State Legislation
▪ 2017: SB 54 (De Leon): California Values Act
▪ 2017: AB 699 (O’Donnell): Educational equity: immigration
▪ 2019: Mental Health dollars for Immigrant and Refugee communities
▪ 2019 State Budget
▪ Maintains coverage for Health4All Kids - 218,571 undocumented
children enrolled
▪ Expansion to undocumented young adults

12. Immigration Enforcement Harms Children
▪ Family separation
▪ Harms children’s mental and physical
health
▪ Undermines family economic security
▪ Climate of fear further restricts
children’s access to education, public
benefits, and other services

13. Discussion:
What are you hearing and seeing
on your school sites and in your
communities?

14. Health Benefits 101

15. Medi-Cal
Benefits and
Access 101
Susan Flores, Maternal and Child Health Access
Marianna Yamamoto, Asian Americans Advancing Justice-
LA

16. Our Organization
Maternal and Child Health Access
(MCHA) improves the health of low-
income women and families through
advocacy, education, training and
direct services, policy and
administrative reform. Our focus
specifically is on access to health
coverage and care as well as
protecting and enhancing the health
and wellbeing of mothers and their
families.

17. Presentation Agenda
1. Defining Medi-Cal
2. Medi-Cal Eligibility
3. Covered Benefits under Medi-Cal
4. Health Care Rights
5. Where to go for Help
6. Presenter Contact Information
7. Q&A

18. What is Medi-Cal?
Medi-Cal is a program that offers free or low-cost health coverage for children and
adults with limited income and resources. If you qualify, you can enroll in Medi-Cal
year-round.

20. Who is eligible for Medi-Cal?
Medi-Cal covers low-income adults, families with children, seniors, persons with
disabilities, pregnant women, children in foster care and former foster youth up to
age 26.
What about undocumented
people?
ALL undocumented children in CA
under age 19, who meet all other
eligibility requirements, have access
to full-scope coverage
Undocumented adults will either have
Restricted (sometimes known as
Emergency) Medi-Cal or full-scope
depending on whether they’re
adjusting their status

23. What if I’m not eligible for Medi-Cal?
My Health LA (MHLA) is
an option for
undocumented
immigrants a
O
R
If you’re over-income for Medi-Cal AND
meet immigration requirements, you
can buy a subsidized plan from
Covered CA

24. Kahoot Time!
https://create.kahoot.it/share/med
i-cal-eligibility/70bb2da1-4493-
4da8-9855-dd668356ec1f

25. What does Medi-Cal Cover?

26. Medi-Cal
Covers
More!
Medi-Cal now covers
Non-Medical
Transportation!

27. Medi-Cal’s Transportation Benefit
There are three kinds of transportation offered by Medi-Cal: Emergency Medical
Transportation, Non-Emergency Medical Transportation (NEMT) and Non-Medical
Transportation (NMT)
Non-Emergency Medical
Transportation
Non-Medical Transportation
● Non-emergency MEDICAL
transport (NEMT) includes the
transportation of sick, injured,
convalescent, infirm or otherwise
incapacitated beneficiaries by
ambulance, litter vans, or
wheelchair vans.
● The beneficiary requires door to
door service. Requires a
prescription from medical provider.
● Visits to the doctor,
dentist, pharmacy, and
other Medi-Cal covered
services where the
beneficiary is able to
travel in a standard
vehicle and does not
need assistance getting
to and from the car.
● Does NOT require a
prescription!
Emergency Medical
Transportation
Transportation for an
emergency that requires an
ambulance or an air-lift.

28. Dental Benefits in Medi-Cal
Fee-for-Service Dental Benefits
Dental Managed Care Plans

29. Dental Care with Medi-Cal
Adult benefits are back!
This includes women who have
Emergency/Restricted Medi-Cal. If you have issues,
please call our office or the Health Consumer Alliance
Sometimes these new benefits have the
hardest time being approved due to the
process of receiving authorization.

30. Dental Care Continued
This is what’s called a “soft cap”. If
you’re in the middle of a treatment
plan when you reach the limit, you
can still get the treatment you need.
Many beneficiaries do not receive a
“Notice of Denti-Cal Action” so often
times they are unaware over what
treatment has been approved or
denied.

31. Your Health Care Rights (Dental)
What can I do if I don’t get the care or treatment I need?
You can also file complaints with
the CA Dental Board!

32. Your Health Care Rights (Medical)

33. Where Can I Go to for Help?
If you’re in LA county and have
undocumented clients or
pregnant women that need help,
call MCHA
Phone number: 213-749-4261
If you’re in ANY county in
California, call the Health
Consumer Alliance
Phone number: 888-804-3536

34. Language Access

35. Health Access Project
Asian American, Native Hawaiian, and Pacific Islander communities have rich and diverse cultures,
languages, and health needs that are often invisible to our health system.
The Health Access Project mobilizes our communities to advocate for their rights, lift their voices, and
share their stories to build a more equitable and inclusive health system where all communities can thrive
and live healthy lives.
www.advancingjustice-la.org/health-justice

36. Overview
● Introduction to language access
● Why language access
● Supporting patients and families
● Working with interpreters
● Examples
● Resources

37. What is language access?
Increasing access to services for individuals with limited English proficiency (LEP).
Individuals with LEP are those who do not speak English as their primary
language and who have a limited ability to read, write, speak, or understand
English
In California:
● Over 200 languages are spoken
● 16 million (44%) Californians speak a language other than English
● Over 6 million (almost 42%) Californians reported speaking English “less than
very well”
○ 1.7 million (48.5%) of Asian and Pacific Islander language speakers
○ 4.3 million (41.3%) of Spanish speakers
U.S. Census Bureau, 2013-2017 American Community Survey 5-Year Estimates

38. Language
translation
Communicating written word
from one language to another in a
culturally and linguistically
appropriate manner
Language
interpretation
Communicating spoken word
from one language to another in a
culturally and linguistically
appropriate manner

39. In a clinical setting, where might someone need
language assistance?
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https://assets.babycenter.com/ims/2015/03/490923893_4x3.jpg; http://healthcentral.nz/wp-content/uploads/2018/05/paperwork1.jpg

40. Why is language access important?
Language access is critical to be able to effectively facilitate communication
between the health system and individuals with LEP. As a result, we will:
● Improve health outcomes
● Reduce health disparities
● Clearly communicate treatment plans and enhance patient adherence
● Obtain informed consent
● Avoid medical errors
● Ensure quality of care
● Supports the patient-provider relationship and builds trust

41. Federal and State civil rights law,
prohibits discrimination on the basis
of race, color, national origin, sex, age
or disability in certain health programs
or activities.

42. Language access
service
requirements
Must be accurate, timely, free of
charge, and protect the privacy and
independence of the individual with
LEP
In accordance with Section 1557 of
the Patient Protection and
Affordable Care Act, entities MUST:
● Offer a qualified interpreter for
oral interpretation
● Use a qualified translator for
written content

43. Working with interpreters
1. Interpreters should be certified professionals
a. Family members or friends should not be expected to interpret
b. Interpreters can be in-person, telefonic, or video medical
interpreting
2. Pre-session with the provider and the patient
a. Clarify interpreter role
b. Note any cultural, religious, and/or gender norms
3. The patient and the provider should talk to each other
4. Reinforce patient confidentiality and patient privacy
5. Be patient. It takes additional time to use an interpreter
TIP:
Note the patient’s
primary language
and whether they will
need an interpreter
in their medical
record.

44. A patient wants to bring their own interpreter
You are working with a patient who speaks
Mandarin. The patient wants to bring their
family member to interpret on their behalf
and does not want to use the provider’s
interpreter service.
What do you do?

45. Family members or friends as interpreters
Using family members or friends is not encouraged.
● Remind the family that the patient privacy and confidentiality is kept with an
interpreter
● If the individual declines an interpreter, you could:
○ Request an interpreter for the provider
○ Have a pre-session with the family member or friend who will be interpreting

46. Example Appointment Pre-Session
● Explain to the family member/friend to interpret exactly what you say and not omit or
add anything
● Give permission for family member/friend to ask questions
○ “I’ll be happy to clarify anything you do not understand”
● Situate the family member/friend next to and slightly behind the patient
● Speak directly to the patient with LEP
○ Do not use “please tell him/her/them”
● Pause frequently after 1 - 2 sentences
● Try to avoid medical jargon. Keep it simple!
● Thank them for their help

47. Going to the dentist
You are referring a monolingual Spanish-
speaking patient to a dentist who accepts
Medi-Cal for an exam and a cleaning.
When you call the dentist to make an
appointment, the receptionist tells you,
“Sorry, we don’t have someone who speaks
Spanish here. The patient will need to bring
someone with them.”
What do you do?
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fotolia_114515402_subscription_monthly_m.jpg?w=960&h=540&fit=crop&crop=faces&auto=format&q=70

48. Where to call for interpretation services through
Medi-Cal Dental:
● Provider Hotline 1-800-423-0507
● Members TSC 1-800-322-6384
TTY: 1-800-735-2922
Written guidance from the Medi-Cal Dental
Program regarding language access:
● Provider handbook page 4-8
● Provider Bulletin Volume 35, Number 12
● Member Bulletin Volume 2, Number 3
Medi-Cal Dental Resources

49. Resources
Dept of Health Care Services Office of Civil Rights:
Individual managed care plans have language
assistance services for their providers and members.

50. What if language needs are not met?
Tell someone
● Reach out to us!
● File a complaint with your managed care plan
● File a complaint with the DHCS Office of Civil
Rights
○ 1-916-440-7370, 711
● File of complaint with the U.S. Department of
Health and Human Services, Office of Civil
Rights
○ 1-800-421-3481; TTY: 1-800-877-8339

51. Reference: Important language access policies
Federal laws and protections
● Title VI of the Civil Rights Act of 1964
● Section 1557 of the Patient Protection and Affordable Care Act
● Office of Minority Health CLAS standards
California state laws and protections
● Dymally-Alatorre Bilingual Services Act of 1973
● CA Government code §§ 11135-11139
● Kopp Act of 1983
● Senate Bill 853 Health Care Language Assistance Act

52. Beyond Clinic Walls: Impacts of
Today’s Climate on Student and
Family Wellbeing

53. Healthy Mind, Healthy Future
● Fall 2017 : Provider Survey
● Fall 2017: Parent and Youth Focus
Groups
● Fall/Spring 2018: Family Survey
● Winter/Spring 2018: Key Informant
Interviews
● Report Released: September 2018
● March 2019: Community Symposium
– Bay Area
● Ongoing: Policy and Action Agenda

54. 2017 California Provider Survey
“I am seeing an increase in depressive, anxious, and somatic
symptoms, as well as recurrent trauma symptoms from the
past. People are extremely scared.”
Health Provider, California

55. 2017 California Provider Survey
“In meeting with key staff of elementary, middle, and high schools, there are
consistent concerns that immigrant parents are too scared to attend school
events, resource fairs, and obtain services due to the fear of immigration
taking them away from their family. Our families report concerns and fears
about going grocery shopping, walking their kids to school, and seeking
mental health/dental/vision services using Medi-Cal, as they think it might
lead to an INS raid.” Health Provider, California

56. 2017 California Provider Survey
“I’ve seen an increase in somatic complaints as well as disruptive
behaviors at home/school, nightmares, and social withdrawal.”
Health Provider, California

57. 2018 Family Focus Groups – Snapshot
“As a mother, I am worried. It keeps
me up at night. Because of the
president, Mr. Donald Trump, the
kids are learning how to hate.”
-Latino immigrant parent, Riverside “I am scared that someone wants to remove me
from my house... I may be at a store with my
children and they arrest me, that is something
that worries me.”
-Latino immigrant parent, Fresno
“I mean right now I feel like I live in
Third World country. You know like in
a camp sometimes the guard comes
and catches people and sends them
back.”
-API immigrant parent, Fresno
“It’s like hanging from a string that can be cut at
any time.” - Latino young male (16-21), Riverside

58. Parents’ Goals for their Children (N=495)

59. Biggest Obstacles to Parents’ Children Meeting
Their Personal Goals (N=495)

60. Feelings and Emotions Experienced Among Immigrant
Parents’ Children since the 2016 Presidential Election
(N=495)

61. Reaching Out to Others to Talk about
Experiences (N=495)

62. Places Where Immigrant Parents Generally Feel
Safe from Immigration Enforcement (N=495)

63. Discussion:
What are you hearing and seeing
on your school sites and in your
communities?

64. Key Policy and Programmatic Recommendations
1. Strengthen Community Safety to Ensure Children, Youth, and Families
Feel Secure and Supported in their Communities
2. Invest in Community-Based Approaches and a Community-Based
Workforce to Support Immigrant Families
3. Improve Access, Coordination, and Integration of Services to
Reduce Barriers for Immigrant Families
4. Build Capacity of Providers, Educators, and Others Who Interact with
Immigrant Families
5. Educate and Engage Communities about Immigrant Rights and Build
Public Will to Take Action

65. Supporting Children’s Wellbeing
Racial
Trauma
Family
Conflict
Poverty
Trauma
History
Community
Support
Supportive
Relationships
Safe
Environments
Competence
Enhancing
Activities
Source: Ghosh Ippen, 2011

66. 1. Strengthen Community Safety
▪ Support codification and expansion of the
current national sensitive locations policy
particularly at or near places that are critical to
children’s health and wellbeing.
▪ State agencies should ensure information will
not be shared with federal immigration
officials.
▪ Full implementation of California laws,
including SB 54 and AB 699.

67. ALL IN for Safe Schools for All Families
▪ Coalition to support AB 699 implementation
▪ Development of Materials
▪ Know Your Education Rights Card
▪ Customizable Fact Sheets
▪ Branding Material (i.e. posters)
▪ Curriculum and training for educators and students
▪ Distribution of model policies

68. ALL IN – Curriculum and Training
▪ Guide for Safe and Welcoming Schools for
Immigrant and Refugee Students in California
▪ Grade-Span Lesson Modules &"Trainer of Trainers"
Workshop Manual
▪ 3 different Classroom Lesson Modules: Grades
K-2, Grades 3-5, and Grades 6-12
▪ A Teacher’s Guide to Support Immigrant and
Refugee Students’ Socio-Emotional Experiences

69. 2. Invest in Community-Based Approaches
▪ Train existing health navigators, enrollers,
and community health workers, and expand
the workforce to educate immigrant families
about their rights and advocate for policy
changes.
▪ Expand community engagement and
partnership programs to reach and empower
local residents in innovative ways and support
model practices.
▪ Invest in the identification, strengthening and
replication of leadership networks that
empower residents to educate their
communities.
Photo by Heidi de Marco/KHN

70. 3. Improve Access, Coordination, and Integration
of Services
▪ Stop efforts to discourage immigrant families and children from
accessing nutrition, health and other programs and services.
▪ Grant all adults low income adults, regardless of immigration status,
access to health care services.
▪ Provide better tools and interventions to help make referrals to social,
mental health, or legal services.
▪ Develop a system across the state that identifies mental health care
that is culturally competent and contextually aware of their unique
needs to support referrals.

71. 4. Build Capacity of Providers, Educators and
Others Who Interact with Immigrant Families
▪ Strengthen and train staff on protocols to minimize harm to children if they
are present during immigration enforcement actions.
▪ Include trauma-informed care training as part of Continuing Medical
Education, medical school curriculum, teacher and school administrator
training, and licenses for social workers and other mental health
professionals.
▪ Adopt a statewide trauma informed care strategy that is adapted to
include the unique needs of immigrant families.

72. 5. Educate and Engage Communities about
Immigrant Rights and Build Public Will to Take
Action
▪ Share accurate, up-to-date information related to the
immigrant community and recognize immigrant
contributions.
▪ Highlight the value of immigrants and immigrants’
rights in media.
▪ Include Know Your Rights programming on
mainstream and ethnic media.
▪ Individual civic engagement at the neighborhood level.

73. Let’s Talk!
What are some resources and tools that you
feel you need to do this work?
How can we support you?

74. Moving Forward: Partner Resources
▪ Protecting Immigrant Families Campaign
▪ National Co-chairs: NILC and CLASP
▪ State level effort: CIPC
▪ Includes state-based immigrants’ rights orgs, health, consumer,
and anti-hunger orgs
▪ Focus on defending and protecting access to health care, nutrition
assistance, and other supports
▪ Resources
▪ In development: Family friendly fact sheet (visual); Public Charge
video
▪ Upcoming: Community Convenings on Public Charge

75. Want to Reach our Presenters?
Marianna Yamamoto
Phone: 213-977-7500
Email: myamamoto@
advancingjustice-la.org
Susan Flores
Phone: 213-749-4261
Email:
susanf@mchaccess.or
g
Mayra E Alvarez
Phone: 202-701-3662
Email: malvarez@
childrenspartnership.org