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Home My WebLink AboutMINUTES - 05051998 - C69 Q,.(V FHS #3 TO: BOARD OF SUPERVISORS ;r_ "--'"/ ,• CONTRA COSTA FROM: FAMILY& HUMAN SERVICES COMMITTEE COUNT*' a DATE: May 6, 1998 SUBJECT: Health Impacts of Restricted MediCal and Food Stamp Benefits to Immigrants SPECIFIC REQUEST(S)OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION R,EC. OMME ATIONtSt: 1. ACCEPT the attached report from the Health Services Director on the status of Medical benefits for undocumented prenatal care and the potential health impact of decreased availability of food stamps for-legal immigrants. 2. ACKNOWLEDGE that the discontinuance of MediCal benefits for undocumented prenatal care has been held in abeyance by various court rulings and that, at this time, no court date has been set which would result in a determination of whether or not undocumented prenatal care is a MediCal benefit. 3. REQUEST the Health Services Department to schedule a report on MediCal benefitsfor undocumented prenatal care before the Family and Human Services Committee following a court decision on this issue. CONTINUED ON ATTACHMENT: .X_YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE —APPROVE —OTHER SI ........... ...........I.................................................................I.......... ............................................................. ........... FHS #31 BACKGROUND/REASON(S) FOR RECOMMENDATION(S): On April 27, 1998, Dr. William Walker, Health Services Director, and Julie Kelley, Assistant for Program and Policy, met with the Family and Human Services Committee to discuss the status of MediCal benefits for undocumented prenatal care and the health impact of decreasing food stamps to legal immigrants. Dr. Walker noted that MediCal currently provides for payment of prenatal care and delivery services for undocumented women. The state has taken the position that such benefits are not consistent with federal welfare reform. However, discontinuance has been restricted by various court appeals. At this time, the issue is still under appeal with no court date pending. Consequently, the restricted MediCal benefits are still available for undocumented prenatal care. The department also has a plan to provide affordable prenatal care for undocumented women if the court does eliminate the MediCal benefits. In response to a question by Supervisor Gerber, Dr. Walker noted that some confusion regarding MediCal benefits and whether or not it was "safe" to sign up for services resulted in a reduction of prenatal visits over the past few months. It was Dr. Walker's impression that Health Services Department outreach has assisted in a resurgence of prenatal visits. With regard to food stamps, Dr. Walker noted that reduction of food stamp benefits for adults in a family results in fewer resources to feed the entire household, including the children. The best that the department can do is to ensure that people are linked to food banks and other auxiliary food services. Supervisor Gerber noted that the policy of reductions in food stamps and prenatal care was fiscally irresponsible since both could lead to higher demands on the system for more expensive health care services. The committee requested Dr. Walker to return with a report once a court decision is made on the prenatal care issue. 2 ......................... Contra Costa County The Baud of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR J/�i,m� Rop�rtryy,y�,l�o,,t,��D,is�yt�riqct�y� 1IYlillam I?I.IAt�tlk�aty I��I.D. Say%8.iFH1►�lm.2nSi ilfYt�C.t V*nna Godes,3rd DWrictDirector&Health Officer Alwk Desauinior.4th District _ J ' 20 Allen Street do h C:malamlife.tlih District 3, ;� Martinez,Cailfomia 94553-3191 Courity Adtinist Mor (510)370-5003 FAX(510)370-5099 Phi Bstehelor County Adit0rf1 tMW DATE: April 22, 1998 TO: FAMILY AND HUMAN SERVICES COMMITTEE Mark DeSaulnier, Supervisor District III Donna Gerber, Supervisor District IV FROM: William Walker,MD , Director,Health Services Department by Julie Kelley,MSW MPH Assistant for Program and Policy SUBJECT: SERVICES TO EMMIGRANTS--IMPACT ON COUNTY SERVICES The following is in response to requests for information from the Family and Human Services Committee from November 17, 1997.The first is to determine the number of women who are at risk of losing their Medi-Cal coverage and the approximate cost of continuing these services.The second request asks HSD to determine, to the extent possible the overall long term. impact on County services,i.e.'mental health,law enforcement and hospital,of having children who are malnourished because their food stamp allocation has been terminated or reduced because adult legal immigrants between the ages of 18 and 65 are no longer eligible for these benefits. MEDT-CAL BENEFITS FOR UNDOCUMENTED PRENATAL CARE Currently, restricted Medi-Gal provides payment for prenatal care and delivery services for undocumented women. There have been many threats to the continuation of this care as a state benefit as it does not adhere to the state interpretation of the federal welfare reform legislation. Numerous court cases have questioned the discontinuation of these benefits.Since early in 1997,we have anticipated the discontinuation of benefits in the aftermath of several court rulings.However, these rulings continue to be successfully appealed.At this time,we do not anticipate any changes in benefits to undocumented women. There is no way to give an exact number of undocumented women currently receiving prenatal care services in the geographic County.HSD is not the only provider of restricted Medi-Cal for prenatal care.However,we can safely say that we provide the vast majority of this prenatal care.Last year, in the Hospital and Health Centers Division,we rendered 6400 prenatal visits with an estimated cost ikrrf#*w a;AsMW Ht>iplW n H801h C**W* • a H$Wth + Mw"HWth • Sub@Wm Muw • EW*"WtsnW H6M Gant carat H.aaaa,ftn • 9warpnw a o*w s+vin • mww mewv,I4wW • Gstwo tae A-W tin of$575,000.Although the Department does not routinely identify the number of"restricted Medi- Cal"services,it is estimated that approximately 33%of the visits/costs fall into this category. In the event that restricted Medi-Cal is eliminated for undocumented women,HSD will implement an affordable prenatal care package for undocumented women. It will be administered in a similar fashion to the Basic Adult Care package.Fees will be based on income and are not expected to cover full cost of prenatal care.Emergency Medi-Cal will provide payment for the labor and delivery. In order to be eligible for the plan, women receiving the prenatal package must agree to apply for Emergency Medi-Cal to receive the reduced-cost prenatal care package. We continue to be concerned about the reluctance of undocumented women to apply for Emergency Medi-Cal. They fear becoming a"public charge"and being required to pay for any public services received. While Medi-Cal records are supposed to be"confidential"there have been occasions in which immigrants have been stopped during a border crossing with a full record of public services received. In addition,there is fear that"public charge" information could hinder someone in their attempts to seek citizenship. We continue to outreach to undocumented',women to provide information,assistance,and encouragement to come for care. ESTIMATED IMPACT OF DECREASING FOOD STAMPS TO LEGAL IMMIGRANTS Overview The purpose of the Food Stamp program is to increase overall nutritional levels and promote a healthy diet. However, reducing Food Stamp benefits for adults within a family results in less resources to feed the entire household.Unfortunately,children,are more likely to be affected by this decrease. Without proper nutrition,children are vulnerable-to a number adverse physical outcomes. They risk permanently retarded physical growth,brain development,and cognitive functioning.They are three times more likely to suffer from health problems such as fatigue,headache, inability to concentrate. Their immune response can became comprised resulting in more frequent and more lengthy illnesses as well as more doctor visits. Finally, children in Contra Costa County already have a higher incidence of iron-deficiency anemia than the average for California`. This condition which is primarily nutrition-related,is easily preventable and could increase if more children have less access to food. Service Impacts We've highlighted the following impacts which might result due to decreased Food Stamps to families • Increased health casts. As mentioned above, studies have shown that decreased nutrition in children increases health care and hospital costs particularly if targeted to clients at risk of malnutrition, e.g. low income children. This includes increased casts due to more immune-depressed illnesses like colds and flu as well as more serious illness like anemia I Anemia rates in Centra Costa County for tow income children ages 1-3 years old were 24.8%in 1995, compared to 19.7%in California. which could result in a chronic,life-long conditions. • Impact on school& Children who are unable to function due to inability to concentrate, fatigue,or nutrition-related illness require more individual teaching time than other students. In addition, poorly nourished students do not do as well academically. Under nourished children are also more likely to be absent from school. It is difficult to say with certainty what the impact of eliminating undocumented prenatal care or decreasing funding for Food Stamps will be to the County.However,both measures are expensive and short-sighted in the lung run.They do not promote good health or good life and will prove to be much more expensive to the County in the long term.