The Brief

Fortina Hernández is called “the one who knows it all.”

For more than two decades, the community health worker has supported hundreds of families throughout southeast Los Angeles by helping them sign up for food assistance, sharing information about affordable health coverage, and managing medications for their chronic illnesses. She’s guided by the expression “an ounce of prevention is worth a pound of cure.”

But she makes only around $20 an hour from a community health organization and must hold down a second job to make ends meet. “They pay us very little and expect too much,” she said in Spanish. "We build trust. We offer support. We’re the shoulder people rely on, but we don't get fair wages."

California looked to professionalize thousands of community health workers such as Hernández to improve the health of immigrant populations, particularly Hispanic residents, who often experience higher rates of chronic diseases, are more likely to be uninsured, and face more cultural and linguistic barriers when trying to access services. Studies show their work may reduce hospitalizations as well as emergency room and urgent care visits.

The state hewed closely to a series of expert recommendations put out in 2019 to standardize training and certification, integrate these workers into the health care workforce, and provide fair wages, including reimbursements through Medi-Cal, the state’s Medicaid health insurance program, to compensate for work that traditionally has been done on a volunteer basis or for low pay. But six years in, California has backed out of many of those initiatives.

The state has eliminated a certification program and rolled back nearly all funding to train and expand this workforce even though it set a goal of 25,000 workers by this year. Although Medi-Cal began covering their services, participating health plans set uneven billing requirements, making it difficult for workers to get reimbursed. And the state didn’t follow through on a planned pay raise.

With federal funding cuts just passed and President Donald Trump targeting immigrants for deportation — even sharing personal Medicaid data with the Department of Homeland Security — advocates fear California is abandoning its health equity initiative for immigrants, people of color, and people with low incomes when they say that effort is needed most.

“We're in a very dire situation right now,” said Cary Sanders, senior policy director for the California Pan-Ethnic Health Network, a statewide health equity advocacy group.

A spokesperson for Gov. Gavin Newsom, Elana Ross, said “the state has taken difficult but necessary steps to ensure fiscal stability” and that the administration continues to have a dialogue with community health workers. Ross added that the Democratic governor, a potential presidential candidate, remains committed to defending immigrants being targeted by the Trump administration.

‘Our office is on the street’

Lourdes Bernis (left) chats with a resident about Latino health issues. Bernis is a community health worker, or promotora, who helps people manage chronic illnesses, connects them to social services, and promotes healthy lifestyles.

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There are more than 60,000 community health workers nationwide, including roughly 9,200 in California, and this workforce is projected to grow 13% over the next decade, three times as fast as for all occupations, according to 2024 data from the U.S Bureau of Labor Statistics. But experts say these numbers are an undercount given the various titles community health workers hold and that many work outside of health care and governmental institutions.

Community health worker is an umbrella term that includes peer supporters and community health representatives. These workers, often known as promotores, tend to be women who work in clinics, hospitals, public health departments, and local nonprofits, places where they are trusted and have a grasp of their community’s most pressing health needs.

Besides helping people manage chronic illnesses such as heart disease and diabetes, they promote reproductive health, children’s health, and oral hygiene, and they help seniors with dementia prevent injuries and review medications. They can make people feel safe when reporting domestic violence and other abuses. They also connect people to housing and food assistance. "The community health worker is not sitting at a desk," Hernández said. "Our office is on the street."

Back in 2019, the California Future Health Workforce Commission recommended integrating community health workers into the health care system, and in 2022, the state authorized $281 million over three years for the California Department of Health Care Access and Information, which oversees health care workforce development, to recruit, train, and certify them.

The agency sought to standardize training and certification, but some community groups feared that would create barriers to entry by not giving enough credit for lived experiences and cultural competency. But just as the agency offered more flexibility and allowed community-based training, the state slashed $250 million in funding last year due to budget constraints. This year, the certification program was officially eliminated.

Spokesperson Andrew DiLuccia said the agency is now considering a program to accredit community organizations rather than individual workers and plans to spend its remaining $12 million on technical assistance, workforce development, and salaries for those working with immigrant communities.

According to the National Academy for State Health Policy, 32 other states offer a voluntary or mandatory community health worker certification program.

Some community health advocates say California’s missing an opportunity to carve a career path for this workforce. Currently, some courses offered by nonprofits, counties, and colleges require a fee, a degree, English fluency, or prior experience. Most are concentrated in the San Francisco or Los Angeles area, leaving training deserts in much of the state.

Lourdes Bernis received training that allowed her to move into a full-time role with the Los Angeles County Department of Mental Health. She says many community health workers remain stuck in low-paying positions and can’t afford training to advance.

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Lourdes Bernis, a dentist from Ecuador, is a model for how community health workers could be integrated into the health care system. She began as a volunteer promotora more than a decade ago and in 2019 received free training from Los Angeles County, allowing her to move into a full-time job with benefits for the county’s Department of Mental Health to help Spanish-speaking women manage depression and anxiety as they recover from drug use.

Bernis now plans to become a peer-to-peer support specialist inside hospitals and clinics. Meanwhile, many of her colleagues with decades of experience remain stuck in low-paying roles and can’t afford training to advance. “There are promotoras who have 20 to 25 years of experience, but they are still volunteering,” Bernis said in Spanish.

Medi-Cal's role

To pay community health workers, Medi-Cal began covering their services in July 2022, but California suspended a planned pay increase for them after voters approved Proposition 35, which hiked the pay of physicians, hospitals, community clinics, and other providers instead. Since then, the state has yet to establish a uniform system for how health plans should contract with organizations that employ community health workers.

“We have to jump through hoops,” said Maria Lemus, executive director at Visión y Compromiso, a Los Angeles-based nonprofit representing community health workers. “It just causes havoc, because each plan could have different requirements.”

Lemus said it took the organization nearly six months to establish payment with one health plan.

And though Medi-Cal reimbursements are tied to individual tasks, ranging from $9.46 to $27.54 for 30 minutes of work, advocates say they aren’t fully compensated for the time they spend building trust and following up with patients. Advocates say these workers should earn at least $30 a visit, with benefits, but many earn about $21 an hour, often without benefits.

Advocates say they’re surprised by how infrequently these services are used in a program with 15 million Californians. More than 16,000 Medi-Cal enrollees used these services in the first year, rising to 68,000 last year, according to state data. “I don't think it's reached the potential that the governor talked about, and that we all imagined that it could possibly achieve,” Sanders said.

Griselda Melgoza, a spokesperson for the California Department of Health Care Services, said the agency, which administers Medi-Cal, has seen “a steady, upward trend” and believes the data underestimates utilization because the benefit is sometimes bundled with other services.

A proposal to assess whether Medi-Cal managed care plans are doing enough outreach and education to enrollees about community health services died this year.

More crucial than ever

With health funding cuts from the Trump administration and passage of the GOP’s tax and spending legislation, advocates fear there will be even less funding and support for community health worker positions, shrinking a workforce tackling health disparities. Already, Fresno County’s Department of Public Health said it has cut its community health workers by more than half, from 49 positions to 20.

Yet, outreach is more crucial than ever. As the Trump administration continues immigration raids, which appear to have targeted at least one health clinic in the state, advocates and policy researchers say community health workers could act as intermediaries for immigrant patients afraid to seek medical care in hospitals and clinics.

Without a state certification program, no raises, and dwindling training funds, the path to professionalizing community health workers is unclear, leaving workers feeling left behind.

"The community trusts me,” said Hernández, the veteran community health worker, “but at the government level, there’s still a long way to go before this work is valued and fairly compensated."

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. KFF Health News is the publisher of California Healthline, an editorially independent service of the California Health Care Foundation.

Big Bear’s famous bald eagle couple, Jackie and Shadow, now have a pair of eggs to look after.

Jackie welcomed the second egg of the season around 5:10 p.m. Monday, according to Friends of Big Bear Valley, the nonprofit that runs a popular YouTube livestream centered on the nest overlooking Big Bear Lake.

More than 22,000 people were watching the livestream when Jackie welcomed the new addition, up from more than 14,000 viewers when the first egg arrived Friday afternoon.

The season so far

Jackie laid the first egg around 4:30 p.m. Friday, with Shadow stopping by to see it for the first time about 10 minutes later, according to Friends of Big Bear Valley records.

It was almost exactly a year after the feathered duo welcomed the first egg of the 2025 season.

Jackie tends to lay eggs three days apart, and the second egg arrived right on schedule.

Jackie could be seen rousing and puffing up her feathers about a half-hour before laying the second egg. She made a high-pitched whistling tea kettle noise a little before 5 p.m. Monday.

Officials from Friends of Big Bear Valley have told LAist those behaviors are signs an egg is imminent.

“She looks almost royal, because all of her feathers are out and it's just — I cry,” Jenny Voisard, the organization’s media and website manager, said with a laugh last week. “It's usually pretty amazing.”

The eagle pair typically takes turns caring for their eggs. Shadow visited the nest for nearly three hours across nine incubation “daddy duty” sessions on Sunday, according to organization records.

What’s ahead for the nest

Jackie has laid up to three eggs in a clutch, including in each of the past two seasons, so fans could see another egg arrive this week.

A clutch refers to the group of eggs laid in each nesting attempt. Bald eagles generally have one clutch per season, according to Friends of Big Bear Valley. A second clutch is possible if the eggs don’t make it through the early incubation process.

For example, Jackie laid a second clutch in February 2021 after the first round of eggs was broken or destroyed by ravens the month before.

The Big Bear eagles also practice delayed incubation, which is when Jackie and Shadow don’t apply their full body heat to the eggs until the whole clutch is laid.

Waiting to incubate full time helps the eggs hatch closer together, making the chicks more similar in size and age, which the organization says gives them a better chance of survival.

Jackie and Shadow successfully delayed incubation for their trio of eggs last season, according to Friends of Big Bear Valley. Sunny and Gizmo hatched and later went on to fledge, or fly away from the nest for the first time, last summer.

Chicks? Chicks soon??

Once egg-laying is over, the chick countdown is on.

Jackie and Shadow's usual incubation time is around 35 to 39 days, starting when the eagles begin to fully incubate their clutch, according to Friends of Big Bear Valley.

Last season, the first egg hatched at around 40 days old, the second egg hatched around 38 days old and the third egg around 39 days old.

“Pip Watch” — short for pipping, which is the first hole an eaglet makes as it emerges from its egg — is typically announced by Friends of Big Bear Valley before chicks break through each season.

Last year’s Pip Watch kicked off in March, a few days before the first chick hatched in the nest.

The Coalition for Humane Immigrant Rights announced a new lawsuit Monday against federal immigration agencies for claims of inhumane conditions at the Adelanto ICE Processing Center in San Bernardino County.

The organization claims people detained in the Adelanto facility lack drinkable water, healthy food, clean clothes, places to sleep and access to medical care. Failing to provide these basic necessities, CHIRLA says in court documents, amounts to punishment — violating detainees rights to due process.

“ We are really at a moment where we are seeing a human rights crisis right before our eyes,” CHIRLA policy director Jeanette Zanipatin said at a news conference Monday. “And the detention centers, especially the one at Adelanto, is where we are seeing it unfold in real time.”

Immigrant Defenders Law Center, Willkie Farr & Gallagher LLP and Public Counsel are assisting in the case against Immigration and Customs Enforcement and the Department of Homeland Security.

 ”We're asking both that the judge force Adelanto, the detention facility, to ensure that basic medical care is being provided, that basic hygiene and sanitary conditions, food and water are provided, and that oversight is conducted over the facility,” said Alvaro Huerta, director of litigation and advocacy at Immigrant Defenders Law Center.

ICE and Homeland Security have not responded to LAist about the case or claims in this article.

A question of constitutional rights

When CHIRLA announced the lawsuit on Monday, Zanipatin said there has been “a long history of unsafe and abusive conditions” at the Adelanto facility. She referenced a July 2025 report from the nonprofit Disability Rights California that found conditions at the facility were “dangerous and inadequate for all people, especially for those with disabilities.”

Court documents filed by CHIRLA also reference previous reports that found issues at the facility, including a 2018 report from the DHS Office of Inspector General that found “a number of serious issues that violate ICE’s 2011 Performance-Based National Detention Standards and pose significant health and safety risks at the facility.”

Those issues included findings of nooses in detainees’ cells, improper use of disciplinary segregation and inadequate medical care.

“Based on interviews with detainees and medical staff and a review of independent reports,” the report states, “we concluded that detainees do not have timely access to proper medical care.”

CHIRLA claims in their lawsuit that Adelanto leadership rejected the findings of the inspector general report and took no corrective action.

The concerns raised by CHIRLA as they announced the lawsuit closely resemble the findings of Disability Rights California, which also claimed detainees were not provided adequate medical care, food, water or clean clothing. The organization also reported that some people had limited access to communication with their loved ones.

Huerta claimed that the conditions in the Adelanto facility are poor by design.

“ Adelanto, like most ICE prisons, is engineered to be so punishing, so relentlessly soul crushing, that people abandon their rights and accept deportation even when they have strong asylum claims or a clear pathway to legal status,” Huerta said.

He said 32 people died while detained by ICE nationwide in 2025, and at least 6 more have died in January. Two people died at Adelanto last fall, Huerta said.

Family members speak out

Mariel Garcia told LAist she would call her father, Gabriel Garcia-Aviles, nearly every day. That ended when he was detained by immigration agents in Costa Mesa on Oct. 14.

Garcia-Aviles had a work permit, his daughter said, but he was detained and taken to Adelanto. She said she tried many times to ask the facility staff to allow her to call her father, or even to get an update on his condition, but she was never able to talk to him again.

Worried, she said she got a call from the staff at Adelanto.

“ They called me the day he was passing away,” Garcia told LAist, “They're like, go tell your family and friends to come and say their last goodbyes because your father's in critical condition.”

Her brother, Gabriel Garcia, said that when they arrived at the hospital their father was intubated and “lifeless." Still, he said, there were law enforcement officers standing outside the hospital room.

Garcia-Aviles died Oct. 23 at age 56.

Jose Ayala also talked about the loss of his brother, Ismael Ayala-Uribe, while he was detained in the Adelanto facility.

“ He was there for about a month and we knew nothing of his condition,” Ayala said at Monday’s press conference, “just that he was sick and that he wasn't getting any help when he asked.”

Ayala said his family learned of his brother’s death when the police came and knocked at their door. He said staff at Adelanto did not tell them Ayala-Uribe had been hospitalized or that he needed a surgery, which ICE said in a news release was for an abscess.

Ayala told LAist that he was able to talk with his brother over the phone a couple of times when he was detained, and Ayala-Uribe was joking with him about the poor conditions of the facility causing him to lose weight.

“ One of the last things he told me,” Ayala recalled, “was, ‘We'll see who comes out skinnier.’”

He said his brother was 39 when he died on Sept. 22, 2025.

CHIRLA alleges in court documents that staff at Adelanto were aware Ayala-Uribe was having a potentially life-threatening medical emergency three days before his death, but he was taken back to his cell after being seen by the facility’s medical team.

An ICE news release said Ayala-Uribe “was evaluated by an on-call medical provider Sept. 18, provided medication, and returned to his dormitory,” but did not mention the severity of his condition.

The cause of both deaths remain under investigation, CHIRLA said in an accompanying news release.

The second deadly shooting of a U.S. citizen by federal immigration officers in Minneapolis is raising the prospect of a partial government shutdown at the end of the week.

Senate Democrats say they will not vote to fund the Department of Homeland Security without new guardrails for immigration enforcement.

But that opposition may also torpedo the larger $1.3 trillion spending package needed to keep large swaths of the federal government operational past Friday night.

"The appalling murders of Renee Good and Alex Pretti on the streets of Minneapolis must lead Republicans to join Democrats in overhauling ICE and CBP to protect the public," Senate Minority Leader Chuck Schumer, D-N.Y., wrote on Sunday. "People should be safe from abuse by their own government."

Democrats were already raising alarms about the conduct of immigration officers before the latest killing in Minneapolis on Saturday.

Last week, all but seven House Democrats voted against the funding bill covering homeland security, which includes money for Immigration and Customs Enforcement and Customs and Border Protection.

At the time, a few Senate Democrats also pledged to vote against the funding when it reached them this week, though the response across the Capitol was far from the near-unified opposition in the House.

That is because the House sent the DHS funding over to the Senate tied together with billions in spending for defense, health, transportation and other federal agencies, in part to expedite the process as Congress races to meet a Friday deadline to keep the government fully open.

"The hard truth is that Democrats must win political power to enact the kind of accountability we need," Sen. Patty Murray, D-Wash., the top Democrat on the Senate appropriations committee, wrote in a statement last week saying she would vote for the total package.

After Pretti's shooting on Saturday by a Border Patrol agent, Murray said she would join her Democratic colleagues in opposing the funding.

Congress faces Friday deadline to avert a partial shutdown

The timeline was already tight once a winter storm delayed the first Senate votes of the week until Tuesday night. But the renewed debate over immigration enforcement is complicating the task more.

Schumer wants to cleave the DHS measure from everything else. The other remaining spending measures have overwhelming bipartisan support. Democrats want to continue negotiating the DHS funding bill without shutting down large parts of the government.

The funding measure needs to reach a 60-vote threshold to pass, meaning some Democratic support is needed for it to clear the Senate. But disentangling different parts of the legislation requires buy-in from Republicans, and so far, GOP leadership has not indicated that they are willing to separate the funding bills.

Flowers, signs and mementos are seen Monday at a makeshift memorial in the area where Alex Pretti was shot dead by federal immigration agents in Minneapolis. On January 24, federal agents shot and killed Pretti, a 37-year-old ICU nurse, while scuffling with him on an icy roadway.

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Senate Majority Leader John Thune's communications director, Ryan Wrasse, wrote on X on Monday that the Senate will proceed as planned to consider all the funding bills together.

"A government shutdown, even a partial one, does not serve the American people well," he wrote. "Hopefully Senate Democrats, who are actively engaged in conversations, can find a path forward to join us before this week's funding deadline hits."

Sen. Susan Collins, R-Maine, the appropriations committee chair, told The New York Times over the weekend, "I'm exploring all options. We have five other bills that are really vital, and I'm relatively confident they would pass."

Collins, who is up for reelection and whose state is also a target of immigration raids by the Trump administration, is among the Republicans who have expressed fresh concerns about the tactics, calling for an investigation.

A handful of Republicans have called for congressional hearings or offered sharper criticism.

"My support for funding ICE remains the same," Sen. Pete Ricketts, R-Neb., wrote in a statement. "But we must also maintain our core values as a nation, including the right to protest and assemble."

Even if Democrats could convince Republicans to agree to separate DHS funding from the rest, that would mean the legislation needs approval again in the House, which is on recess until Feb. 2. It is unlikely that House Speaker Mike Johnson, R-La., would call members back to Washington early, increasing the risk of a partial shutdown.

Why Democrats are willing to risk another shutdown

Before this weekend, few lawmakers expressed appetite for another shutdown after a record 43-day one this fall. For weeks, Democrats withheld their votes from a short-term funding measure to reopen the government without a deal to extend expiring health insurance subsidies.

Eventually, a handful of Democrats joined with Republicans to reopen the government, with the promise of a vote on the subsidies. That vote failed in December. The deal included the passage of three bipartisan spending packages for veterans, agriculture and other areas through the end of September 2026 and a short-term extension for everything else through Jan. 30.

Congress has already passed several more full-year funding bills through September, but the measures still awaiting final passage in the Senate account for 75% of annual federal discretionary spending.

But even Democrats who ultimately voted with Republicans to end the last funding stalemate now say they will vote against the DHS funding despite the risk of another shutdown.

"We have bipartisan agreement on 96% of the budget," Sen. Catherine Cortez-Masto, D-Nev., wrote in a statement. "We've already passed six funding bills. Let's pass the remaining five bipartisan bills and fund essential agencies while we continue to fight for a Department of Homeland Security that respects Americans' constitutional rights and preserves federal law enforcement's essential role to keep us safe."

Federal agents look on as demonstrators gather near the site of where Alex Pretti was fatally shot by.

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Holding up the DHS funding bill would not halt the administration's immigration crackdown. Last summer, Congressional Republicans allocated $75 billion for ICE over four years in President Donald Trump's "One Big Beautiful Bill."

Democrats say they do not want to give ICE the roughly $10 billion base funding that is on the line now. But more so, Democrats see this as rare leverage in the minority to extract policy changes.

Democrats already negotiated to include $20 million in funding for officer-worn body cameras, plus more funding for oversight and a reduction in funding for enforcement and removal operations and detention bed capacity. But most Democrats said this did not go far enough.

Democrats want more sweeping reforms to reign in the tactics, such as prohibiting ICE from deploying excessive force and explicitly preventing them from raiding places of worship, hospitals and schools. Republicans previously rejected these demands.

The DHS funding bill also includes funding for the Transportation Security Administration, the U.S. Coast Guard and the Federal Emergency Management Agency.

But Democrats are betting that the American public is on their side. A recent New York Times poll found that a majority of respondents said the federal immigration tactics have gone too far.

Nearly $1.3 trillion in federal funding is at stake

The funding fight over DHS is the latest dispute over funding in Congress. Last year, the Trump administration moved to rescind billions in federal funding appropriated by Congress for foreign aid and public broadcasting — and proposed a budget slashing nondiscretionary funding by some 20%.

Instead, the final legislation keeps federal nondiscretionary spending essentially flat. For example, the administration called for cutting the Centers for Disease Control and Prevention budget by 50%. Under the bipartisan health spending bill, the agency's funding would remain roughly unchanged.

Bill Hoagland, senior vice president of the Bipartisan Policy Center and a former longtime appropriations committee staffer, said this is striking considering Congress has mostly followed Trump's lead.

"Congress is starting to show a little bit of backbone," Hoagland said. "I think there is increasing recognition of the need to have Congress exert its power of the purse."

Hoagland also notes that Congress is nearly a quarter of the way into the fiscal year, so once lawmakers greenlight the remaining funding, it will not be too long before the appropriations process begins again.
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