Health

‘They still need care’: Why California migrant workers are avoiding medical clinics

By Larry Valenzuela | CalMatters

Published Dec 1, 2025 12:00 PM

Farmworkers, wearing long sleeve shirts, gloves, hats, pants, and bandanas covering their mouths, carry buckets over the shoulders while walking through a field of produce. The sun shines as it rises in the background.

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On a scorching summer day, dozens of farm laborers paused their work picking banana peppers in a remote field 26 miles from Fresno and filed into a pop-up medical clinic. It was a chance to pick up medication and take basic health assessments, such as blood pressure and glucose monitoring.

For almost a decade, the University of California San Francisco has been fielding mobile clinics like this one in rural Fresno County to support a hard-to-reach population of unauthorized immigrants who otherwise would avoid routine health care.

The program gathered steam through the COVID-19 pandemic and during California’s decade-long expansion of health care to immigrants who are in the country without authorization. But this year, doctors are starting to notice that laborers aren’t showing up for care like they used to.

The doctors sense the decline in participation is connected to the Trump administration’s aggressive immigration enforcement activity. UCSF mobile health clinic director Dr. Kenny Banh said patient visits to his rural mobile health vans started dropping at the beginning of the year, when President Donald Trump took office for his second term, vowing to crack down on illegal immigration.

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Families can get notified when services reach their area and whether they qualify.

“There’s a lot of distrust. I come from the university, I have a white coat; people are worried. We do as much as we can to tell them how we protect their data,” Banh said.

A person with medium skin tone, orange-dyed hair combed to the side, wearing a white doctor's coat with embroidery and patches that read "UCSF Fresno" and "UCSF Faculty Fresno" while standing in front of a row of trees.

According to UCSF, visits to their mobile clinics dropped by around 36% as enforcement activity increased in California. In 2024, the mobile clinics would see on average 34 patients per outing, but in the past few months, the number of patients had dropped to around 22 per outing. People are also less willing to sign up for Medi-Cal, the state’s health insurance program for lower-income households, because they fear giving the government their data if they aren’t authorized to be in the country, Banh said.

It could get worse.

California scaled back the law that allows all income-eligible residents regardless of immigration status to receive health insurance through Medi-Cal by temporarily limiting enrollment next year. And, counties are bracing for Medicaid cuts under the budget law Trump signed earlier this year that they say will make it harder for them to sustain programs serving distinct populations, like the one that brings health care to rural farmworkers.

“It's going to be more restrictive in terms of work requirements, more regular re-enrollments, and more stringent requirements on states to comply with federal mandates,” Maria-Elena De Trinidad Young, an assistant professor of public health at UC Merced. “This is a push-out. The policy is really designed to restrict people from accessing Medicaid, or you know, in California, we call it Medi-Cal.”

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A woman with light skin tone, wearing dark gray scrubs, takes the blood pressure of a person sitting on a foldable white plastic chair next to a white table with items on it. Another person wearing a blue sweater watches them.

Getting health care to remote communities

The mobile clinic Banh leads is part of a larger initiative from the Fresno Department of Public Health to reduce chronic and communicable diseases among hard-to-reach populations in the county. It gained funding most recently through a COVID-19 relief law that Fresno County steered to the clinics, which were led by UCSF and Saint Agnes Medical Center.

The COVID-19 money is running out, but the program has another year of funding locked in.

Farmworkers pulling crops from plants in a field. Some carry buckets in the foreground and background.

People wearing hoodies, hats, bandanas and other items covering their faces, line up under a metal structure with old farming equipment in the background.

Farmworkers line up in an equipment barn to get a check-up by the staff of UCSF-Fresno, part of the Rural Mobile Health program, at a farm outside of Helm on June 16, 2025.

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Larry Valenzuela

CalMatters/CatchLight Local

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A person wearing a pink hoodie, blue hat, and green bandana covering their face, speaks with a person behind a white table with items using a laptop. People, out of focus in the background, stand in a line.

Farmworkers line up in an equipment barn to get a check-up by the staff of UCSF-Fresno, part of the Rural Mobile Health program, at a farm outside of Helm on June 16, 2025.

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Larry Valenzuela

CalMatters/CatchLight Local

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Clinics from both organizations can be found at community events, food distribution drives in rural communities, schools, and sometimes at farm working sites. The Saint Agnes mobile clinic van has two exam rooms inside for patients to receive care.

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A person walks up steps into a mobile clinic. Others walk by the clinic.

A man with light skin tone, wearing navy blue scrubs, uses a stethoscope on a man with medium skin tone, gray mustache, wearing a tan hat and olive green long-sleeved shirt.

Patient and Parlier resident Javier Hernandez getting his blood pressure and blood sugar test during a check-up.

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Larry Valenzuela

CalMatters/CatchLight Local

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A close up of hands with blue latex gloves pulling blood sugar testing strips from a small cylinder container on a white table with other items.

Doctor Nicholas Gill is pulling blood sugar testing strips from a container during a check-up examination in the Saint Agnes Mobile Health Unit mobile clinic, parked in the City Heritage Park parking lot in Parlier on May 16, 2025.

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Larry Valenzuela

CalMatters/CatchLight Local

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According to Ivonne Der Torosian, vice president of community health and well-being with Saint Agnes Medical Center, the program is designed to provide medical school students an opportunity to serve the community and create access to health care.

“We are explicitly contracted to go out to rural Fresno County and serve agricultural workers, partner with employers of those farming workers, and also provide services to their families.”

An over the shoulder view of a close up showing a person, wearing a blue sweater and blue latex gloves, pricking the finger of a person's hand, who is wearing a yellow safety vest.

Community health workers also provide health education and make referrals to nearby primary care providers for individuals who cannot be treated on-site.

“We do basic screenings, including primary and preventive care, for many of the families we serve. We’re looking at connecting them to primary care providers,” Der Torosiran said. “We are providing vaccinations, we are providing glucose monitoring, and looking at their hypertension and blood pressure readings. So, really basic services they would get in a primary care setting."

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A man with medium skin tone, wearing navy blue scrubs and blue latex gloves, takes the blood pressure of a person wearing a red shirt who is sitting next to a table with items on it outside a mobile clinic.

No nearby hospital

Dr. Navdeep Lehga, a resident physician, recently began a shift in the Saint Agnes medical van in Mendota’s Rojas Pierce Park. It’s an agricultural community just less than one hour west of Fresno. A line of people awaited her on the curb to pick up food from the distribution center and to see her and her team for a check-up.

A person, out of focus in the foreground, sits on a green chair next to a blue bike in a parking lot with a mobile clinic parked across them with signage on it that reads "Saint Agnes Community Health Outreach." A park and playground is visible behind the mobile clinic.

As the morning progressed, Navdeep saw patient after patient in the mobile clinic's exam room or went outside to see patients in the parking lot, checking blood pressure with a gauge strap on their patients' arms and glucose levels with finger pricks.

A woman with medium skin tone, wearing teal scrubs, reaches for supplies on a desk in a mobile clinic. A blood pressure gauge is posted on a wall, out of focus in the foreground.

A close up of a person, wearing teal scrubs and blue latex gloves, checking the blood sugar of a person, who's arm is resting on a white table.

Dr. Navdeep Lehga checks a patient’s blood sugar in the exam room of the Saint Agnes Mobile Health Unit clinic, parked in the lot of Rojas Pierce Park in Mendota on Aug. 28, 2025.

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Larry Valenzuela

CalMatters/CatchLight Local

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A woman with medium skin tone and brown hair, wearing teal scrubs, writes on a paper on an exam table. A person with medium skin tone, wearing a black shirt, sits next to the table slightly out of frame, and another person, wearing navy scrubs, stands a little away while clasping his hands.

Dr. Navdeep Lehga checks a patient’s blood sugar in the exam room of the Saint Agnes Mobile Health Unit clinic, parked in the lot of Rojas Pierce Park in Mendota on Aug. 28, 2025.

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Larry Valenzuela

CalMatters/CatchLight Local

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She said most of the patients she sees are farm workers and immigrants. Much of the rural population doesn’t have easy access to medical care — the nearest hospital is 35 miles away. Some of her patients may seek out the medical van for primary care because they don’t know where else to go.

“That's why they come here. We give them the gist of what's going on. But we're limited on our supplies and what we can check,” she said.

Lehga says the number of people coming to the van has slowed down since immigration enforcement has kicked up. She has heard patients speaking to staff during the intake session talk about their fears of coming to the van and seeking out health care after a summer of intensified immigration raids.

A woman with medium skin tone, wearing teal scrubs and a long sleeve shirt underneath, speaks with a person, slightly out of focus in the foreground, wearing a hat and green shirt. Another person speaks with the person sitting. In the background is a person wearing orange scrubs next to another person wearing a gray flannel shirt and hat. All are underneath a canopy.

“We did notice there used to be a lot more patients coming before they have gotten scared and they don't want to because they're not sure who will show up,” Lehga said. “They did feel comfortable before coming here because they knew it was safe. Now I think patients are more scared to come in general just because they don't know who can show up.”

Dr. Arianna Crediford, chief resident physician with Fresno St. Agnes Rural Mobile Health, said that visits to the van have dropped by 15 to 20% this year.

“We can speculate that it’s because of the issues with immigration at this time, that seems to be a big influence with farmworkers and food packing,” she said.

Crediford said she’s heard some patients mention the worry about seeking care and what that might imply for them but they have made it clear that they don’t collect immigration information and that they don’t need to talk to them about it at all.

A woman with medium skin tone, wearing a blue sweater, checks the blood sugar of a person sitting on a chair, wearing an orange safety vest, hat, and bandana covering their face. There are other tables with people and farm equipment in the background.

“The idea that people have to be scared to receive health care is heartbreaking. It would really put their health conditions at risk, conditions that require weekly sometimes monthly follow-up. We’re the last line of defense that they’re able to go to besides emergency rooms when they come in with an actual life-threatening event. The day this population can’t comfortably and safely seek care their health is going to be put in danger because of that,” said Crediford.

The population, which is often uninsured, suffers from high rates of hypertension, diabetes or high blood sugar, and high cholesterol, oftentimes without treatment, Banh said. Frequently, the rural health team is the only health care provider patients see.

A silhouette of a person carrying a bucket full with produce on their shoulder.

With fewer patients showing up for preventive care, Banh said, people will inevitably get sicker and end up in the emergency room. That costs more money and threatens to overwhelm the health system.

“People don’t disappear because you changed policy. They still need care. What you’re doing is delaying care until the outcomes are worse, and there’s not much you can do but hospitalize the patient,” he said.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

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‘They still need care’: Why California migrant workers are avoiding medical clinics

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