LA County grapples with health care plan for those in the US illegally

As L.A. County moves towards a managed care-style approach to providing health care for people in the US illegally, immigrant advocates are pushing for a doubling of the funding for the initiative.

Officials believe about one million people in the county will not benefit from the expanded health insurance available under the Affordable Care Act, because as immigrants who came to the US illegally, they are ineligible for coverage under the federal law.

On Tuesday, advocates for this population asked the County Board of Supervisors to double the $56 million the county currently allocates to care for the uninsured. 

The county plans to redesign the way it provides treatment for the uninsured by this fall. Its program for doing so, called Healthy Way L.A. Unmatched, currently reimburses hospitals and clinics $94 for each patient visit.

The county is transforming the program into a managed-care model. It will assign patients to primary care providers, most likely a community clinic, and pay the clinic a set amount each month for each patient it takes on, regardless of how often that patient visits.

The new program will be "more efficient… and really encourage primary care as opposed to more expensive emergency room care," which is where undocumented immigrants often end up for treatment, Department of Health Care Services Director Dr. Mitchell Katz told the supervisors.

Katz said the new approach, which still needs approval from the supervisors, would cost the same as the current program and care for the same number of patients as it currently does, about 106,000.

The advocates who showed up to Tuesday’s board meeting applauded the redesigned program, saying it would provide better quality care to the poor, undocumented and uninsured. But they said the number of residents it is expected to serve is too small.

"What we really want to see is an expansion of this program," said Jim Mangia, CEO of the St. John’s Well Child and Family Center, a chain of community clinics in south and central L.A. "There’s still 900,000 people who are remaining uninsured."

By doubling its allocation for the program to at least $110 million, Mangia estimated the county could provide coverage for up to 250,000 people. 

The county currently has no plan to expand the program.

Supervisor Don Knabe said he would rather wait to see how other efforts to expand coverage for the undocumented play out.

A bill recently introduced by State Senator Ricardo Lara of Long Beach would provide partial or full state subsidies to cover health insurance for immigrants in the US illegally.

"We probably want to wait and see how that develops until we come up with a plan of our own," Knabe said.

Supervisor Mark Ridley-Thomas seemed more receptive to considering the advocates’ request.

"It’s important to look at Healthy Way L.A. and see it as an opportunity to do more rather than less," Ridley-Thomas said.

The Board of Supervisors is not expected to decide on the scope of the redesigned program until it begins drafting its next budget in May or June.