In a cramped cubicle in the Sunnyside neighborhood of Fresno County, Neng Yang is playing a small role in the country’s healthcare overhaul. On this afternoon, she’s helping a Hmong woman enroll in Medi-Cal.
“She prefers English, so her kids can read to her, because she doesn’t read and write in Hmong, and sometimes the translation gets lost when it’s sent to her in Hmong,” says Yang, a certified enrollment counselor at Fresno Center for New Americans.
Since enrollment kicked off October 1, Yang and her team have enrolled about 500 people into Medi-Cal. It hasn’t been easy: At Fresno Center for New Americans, there’s a week-long wait to get an appointment with an enrollment counselor. The counselors only see about six people per day.
“It’s overwhelming, but it’s also a good feeling knowing that people who don’t have coverage are getting covered,” Yang says.
Throughout Fresno County, those involved in Medi-Cal enrollment say the process has been stressful - but steady. One by one, and in a spectrum of languages, they’ve enrolled people at community group offices, public events, in rural communities, and even parole offices.
"It's overwhelming, but it's also a good feeling knowing that people who don't have coverage are getting covered" - Neng Yang
By the end of last year, they’d enrolled about half of the estimated 56,000 Fresno County residents who are eligible for Medi-Cal. That’s according to the county Department of Social Services.
But enrollment is just one hurdle in this long process. Looking forward, there are questions about how tens of thousands of people – many of whom have never had insurance – will learn how to navigate the complicated healthcare system.
And looking back, there are questions about whether this process could’ve been easier, if the Fresno County Board of Supervisors had not turned down millions of federal dollars to establish a program to enroll the poorest people into insurance earlier.
“There are people who have literally lost limbs, lost their sight, had heart attacks, who would not have had that happen to them if the county had gone for the Low Income Health Program,” says Kevin Hamilton, deputy chief of programs for Clinica Sierra Vista.
The program, which was considered a “bridge” to Medi-Cal, would’ve allowed the county to get a jump-start at enrolling thousands of the most vulnerable people into insurance. They would have been transitioned into Medi-Cal on January 1st. Instead, county officials and agencies are playing catch-up now, during Medi-Cal enrollment, Hamilton says.
“It has gone so much more smoothly in other counties, where these patients were transferred by the states in a very smooth fashion,” Hamilton says.
"It has gone so much more smoothly in other counties, where these patients were transferred by the states in a very smooth fashion" - Kevin Hamilton
Others say it’s not worth looking back at the Low Income Health Program, when there are still so many more people to enroll, and applications to process.
“Fifty percent (enrollment), three months into it, is a huge accomplishment, given the statewide numbers of how many people need to enroll and where we’re at,” says Sonya Bugay, deputy director of the county Department of Social Services. “I don’t know if it would’ve made a huge amount of different. We’re kinda going, ‘woulda, coulda, shoulda.’”
Whenever people are enrolled into Medi-Cal, the next question is: Does expanded access to health care translate to expanded use of preventative health care services? Not necessarily, says Kevin Hamilton, of Clinica Sierra Vista.
“When somebody is sick, is not the best time for them to learn,” Hamilton says.
He says teaching people to use their new Medi-Cal insurance to seek preventative healthcare – instead of relying on the emergency room in a pinch – will require generational shifts. He envisions classes on navigating the health care system incorporated into school curriculums, and workshops offered by local community groups.
“I’d love to see – and I’d love to be referring my patients to – one of the local community based organizations for their, ‘so you got health insurance now, what next’ classes, where they’re going to have pizza – healthy pizza, of course – and learn all about this, and bring the family,” he says.
At Centro La Familia in southwest Fresno, enrollment counselors like Cindy Avila are beginning to do that on an individual basis. She will follow up with her newly insured clients, to make sure they visit a doctor before they ever get sick.
“We keep status, we keep checking on them until they make their first appointment, so we get them to the first appointment, then we’ll check on them within six months,” Avila says.
That leads us to our next question. If all 56,000 people enroll in Medi-Cal, and learn how to utilize their insurance, will there be enough doctors to see them? The Central Valley already has a chronic shortage of primary care doctors and specialists.
David Pomaville, interim director of the county health department, says that’s a concern for down the line.
“Right now, the focus is on getting as many people into the system as we can. I think those will be the challenges going forward,” Pomaville says.
"Right now, the focus is on getting as many people into the system as we can" - David Pomaville
But Hamilton, of Clinica Sierra Vista, says it’s an immediate problem. His network of federally qualified health centers has been swamped with people who are eager to finally see a doctor.
“It’s busier than it’s ever been,” Hamilton says. “It’s always been busy, but now it’s getting a little ridiculous.”
Those on the ground say the stress of enrolling thousands more into Medi-Cal, and of looming unknowns, becomes worthwhile when they see how relieved people are to finally have health insurance.
Back at the Center for New Americans, Neng Yang lights up as she tells the story of one happy client.
“He brought in some fruits and vegetables, and said, ‘I don’t have anything, but this is for you and the staff,” Yang exclaims.
She becomes more serious as she explains that his reaction is motivation to push forward.
“This is the reason we work so hard,” she explains. “It’s not so much for the money, but it’s so much to help people out. All this time, some of them don’t know the system, don’t know how to access health care. That’s why we’re here.”
The deadline to enroll in insurance plans through Covered California, the state’s insurance exchange, is March 31. Medi-Cal enrollment continues through the end of the year.
