For Los Angeles County’s undocumented immigrants and transgender residents, a recently approved expansion of funding by the LA County Board of Supervisors for the My Health LA program comes as welcome news. After months of deliberations, the Department of Health Services reached an agreement with community clinics, including the county’s largest clinical system, St. John’s Well Child & Family Center, to support countywide universal coverage in a historic expansion of immigrant health services and access to care.
My Health LA is a partnership between the County and local community clinics and health centers aimed at providing healthcare for every county resident. Clinics provide primary care services like screenings, physicals, chronic disease management and prescription medications. The Supervisors’ Nov. 20 action addresses the healthcare needs of undocumented immigrants who are ineligible for coverage under the Affordable Care Act because of their immigration status.
Supervisor Hilda Solis said it was “one of the very few in the entire nation that exists that provides this kind of service.”
While the Department of Health Services offers specialty care and more acute services, Jim Mangia, the openly gay President and CEO St. John’s Well Child & Family Centers, points out that non-profit healthcare service providers are critical to the over 150,000 county residents who are dependent on free or low cost healthcare. The Board action raises the cap to 165 thousand residents.
“The 17 St. John’s Well Child & Family Centers currently serve over 25,000 residents enrolled in My Health LA and with an overall client base of 100,000 patients of all ages through the network of health centers and school-based clinics in Central, South LA and Compton, is the largest single provider,” Mangia told the Los Angeles Blade.
Mangia said that under the new My Health LA partnership terms, “patients must be able to get an appointment for routine care within 21 days.” Currently some people wait up to three months for a visit. But, he adds, “urgent primary care must be made available within 96 hours.”
With the omnipresent threat of enforcement actions by the U. S. Immigration & Customs Enforcement agency, (ICE), some in the immigrant community eschew even basic healthcare out of fear of being caught up in an ICE raid, followed by deportation. Mangia said that his staff is trained to ensure the protection of their immigrant clients. Additionally, they are culturally and language competent to better serve patients and their families.
“Rather than just wait and react, we figured we would equip our staff,” Mario Chavez, director of government affairs at St. John’s, told Healthcare Dive Magazine last September. “We had to have a game plan, given all the fear in the community. We couldn’t be reactionary.”
St. John’s makes sure its front desk staff and clinicians are “made clear” on the rights granted to them and their patients by the Fourth Amendment protection against unreasonable search and seizure. Front desk employees are also given a script to prepare them for questions they may be asked by ICE agents. Managers are trained in how to read warrants.
Staff have also learned how to form a human shield to prevent apprehension. If the worst situation arises, St. John’s staff have a protocol for keeping ICE agents in place while patients are locked in their rooms.
“We shouldn’t have to compromise our constitutional rights as citizens or residents in this country in the name of national security when there’s clearly a due process,” Chavez told Healthcare Dive Magazine.
Another area of much needed funding expansion is an increase for the funding of pharmaceutical drugs, which St. John’s is required to provide at no cost to patients enrolled in the program.
“There’s now an agreement to look at increasing grants targeted for pharmaceuticals,” Mangia tells the Los Angeles Blade, “which would include hormone treatments for trans patients that weren’t previously allowable.”
St. John’s has been working with LA LGBT Center volunteers to target care for trans and homeless sex workers. “Currently only Los Angeles and San Francisco have such targeted programs,” Mangia says.
Teanna Herrera, a Victims Advocate for St. John’s Transgender Health Program who connects undocumented trans women of color to healthcare, was recently profiled by INTO Magazine. Rizi Timane, the manager of the Transgender Health Program at St. John’s and founding director of the Happy Transgender Center, sees Herrera as a vital part of his team, and an asset in community outreach.
“Teanna brings a vast knowledge about trans women and trans patients,” Timane told INTO. “[Patients] are more inclined to listen and to trust her advice on how to possibly find a way into mainstream employment, as well as how to stay safe while still in the sex work life. … She goes out into the community to present and share her story and attends important community meetings where she advocates for the community as well.”
Although the agreement reached to increase the trans healthcare program is verbal, Mangia tells the Los Angeles Blade that he feels strongly that county officials are acting in good faith.
“St. John’s Well Child and Family Center, which is the largest provider of services to undocumented immigrants in the country and the largest My Health LA provider, was able to get assurances from the County that services would be expanded to include transgender health services,” a grateful Mangia tells the Los Angeles Blade. “At this time of unprecedented attack by the Trump administration against immigrant families and individuals, this expansion in the largest county in the United States sends a clear message of support for the right of everyone to healthcare services, regardless of immigration status.”
Trans care also includes a healthcare reentry program for offenders leaving County detention facilities. Currently St. John’s has the only certified reentry program for trans offenders, staffed by former offenders, Mangia says.
The additional approved funding expansion will also supplement St. John’s HIV-Prevention and Treatment program, especially in the PrEP and PEP pharmaceuticals program. Mangia notes that St. John’s is working with the Black AIDS Institute, which last April opened A Clinic for Us (C4U), a free and or low-cost community primary care facility in Crenshaw’s Leimert Park neighborhood.
Phill Wilson, out-going Founder, President and CEO of the Black AIDS Institute, pointed out in a BAI release that Blacks account for 64 percent of recently diagnosed HIV/AIDS cases in Leimert Park and surrounding areas. According to AIDSVu, interactive online map displaying HIV/AIDS prevalence in America, 1,377 out of every 100,000 Black Angelinos is living with HIV, compared to 591 out of every 100,000 white Angelinos.
“These numbers speak to the need for additional resources and services within Black communities, particularly communities in south Los Angeles,” Wilson said. “Clearly, health disparities between Black and other racial ethnic groups in this county continue to exist and there are still enormous unmet needs in this community. It is our hope that ‘A Clinic for Us’ will help mitigate those issues and extend much needed free or low-cost prevention and treatment services to those most in need in this community.”
Mangia echoes Wilson’s sentiments, saying that under-served minority communities must be better served by efforts such as the increased funding from the County.
Access to medical care is always an ongoing concern he adds. St. John’s clinics are located near bus lines and the clinics offering free MTA tokens and free parking. Additionally, care is provided through two state- of-the-art medically equipped two-room mobile clinic vans. For homeless HIV patients, these vans can be literal lifesavers, even transversing the County’s dry concrete riverbeds to serve the folks living there.
But many issues remain. “Of particular concern is addressing mental health issues, for which, at this point, there currently is no funding for undocumented Angelos,” Mangia says.
Supervisors Sheila Kuehl and Supervisor Kathryn Barger have also recommended that the County also look at expanding access to substance abuse treatment and mental health care for My Health LA patients. Free substance abuse treatment is available under the plan but is underutilized, so the supervisors directed staff to find out why. Options are also limited for treating less severe, but prevalent mental health issues such as depression and anxiety and the board also directed staff to look at sources of funding to expand available treatment.
“Healthcare is and should be a fundamental right,” Mangia tells the Los Angeles Blade. He hopes to improve St. John’s Well Child & Family Center’s holistic approach to providing the County’s residents with better comprehensive services.