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Health care bill expands Medi-Cal to undocumented elder immigrants age 50+

Health care trailer bill expands full-scope Medi-Cal to approximately 235,000 undocumented immigrants age 50 and older. 

At a health clinic in Fresno County on Tuesday, Governor Gavin Newsom signed legislation making California the first state in the nation to expand full-scope Medicaid eligibility to low-income adults 50 years of age or older, regardless of immigration status – a major milestone in the state’s progress toward universal health coverage.

With the rise of the COVID-19 Delta variant and the prevalence of health disparities among low-income and minority communities, access to health care coverage for low-income, undocumented immigrants is crucial at this time. 

The new bill, AB 133, will make bold changes toward a more equitable and prevention-focused approach to health care through expanded behavioral health initiatives supporting California youth and people with severe behavioral health challenges, including those experiencing homelessness; extending Medi-Cal eligibility for postpartum individuals; supporting continued telehealth flexibilities; and advancing the state’s innovative CalAIM initiative.

Medi-Cal, Governor Newsom,

At Fresno health clinic, Governor Newsom signs health care trailer bill expanding Medi-Cal to undocumented immigrants age 50 and over. (Photo source: gov.ca.gov)

“We’re investing California’s historic surplus to accomplish transformative changes we’ve long dreamed of – including this historic Medi-Cal expansion to ensure thousands of older undocumented Californians, many of whom have been serving on the front lines of the pandemic, can access critical health care services,” said Governor Newsom. “I thank the Legislature for its steadfast partnership to bring California closer to universal health care coverage and advance comprehensive initiatives to ensure California’s communities come back from the pandemic stronger and healthier than before.”

Medi-Cal becomes the most inclusive health coverage for vulnerable persons in the country

Under AB 133, approximately 235,000 Californians aged 50 years and older are newly eligible for Medi-Cal, including preventive services, long-term care, and In-Home Supportive Services. 

In 2016, California extended Medi-Cal to undocumented children, and in 2019, California became the first state to extend Medi-Cal coverage to all eligible undocumented young adults up to the age of 26. With this newest expansion, the state has the most inclusive health coverage for vulnerable persons in the country covering all persons regardless of immigration status, except those aged 26-49.

AB 133 will also extend the postpartum care period. (Photo by Aditya Romansa on Unsplash)

Additionally, AB 133 also extends the Medi-Cal postpartum care period from 60 days to 12 months without requiring a mental health diagnosis, including for eligible undocumented Californians.

Further benefits and expansions under the new bill 

Governor Newsom signed the legislation on Tuesday at a Clinica Sierra Vista location in Fresno. During his visit, the Governor highlighted the state’s multi-pronged strategy to reach communities with low vaccination rates and the first-in-the-nation measures announced yesterday to require all state workers and workers in health care and high-risk congregate settings to either show proof of full vaccination or be tested at least once per week. Local governments and businesses are encouraged to adopt similar measures amid the growing threat of the Delta variant.

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Changing the life trajectory of children and youth in California, the health care trailer bill creates a prevention-focused behavioral health system in which all Californians age 25 and younger are supported and routinely screened for emerging and existing behavioral health needs – enabling them to grow up healthier, both physically and mentally. The initiative includes the creation of a statewide portal to connect young people with telehealth visits.

AB 133 implements an important component of the California Comeback Plan’s $12 billion homelessness package, creating the Behavioral Health Continuum Infrastructure Program at the Department of Health Care Services (DHCS) to expand treatment and housing options for all Californians, including people experiencing homelessness who struggle with the most acute behavioral health needs. AB 133 implements the Plan’s $2.2 billion investment for DHCS to provide competitive grants to local governments to construct, acquire and rehabilitate real estate assets or to invest in mobile crisis infrastructure to expand the community continuum of behavioral health treatment resources. The Plan’s total investments in this space constitute the biggest expansion in decades for clinically enhanced behavioral health housing.

forced sterilization

California sets aside $7.5 million in reparations to victims of forced sterilization

California follows Virginia and North Carolina as the third state to compensate victims of the eugenics forced sterilization movement that peaked in the 1930s, setting aside $7.5 million in reparations to victims. 

forced sterilization

Among one of the first states to begin forcibly sterilizing people in the early 1900s, California sterilized more than 20,000 people before its law was repealed in 1979. (Photo by Martha Dominguez de Gouveia on Unsplash)

The nonprofit, California Latinas for Reproductive Justice (CLRJ) has been a key leader in pushing for reparations. As an organization, California Latinas for Reproductive Justice is committed to honoring the experiences of Latinas/xs to uphold their dignity, bodies, sexuality, and families. They build Latinas’/xs’ power and cultivate leadership through community education, policy advocacy, and community-informed research to achieve reproductive justice.

“We must address and face our horrific history,” said Lorena Garcia Zermeño, policy and communications coordinator for the advocacy group California Latinas for Reproductive Justice, in a statement to the Associated Press. “This isn’t something that just happened in the past.”

Indeed, the history of forced sterilization in California is not as far in the past as many may think. Among one of the first states to begin forcibly sterilizing people in the early 1900s, California sterilized more than 20,000 people before its law was repealed in 1979. 

However, the Center for Investigative Reporting exposed in 2013 that 144 women in prison were coerced by the state into sterilization procedures between 2005 and 2013. 

California’s proposal for reparations to victims of forced sterilization will also include these women since most of these incarcerated individuals were not given proper counsel, offered alternative treatments, or able to give informed consent to these procedures. 

 

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Facing a horrific chapter in our country’s reproductive healthcare history 

The forced sterilization of thousands by the state cannot be forgotten. It is a horrific chapter in our country’s reproductive healthcare history that needs to be acknowledged. California’s eugenics law enacted in 1909 was one of the first in the United States and it was not the only. Other states, such as Indiana and Washington soon followed and over two dozen states would pass similar laws in the subsequent years.

The law allowed medical officials to order the forced sterilization of people they deemed “feebleminded” or otherwise unfit to have children. Most of these individuals were poor, disabled,  or suffered from untreated psychiatric disorders and a disproportionate number were people of color. They all ranged in age with some as young as 13. Those who supported the eugenics law believed they were improving society by preventing “undesirables” from having children, hoping that forced sterilization would lead to fewer “defective” residents in state care. 

These procedures lasted for seven decades with over 20,000 victims and it’s scale and efficiency was noticed abroad, inspiring similar practices in Nazi Germany

“The promise of eugenics at the very earliest is: ‘We could do away with all the state institutions — prisons, hospitals, asylums, orphanages,'” Paul Lombardo, a law professor at Georgia State University and an expert on the eugenics movement told the Associated Press. “People who were in them just wouldn’t be born after a while if you sterilized all of their parents.”

144 women in prison were coerced by the state into sterilization procedures between 2005 and 2013. (Photo by Kelli McClintock on Unsplash)

This chapter of forced sterilization in California supposedly ended in 1979 with the repeal of the eugenics law. However, we now know sterilizations continued in California prisons appearing to date in 1999 when the state changed its policy for unknown reasons to include “tubal ligation” as part of inmates’ medical care. These coerced procedures continued into the next decade, until 2014 when a state law passed banning sterilization for the purpose of birth control at state prisons and local jails. Facilities are now required to report any “medically necessary” sterilization procedures–which are still allowed under the new law–such as removing cancer or other life-threatening conditions. 

Remembering the victims 

The $7.5 million in reparation to the victims of forced sterilization in the state of California is a good first step in making amends. Under the proposed plan, of the $7.5 million, more than $4 million will go toward the actual payouts. Each survivor is expected to receive about $25,000. 

“I don’t know if it is justice. Money doesn’t pay for what happened to them. But it’s great to know that this is being recognized,” said Stacy Cordova, the niece of Mary Franco, a victim who was sterilized in 1934 when she was just 13 years old. 

Relatives like Stacy are not eligible for the payments, only direct victims. However she says, “For me, this is not about the money. This is about the memory.”

Remembering her aunt, she recalls how Mary Franco loved children and always wanted a family. Paperwork described her as “feeble minded” because of “sexual deviance,” according to Stacy, who has researched her case. Stacy said her aunt was actually molested by a neighbor and her family put Mary in an institution to protect the family’s reputation. She, unfortunately lived a lonely life in a Mexican culture that revered big families, Stacy said.

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Of the remaining funds, $1 million will go toward paying for plaques and markers honoring victims. The remainder of the funds–approximately $2 million will cover an extensive outreach campaign to locate living victims which advocates predict will be difficult. Of the victims, only a few hundred are believed to still be alive. Including the inmates who were most recently sterilized, there are about 600 estimated individuals eligible for reparations. 

However, advocates predict only about 25% of eligible people will ultimately apply for reparations and be paid. The $2 million will be used by California’s Victim Compensation Board to run the program and advertising to locate victims in addition to poring through state records.