Preventing Care

Proposition 187 may have stalled in the courts, but it seems to have scored at least one victory: persuading immigrants—legal and otherwise—not to apply for services such as Medi-Cal, which provides free access to health care for low-income residents regardless of citizenship.

Take, for example, the case of Karla Ceja, now a 19-year-old resident of Anaheim. Born in Mexico, Ceja has spent all but her first five years of life in Orange County. Fluent in English, she's still awaiting her green card. In December 1998, Ceja became pregnant and decided to keep the baby. When she went to a community clinic in Santa Ana for a physical checkup, a nurse asked Ceja if she had insurance coverage; Ceja said she did not.

Ceja says she was then asked if she wanted to pay cash. Because there was only a small fee for the exam, she agreed. After more than four months of pregnancy, Ceja went to a hospital in Garden Grove for another checkup, where she also paid cash; Ceja says she was never asked if she wanted to apply for Medi-Cal.

Worse, the hospital discovered Ceja was not producing enough amniotic fluid for her baby. As instructed, Ceja stayed home from school and lay on her left side and drank water all day. “When I went back to my next appointment, they said I still wasn't gaining anything,” she recalled. “And when I got home, I started having spot bleeding.”

Things only got worse from there. After spending two days in the hospital, Ceja was allowed to go home when the bleeding stopped. But two weeks later, in June of last year, she was rushed to UC Irvine Medical Center, where doctors performed a Caesarean section. At one point in the confusion, a county social worker asked Ceja if she had Medi-Cal. When Ceja told her that she hadn't applied for Medi-Cal because she was still awaiting her green card, the social worker apparently backed off.

Ceja's baby daughter, whom she named Anabeli, lived for only six hours.

“I remember that the doctors and nurses came into my room and the social worker was there,” Ceja said. “They told me something was wrong with the baby and she wasn't going to be able to live. The oxygen was intoxicating her blood, and they said they were going to have to turn off the machine.”

The tragedy of this event was only compounded by what happened next. About a month after Ceja's visit to UCI Medical Center, the bills started pouring in—not just from the hospital but also from the community clinic in Santa Ana and the hospital in Garden Grove. The bills, which Ceja says she is unable to pay, total thousands of dollars. Only the delivery of Anabeli was covered by Medi-Cal.

In retrospect, the biggest tragedy is that Ceja didn't realize until it was too late that she was eligible not just for Medi-Cal but also for the federally funded Healthy Families program, which covers low-income mothers and their children. Her confusion about the effects applying for Medi-Cal might have on her green-card status—perhaps an intended consequence of Prop. 187—led to a chain of events that, never rectified by county social-services workers or hospital officials, now threatens to leave Ceja with a ruined credit record and never-ending debt.

Interviewed about Ceja's case, health-care officials in Sacramento and Orange County acknowledged that not enough low-income residents are aware of what medical benefits are available. Ken August, deputy director of public affairs for the California Department of Health Services, explained that anyone younger than 21 or older than 65 is eligible for Medi-Cal, as are disabled people of all ages—with limited exceptions based on a high level of income.

August said that Ceja would have been eligible for Medi-Cal through CalOptima, which administrates the program in Orange County.

Kathleen Crowley, CalOptima's public-affairs director, responded to Ceja's story by saying the county's social-services agency is responsible for enrolling people in CalOptima.

“Folks still have difficulty with access” to CalOptima, she said.

“A while ago, people were showing up in hospital emergency rooms who had never seen a doctor before,” Crowley said. “It was a huge problem for UCI Medical Center. They had all these overflowing emergency rooms and women showing up for a last-minute delivery and there was no room for them.

“To a certain extent, immigration status causes a fear factor for some people. Women who are pregnant and illegally in this country may not realize that they are eligible for prenatal care just as if they were legal. A lot of them don't know, but they should because the entire reason for this policy is so that their babies can be born healthy.”

“It's a recurring problem and one that is pretty widespread,” commented Nativo Lopez, executive director of Hermandad Mexicana Nacional, the Santa Ana-based social-services organization that primarily serves Mexican immigrants. Lopez said that many immigrants are “treated shabbily by Medi-Cal workers or are turned away when they go in to apply.”

“Therefore, even when people would probably qualify, they don't seek Medi-Cal coverage,” Lopez concluded. “To avoid problematic confrontations—or the impression that they are asking something of the government—they just simply don't apply.”

Ceja is now dealing with one or two telephone calls per day from collection agents assigned to her case.

“How can I pay more than $10,000 when I'm not even working?” she wondered. “That's all they want—the money. They don't care what happens to you once you are out of their hands.”