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An additional 90,000 people — undocumented immigrants ages 18-25 — were recently granted eligibility for Medi-Cal. Image via

published on August 2, 2019 - 12:47 PM
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Federally Qualified Health Centers in California and other Medi-Cal providers are getting ready for an influx of patients — nearly 100,000 to be exact — that could mean strain in an already understaffed medical community.

In July, Gov. Gavin Newsom signed a measure to extend coverage to undocumented immigrants between ages 18 and 25. The measure is expected to extend coverage to approximately 90,000 people in the state.

Funding for the new measure is expected to come out of California’s budget surplus, pegged at $21.4 billion.

For Federally Qualified Health Centers in the region, this means a lot more patients coming through the door, but they’ll be doing so in one of the most thinly stretched areas of the Central Valley for treatment — primary care.

According to The Robert Graham Center, which focuses on family medicine and primary care policies, California will be short by 8,200 physicians 11 years from now, while the Valley is behind even more than the average in part due to the aging workforce. In fact, a report from four years ago shows that 29% of Fresno County’s physicians are older than 60, while Tulare and Kings County are at nearly 40%.

On Monday, the concerns of the physician shortage became the subject of a state hearing. In it, attendees discussed the lack of proper nutrition and parks for active living, but also discussed the problem of not enough doctors for all the patients living in the Valley.

Gary Herbst, CEO of Kaweah Delta Medical Center, added that approximately 43% of patients treated at their facilities are covered by the Medi-Cal system, and while there’s no guarantee of a large influx, he acknowledged the possibility that there will be more people seeking primary care treatment who were previously uncovered and thus reluctant.

“However, if this patient population now feels more comfortable seeking primary and specialty health care services — like annual physicals and elective procedures — it might put some strain on our current workforce,” Herbst said. “Particularly for our county’s network of rural and Federally Qualified Health Clinics and Centers.”

But Herbst says there’s a big silver lining in all of this. As it stands, Tulare County already has the highest level of Medi-Cal enrollment in California, covering an estimated 60% of the population. With respect to Kaweah Delta as a whole, Herbst further said that they will now have coverage through Medi-Cal and be reimbursed for some of the cost of providing care to this population.

“Now with Medi-Cal coverage in place, this population of patients might also now be more inclined to seek health care sooner though outpatient clinics, urgent care centers and the emergency department,” he said. “This is a good thing.”

This could also mean potential financial boons to FQHCs in the region, with organizations like United Health Centers and Camarena Health in Madera County already experiencing significant growth recently.

However, another point of concern for some is not only the workforce end of the issue, but also the financial. Greg Eaton, president at Eaton & Eaton Insurance Brokers in Downtown Fresno, says it’s not realistic to assume that the $98 million being allocated towards the measure will cover the 90,000 people now being insured, especially if there are more people to come.

“Health insurance… is all about actuary numbers. You get a big enough pool to where the numbers can prove themselves out, so it can’t be a pool of 1,000 or 2,000,” Eaton said. “Typically you’d like a pool at 100,000, and into that mix, you’re going to have some people that are really sick, some that are really good and then everybody else in-between.”

Eaton warned that these costs will eat up the $98 million, while saying that there are other problems that California needs to address with the surplus — namely its unfunded pension liability and medical for retirees.

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