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Little-Known State Provision Gives Some Undocumented Immigrants Full Medi-Cal

Jun 2, 2015

Ilse Gallardo with Centro La Familia says over the past few months there's more undocumented immigrants in Fresno turning to PRUCOL in search for health insurance.
Credit Diana Aguilera / Valley Public Radio

Most undocumented immigrants throughout the country aren’t eligible for Medicaid or Medi-Cal because of their immigration status. But in California there’s a little known provision that allows certain immigrants to obtain full-scope Medi-Cal benefits even if they aren’t here legally.

Until last December, if you were an undocumented resident in Fresno you could get health care through a county program known as MISP. That stopped when the county changed the rules and kicked at least 5,000 undocumented residents out of the program late last year.

"We've seen an increase number of people showing up in our clinic who are uninsured and now are on our sliding scale." Kevin Hamilton, CEO of Clinica Sierra Vista.

This left people searching for ways to get health insurance. Undocumented residents aren’t eligible for health care under the Affordable Care Act, like the state’s health insurance exchange and federally funded Medi-Cal.

But in California a little known legal provision in California law allows some undocumented residents to receive full scope Medi-Cal benefits including some who were left out of the county’s old program.

It’s called PRUCOL- which stands for permanently residing under color of law. It’s a category that applies to immigrants who can prove that immigration officials know they are here and don’t plan to deport them. It includes being granted a stay of deportation, deferred action, and asylum.

Ilse Gallardo with Centro La Familia in Fresno says more and more of her clients are taking advantage of this option.

“We probably do a PRUCOL form five to ten a day depending on how many people come in.”

She says many undocumented people don’t know about PRUCOL or that it might make them eligible for state funded health insurance for low income residents. California and New York are the only states that offer this benefit.

Fresno County health officials say they’re seeing a big increase of people enrolling for Medi-Cal under PRUCOL.

“Most recently with some of the changes in the MISP program it became more sought after in the Hispanic community,” says Oralia Gomez, with the county’s department of social services. “Specifically those individuals that have different type of criteria stay of deportations or just different aspects that they qualify to continue living here.”

Gomez says the uptick is a direct result of the county’s vote to change the old safety net program. Since the changes in December, the county has received roughly 1,800 PRUCOL forms. As of April, it granted full scope Medi-Cal to 1,200 of them. That’s in comparison to the 5,000 people in the old program. But getting Medi-Cal benefits through Prucol is not new.

“This has been in effect since 2009 it wasn’t as widely known but with MISP going away it kind of left a category of individuals seeking,” Gomez says. “Not only that but remember the president approved the DACA program, even at that point the numbers started to increase as well.”

"We've done more PRUCOL forms than we had done in the previous four years combined." -Kevin Hamilton.

When the county excluded undocumented immigrants from the program in December, local health centers felt the impact right away.

“We’ve seen an increase number of people showing up in our clinic who are uninsured and now are on our sliding scale,” says Kevin Hamilton, the CEO of Clinica Sierra Vista. “We’ve done more PRUCOL forms than we had done in the previous four years combined.”

Clinica Sierra Vista partnered up with Community Regional Medical Center to help immigrants who were left behind.

“Community ended up with hundreds of patients who were on MISP and had chronic illnesses who were going to be dropped from coverage,” Hamilton says. "So our conjoined goal was to get as many of these people back in, rerun their Medi-Cal applications and making sure that we ran the PRUCOL statement.”

There are 16 PRUCOL categories that people can fall under in order to get full scope Medi-Cal. The first fifteen require some type of proof and verification, like DACA status or proof of asylum.

But the last category, is a bit different. Hamilton says if a person can indicate that the Immigration and Naturalization Service knows they are here “and has chosen not to deport you or take any other legal actions against you and then that’s what you would say. You say yes and that’s it. There’s no paper requirement at that point.”

Hamilton says this option is controversial because it may open the door for people to commit fraud who are desperate for health insurance.   

“The county did clarify that they did not want anybody to make statements that would be leading and in fact were not supposed to suggest to individuals who are trying to enroll what would qualify them to check that box.”

Back at Centro la Familia, Ilse Gallardo says they’re still a lot of work to do to get more people into coverage.

“We have a lot of my friend or my comadre told me that she signed this form. I want to see if I’m eligible. So I mean it’s growing but there’s still a lot of individuals that might be eligible for it.”

For those who do not qualify, Fresno County recently approved a short-term program offering limited specialty care for unauthorized immigrants.