California says it can no longer a ord aid for COVID testing, vaccinations for migrants

ALL day and sometimes into the night, buses and vans pull up to three state-funded medical screening centers near California’s southern border with Mexico.

Federal immigration officers unload migrants predominantly from Brazil, Cuba, Colombia, and Peru, most of whom await asylum hearings in the United States.

Once inside, coordinators say, migrants are given face masks to guard against the spread of infectious diseases, along with water and food. Medical providers test them for the coronavirus, offer them vaccines, and isolate those who test positive for the virus. Asylum-seekers are treated for injuries they may have suffered during their journey and checked for chronic health issues, such as diabetes or high blood pressure.

But now, as the liberal-leaning state confronts a projected $22.5 billion deficit, Gov. Gavin Newsom said the state can no longer afford to contribute to the centers, which also receive federal and local grants. The Democratic governor in January proposed phasing out state aid for some medical services in the next few months, and eventually scaling back the migrant assistance program unless President Joe Biden and Congress step in with help. California began contributing money for medical services through its migrant assistance program during the deadliest phase of the coronavirus pandemic two years ago. The state helps support three health resource centers — two in San Diego County and one in Imperial County — that conduct covid testing and vaccinations and other health screenings, serving more than 300,000 migrants since April 2021. The migrant assistance program also provides food, lodging, and travel to unite migrants with sponsors, family, or friends in the U.S. while awaiting their immigration hearings, and the state has been covering the humanitarian effort with an appropriation of more than $1 billion since 2019.

Though the White House declined to comment and no federal legislation has advanced, Newsom said he was optimistic that federal funding will come through, citing “some remarkably good conversations” with the Biden administration. The president recently announced that the United States would turn back Cubans, Haitians, and Nicaraguans who cross the border from Mexico illegally — a move intended to slow migration. The U.S. Supreme Court is also now considering whether to end a Trump-era policy known as Title 42 that the U.S. has used to expel asylum-seekers, ostensibly to prevent the spread of the coronavirus.

Already, one potential pot of federal money has been identified. The Federal Emergency Management Agency and the U.S. Department of Homeland Security issued a statement to KHN noting that local governments and nongovernmental providers will soon be able to tap into an

California dangles bonuses for nursing homes...

deputy director at the Department of Health Care Services, which administers Medi-Cal, the state’s Medicaid insurance program for people with low incomes and disabilities.

Patient advocates and industry officials described the changes as an improvement, but they expressed skepticism about whether they would work. They said the bonuses fall short of what’s needed to address chronic understaffing and the closure of rural facilities.

Last year, lawmakers allocated $280 million for the bonus program — just a fraction of the more than $6 billion that nursing homes take in every year from Medi-Cal. The safety-net health program insures two-thirds of nursing home residents in the state. Meanwhile, the money nursing homes could get by improving working conditions for their employees is comparable to temporary funding that facilities received from the state during the pandemic — which means funding essentially remains flat overall.

“The overwhelming majority of the money goes to facilities regardless of what their quality looks like,” said Tony Chicotel, an attorney with California Advocates for Nursing Reform, a nonprofit that represents long-term care residents. “The worst performers will still get paid about the same as the best performers.”

Newsom and legislators adopted the new payment structures in a state budget bill last year, explicitly calling on regulators to leverage taxpayer funding in order to improve pay and working conditions for staffers who feed, bathe, dress, and ensure the wellbeing of elderly and frail patients at the state’s 1,200 nursing homes. But the pandemic had already exposed deep, systemic problems at nursing homes. While older adults have a heightened risk of dying of covid, the coronavirus spreads more easily in institutional settings — and some studies have found that nursing homes with fewer staff members had significantly higher covid infection and death rates.

According to an industry official, California’s nursing homes care for 350,000 residents each year. More than 10,000 nursing home residents have died of covid since January 2020, about a tenth of Californians killed by the virus so far.

Nationwide, at least 163,538 had died of covid in U.S. nursing homes as of Jan. 22, according to the latest data from the Centers for Medicare & Medicaid Services.

In an August memo, CMS Deputy Administrator Daniel Tsai encouraged states to use Medicaid money to improve training and staffing at nursing homes. The federal agency is also reviewing mandatory staffing levels.

In California, regulators are acting on the belief that increased staffing and better working conditions will reduce patient injuries and emergency room visits. Hence, facilities that make improvements in those areas will qualify for boosted MediCal payments. Guidelines are expected to be drafted this year.

Democratic lawmakers, many with ties to labor, suggested the administration consider rewarding facilities that unionize or pay a prevailing wage. The inclusion of those incentives in the bill was a win for labor, since only 20% of California nursing home workers belong to a union.

Industry officials have largely shrugged at the state’s incentives. They said Medi-Cal payments are lower than what they receive from Medicare and private health plans.

“This is not going to move the needle fundamentally as long as the state continues to disinvest so badly into nursing homes,” said Craig Cornett, CEO of the California Association of Health

Facilities. “Facilities desperately want more staff. They want to hire more staff, but they are paid so poorly through Medi-Cal that that’s virtually impossible.”

Harrington, who is implementing the nursing home rules, called the funding level “appropriate.”

This isn’t the only change the state has made to get nursing homes to hire more workers.

Lawmakers rewrote complicated Medi-Cal formulas last year so that nursing homes have an incentive to pay workers more. Under the change, facilities can collect up to 5% more in labor costs every year through 2026, compared with a 2% increase for administrative and other nonlabor costs. That amounts to an estimated $473 million more for nursing homes in the next fiscal year, according to the Department of Health Care Services.

Labor is also pushing for a statewide $25 minimum wage for health support staffers, who include nursing home workers. In 2022, California nursing assistants earned an average $20.38 an hour across the health industry, according to the state Employment Development Department.

“We’re really making sure the needs of a patient are met,” said Arnulfo De La Cruz, president of Service Employees International Union Local 2015, which represents nursing home workers and in-home caregivers. “And a big part of that is addressing the needs of workers who deserve to work with dignity, to be well paid, to have benefits, and certainly not to be overly taxed and stressed out physically because they’re caring for too many patients.”

(Samantha Young/Kaiser Health News)

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.