California looked at them to close health variations, then retreated

Vanessa C. Sanchez

Fortina Hernández is called “the person who knows everything”.

For more than two decades, a community health worker has supported hundreds of families across Southeast Los Angeles by helping them participate in food aid, share information about health coverage at reasonable prices, and manage medicines for their chronic diseases. It is guided by an expression “an ounce of prevention that deserves a pound of treatment.”

But it gets only about 20 dollars per hour from the Community Health Organization and must put a second job to cover their expenses. “They pay a little and expect a lot,” she said in the Spanish language. “We are building confidence. We offer support. We are the shoulder depending on it, but we do not get fair wages.”

California looked at the professional character to thousands of health workers in society such as Hernandez to improve the health of the migrant population, especially the population of Spanish origin, who are often experienced Higher rates From chronic diseases, it is more It is likely that you are not secureAnd confronting more Cultural and linguistic barriers When trying to access services. Studies show their work You may reduce Hospitals as well as the emergency room and urgent care visits.

The state was closely raised to a series of Expert recommendations It was presented in 2019 to unify the training and issue certificates, integrate these workers into the workforce for health care, and provide fair wages, including payment through Medi-Cal, the health insurance program in the state, to compensate for the traditional work on volunteering or for a low fee. But after six years, California retracted many of these initiatives.

The state has canceled a program to issue certificates and almost all funding has declined to train and expand this workforce, although it set a goal 25,000 workers By this year. Although Medi-Cal has started covering its services, the participating health plans put the requirements of unequal bills, which makes it difficult for workers to obtain compensation. The state did not continue to increase the planned wages.

with Federal financing discounts It has just passed and President Donald Trump targets migrants to deport – even Share medicaid personal data With the Ministry of Internal Security – defenders are afraid that California is giving up the Hygiene Rights Initiative for Immigrants, Persons with Low -income when they say this effort is more required.

“We are in a very comfortable position at the present time,” said Carrie Sanders, chief policy manager in the California Health Network, a state of defense of health stocks at the state level.

“The state has taken difficult but necessary steps to ensure financial stability” and that the administration is still a dialogue with health workers in society. Ross added that the democratic ruler, a Possible presidential candidateHe is still committed to defending the targeted immigrants by the Trump administration.

“Our office is on the street”

There are more than 60,000 community health workers worldwide, including approximately 9200 in California, and this workforce is expected to grow 13 % over the next decade, three times at the speed that all professions enjoy, according to what it said. 2024 data From the American Labor Statistics Office. But experts say that these numbers are less than the dependency of health workers in society and that many work is outside health care and government institutions.

A community health factor is the term umbrella that includes peer supporters and community health representatives. These workers, often known as promotion, It tends to be women Those who work in clinics, hospitals, public health departments and local non -profit organizations, are reliable places and have the most urgent health needs in their community.

Besides helping people to manage chronic diseases such as heart disease and diabetes, they boost reproductive health, child health and oral hygiene, and they help The elderly with dementia Preventing injuries and reviewing medicines. It can make people feel safe when reporting domestic violence and other violations. They also link people to housing and food assistance. “The health worker in society does not sit at an office,” Hernandez said. “Our office is on the street.”

In 2019, the California Health Manpower Committee recommended in the future to integrate health workers into the health care system, and in 2022, he authorized the state 281 million dollars For three years for the Ministry of Health Care for Health Care and Information, which oversees the development of the workforce for health care, to employ, train and ratify it.

The agency has sought to unify training and issuing certificates, but some community groups are afraid to create barriers to entry by not giving sufficient credit to live experience and cultural competence. But just as the agency provided more flexibility and allowed community training, the state reduced $ 250 million in financing last year due to budget restrictions. This year, the certificate program was officially canceled.

Andrew Deloxia spokesman said that the agency is now considering a program to accredit community organizations instead of individual workers and plans to spend $ 12 million on technical assistance, workforce development and salaries for those working with migrant societies.

According to the national policy of state health policy, 32 other countries Provide a voluntary or mandatory program for community health certificates.

Some community health defenders say that California is missing an opportunity to sculpt a functional path to this workforce. Currently, some courses offered by non -profit organizations, provinces and colleges It requires feesDegree, English fluency, or previous experience. Most of them are concentrated in the San Francisco or Los Angeles region, and they leave Training deserts In a large part of the state.

Lurdis Bernes, a dentist from Ecuador, is a model for how to integrate health workers in the community in the health care system. She started as a volunteer promoter more than a decade ago, and in 2019 she received free training from Los Angeles Province, allowing her to move to a full -time job with advantages of the District Mental Health Ministry to help Spanish -speaking women to manage depression and anxiety while recovering from drug use.

Bernis is now planning to become a supportive supporter to a counterpart inside hospitals and clinics. Meanwhile, many of her colleagues with contracts of experience are still stuck in low -wage roles and cannot withstand training for progress. “There are promoters who have 20 to 25 years of experience, but they are still volunteering,” Bernes said in Spanish.

Medi-Cal role

To pay community health workers, Medi-Cal started covering their services in July 2022, but California Increased wages planned wages have been suspended For them after the voters agreed to the 35th proposal, which increased the salaries of doctors, hospitals, community clinics and other service providers instead. Since then, the state has not yet established a unified system of how to contract health plans with organizations that employ community health workers.

“We have to jump across the hoops,” said Maria Limos, Executive Director of Visión y novromiso, a non -profit organization based in Los Angeles, who represents community health workers. “It only causes chaos, because every plan can have different requirements.”

Limos said that the organization took nearly six months to create one health plan.

Although Medi-Cal compensation is linked to individual tasks, ranging from $ 9.46 to $ 27.54 for 30 minutes of work, defenders say they are not fully compensated for the time when they spend confidence and follow-up of patients. Defenders say that these workers should earn at least $ 30 visits, with benefits, but many earn about $ 21 per hourOften without interest.

Defenders say they were surprised by how these services are used in an unenviable program in a program of 15 million California residents. MEDI-Cal registrars used these services in the first year, as it rose to 68,000 last year, according to state data. “I don’t think it has reached the capabilities that the ruler spoke about, and that we all imagined that he could achieve this,” Sanders said.

Grace Milgosa, a spokeswoman for the California Healthcare Ministry, said the agency, which runs Medi-Cal, has witnessed a “fixed and upward trend” and believes that data reduces use because interest sometimes is combined with other services.

suggestion To assess whether the Medi-Cal care plans are doing enough awareness and education to meet about community health services this year.

More important than ever

Through health financing discounts from the Trump administration and the approval of tax legislation and spending for the Republican Party, preachers feared that there will be less funding and support for health workers in society, which reduces the workforce that addresses health variations. Indeed, the Ministry of Public Health in Fresno Province said it had reduced community health workers by more than half, 49 jobs to 20.

However, awareness is more important than ever. As the Trump administration continues to migrate raids, which seems to target At least one health clinic In the state, defenders and political researchers say that community health workers can work as mediators for migrant patients who fear medical care in hospitals and clinics.

Without the presence of a state certificate program, there is no increase, and training funds are diminished, the road to professionals in community health is unclear, which makes workers feel backward.

“At the government level,” Hernandez, a veteran community, said, “At the government level, there is still a long way before this work is estimated and somewhat compensated.”

This article was produced by KFF Health NewsWhich is published California HealthyinIndependent editorial service for California Health Care Corporation.

KFF Health News It is a national news room that produces in-depth press on health issues and is one of the basic operating programs in KFF-independent source of health policy research, polling, and journalism. Learn more about KFF.