Improving Immigrant Health

Understanding the challenges for implementing California's inclusive immigrant policies in rural regions

Maria-Elena de Trinidad Young, PhD is an Assistant Professor of Public Health at the University of California, Merced.  Her research seeks to understand the impact of the U.S. immigration system on the well-being of immigrants and their families. She is examining the ways in which national, state, and local policies create contexts of both immigrant integration and criminalization and the impact of these contexts on health. Her most recent paper, published in the American Journal of Public Health, presents state-level policy data to demonstrate the patterns of criminalization and integration policies across U.S. states. Professor Young recieved her PhD from the University of California, Los Angeles, and her MPH from the University of California, Berkeley.  

Project Description | This project aims to produce actionable policy knowledge for advocates and policy-makers to be able to understand and respond to the impact of the state’s immigrant policies on rural and agricultural communities. Professor Young will be focusing on three aims: 1) To identify the major challenges and barriers for immigrants in rural regions of California to access the services, rights, and protections granted under California’s immigrant policies,  2) to understand the role of immigrant service providers, as well as county and city policies and agencies in implementing state policies in rural regions of California. For example, this may include disseminating policy information, administering state programs, or connecting immigrants to services, and 3) to identify the individual, organizational, or policy strategies used by service providers, agencies, and advocates to ensure that rural communities benefit from inclusive immigrant policies. 

Community Partners | Professor Young will collaborate with the Scholars Strategy Network to disseminate findings to policymakers. 

Protecting and Welcoming Immigrants in the Healthcare Context

Dr. Altaf Saadi is a UCLA Health Sciences Clinical Instructor of Medicine, neurologist, and a National Clinical Scholars Program Fellow. Dr. Saadi completed her residency at the Partners Neurology Residency Program at Massachusetts General Hospital and Brigham and Women’s Hospital. She graduated cum laude from Harvard Medical School, where she completed a thesis about preventive health practices among refugee women.

Dr. Saadi believes in promoting social justice through equity in health care and is a leader-advocate for marginalized communities in the United States and abroad, by combining her interests in health disparities, health services research, and implementation science. She is also interested in promoting diversity in medicine. She is a firm believer in upholding human rights for all, including those in immigration detention, children or adults. She hopes to translate clinical research into improved public health and health care delivery on the local, state, and national levels.

Project Description | Dr. Saadi conducted qualitative research across five states with the largest undocumented populations (CA, FL, NY, FL, IL) to garner information and understand the factors that enhance or prevent implementation of a "safe space" health institution to safeguard immigrant patients and their families. Dr. Saadi will create animated videos and infographics to share her gained knowledge and best practices findings with other health care professionals and institutions. The videos will present the different organizational policies and actions that can be put into place by health care facilities to protect and welcome their immigrant patients. Due to highly aggressive and discriminate immigration enforcement and anti-immigrant rhetoric under the Trump Administration, immigrant communities in California have decreased their use of important health services. Immigrant policy impacts mental health outcomes like depression and anxiety—for adult immigrants, immigrant children, and US-born children in families with mixed immigration status. Dr. Saadi’s Cal-IHEA evidence to action videos will use a holistic approach to highlight the many institutional policies and actions that can help immigrant patients in the clinical setting using a spectrum of interventions at three different levels: (1) hospital and clinic, (2) provider, and (3) patient.

Community Partners | Dr. Saadi will partner up with the California Immigrant Policy Center to use the videos to advocate for improving the health care environment for immigrants throughout California and potentially across the United States.

Policy Options to Expand Health Care Coverage for the Undocumented

Arturo Vargas Bustamante, PhD is an Associate Professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health. He has a broad background in health policy, with specific training and expertise in health care survey research and data analysis, health care cost estimation, economic valuation and program evaluation. His research investigates unexplored or underexplored topics on access to health care, predominantly among Latinos/Hispanics and immigrants in the United States. Professor Vargas Bustamante has a decade of experience researching access to care among the undocumented in California.

He also specializes in the comparative analyses of health care delivery systems in Latin American countries. The outcomes of his research have had direct policy applications, particularly since they estimate the share of disparities that can be attributed to socioeconomic and demographic factors and the corresponding part associated to health system variables, such as usual source of care and insurance status.  

Professor Vargas Bustamante holds a PhD (2008) in Public Policy, an M.A. (2006) in Economics and an M.P.P. (2004) all from UC-Berkeley. As part of his professional experience, he worked as a consultant for the Inter-American Development Bank and for the California Program on Access to Care. Before he worked for the Health Care Financing Administration of the Mexican Ministry of Health.

Project Description | Professor Vargas Bustamante will disseminate his work on how state and local governments in California have expanded coverage to some undocumented immigrants since the approval of the ACA in 2010, and how local policies compare and contrast across California. Undocumented immigrants are ineligible to participate in the Affordable Care Act (ACA) health insurance expansion. In spite of it, state and local government programs in California have tried to close the gap between its ACA-eligible and other populations. Locally funded initiates have offered different forms of health insurance coverage or a medical home to some undocumented immigrants through the expansion of Medi-Cal eligibility to young adults, or through locally managed health plans such as Healthy San Francisco or My Health LA. The Cal-IHEA project will produce and disseminate an implementation toolkit to state and local health services and public health agencies to enable them to assess existing efforts to cover the undocumented and inform the design of their own programs and policies. His Evidence to Action project will assemble useful evidence and policy lessons into an easily accessible implementation toolkit that identifies policy option to expand coverage to underserved undocumented immigrants.

Community Partners | Professor Vargas Bustamante will collaborate with the California Primary Care Association (CPCA)(link is external) and the Latino Coalition for a Healthy California(link is external) to disseminate his toolkit and to support a more effective translation of lessons to state and local policy arenas.

Cecilia Ayon

UndocuElders in the Inland Empire

Cecilia Ayón, PhD is an Associate Professor at the School of Public Policy at UC Riverside.  Her research broadly examines factors that promote and hinder Latino immigrant families’ wellbeing, health disparities, and intervention development and evaluation. Her research has been founded by the Silberman Foundation and the Foundation for Child Development.  She is currently carrying out a large mixed methods study on the ethnic-racial socialization process among Latino immigrant families; the study examines the impact of restrictive state level immigration policies and discrimination on parenting practices. Her research interests include: Latino immigrant family wellbeing, immigration policy, health disparities, intervention research, and social policies. She has a PhD in social welfare from the University of Washington and a master of social work degree from California State University, Long Beach.

Project Description | Dr. Ayón’s Cal-IHEA study will shed light on the health needs of a segment of the undocumented population that is often ignored – older adults. It examines undocumented older adults’ perceptions and experiences regarding their health needs and barriers to health care; as well as the socioeconomic resources (i.e., employment, retirement plans, housing, family and other sources of support) available to them as they get older in the US. The project aims to produce data that will support health policy change in California and will include: 1) health and health care narratives from the perspective of undocumented older adults; and 2) a health profile for those interviewed (including global health, depression, and activities of daily living and instrumental activities of daily living measures). Dr. Ayón is conducting interviews with older adults ages 65+ and those approaching retirement age 55-64. Dr. Ayón will create three main products that will be broadly disseminated: 1) a policy brief on the health and barriers to health care access experienced by undocumented older adults; 2) educational visits with elected officials in the Inland Empire region to share study findings and discuss the need for legislative change; and 3) a community forum at UCR to disseminate study findings.

Community Partners | Dr. Ayón will partner with the Inland Coalition for Immigrant Justice (ICIJ), Inland Empire Immigrant Youth Collective (IEIYC), and the California Immigrant Youth Justice Alliance (CIYJA) in the development and dissemination of the policy brief, coordination of visits with elected officials, and convening of the community forum.

Path to Health (Camino a la Salud)

Gerardo Moreno, MD, MS is Associate Professor of Family Medicine at the UCLA David Geffen School of Medicine and Director of UCLA PRIME-LA (Program in Medical Education) which focuses on Leadership and Advocacy for underserved communities. He received his medical degree from the University of California Los Angeles, and completed his residency training in Family Medicine at the University of California San Francisco. He received a Masters of Science in Health Services from the UCLA School of Public Health and completed a post-doctoral research fellowship in the Robert Wood Johnson (RWJ) Foundation Clinical Scholars Program at UCLA. Dr. Moreno is associate editor of the Annals of Family Medicine and serves on the Board of Directors for the American Board of Family Medicine (ABFM). 

Project Description | Dr. Moreno and colleagues are conducting a qualitative evaluation of the County Medical Services Program (CMSP) Path to Health Pilot Program (Camino a la Salud), which extends coverage for primary and preventive services to low-income, undocumented county residents. CMSP provides medical care to indigent adults in 35 rural counties across California, and the pilot program expands coverage to individuals that previously only qualified for emergency medical services under Medi-Cal. Dr. Moreno’s Cal-IHEA project assesses Path to Health implementation in 13 counties from the perspectives of community health center patients, clinicians, and staff using key informant interviews. The Cal-IHEA project will shed light on the implementation factors that impact the effectiveness of Path to Health.

Community Partners | Dr. Moreno will collaborate with community health centers and community stakeholders across the state to evaluate the Path to Health Pilot Program.

Paying for Universal Coverage: California’s Integrated Healthcare Opportunity

Richard M. Scheffler, PhD, and Stephen M. Shortell, PhD, MPH, MBA, will lead this project. Dr. Scheffler is Distinguished Professor of Health Economics and Public Policy at the School of Public Health and the Goldman School of Public Policy at UC Berkeley. Professor Scheffler directs the Nicholas C. Petris Center on Health Care Markets and Consumer Welfare and has been a Rockefeller and a Fulbright Scholar. Professor Scheffler has published over 200 papers and edited and written twelve books. Dr. Shortell is Professor of the Graduate School and UC Berkeley School of Public Health Dean Emeritus and co-director or the Center for Healthcare Organizational and Innovation Research. His expertise is in analyzing organizational factors that are associated with physician organization and health system performance. His more than 300 peer-reviewed papers have appeared in a wide variety of organizational and health services/health policy research journals, and he is the author or co-author of ten books. Dr. Shortell is an elected member of the National Academy of Medicine, past editor of Health Services Research, and past president of AcademyHealth.

Project Description | Building on the work of The Berkeley Forum in 2012-2014, Drs. Scheffler and Shortell will disseminate a follow-up white paper entitled “California Dreamin': Integrating Health Care, Containing Costs and Financing Universal Coverage” to the legislative and executive branches of California state government. The paper presents evedence to policymakers about how moving more Californians, including those on Medi-Cal and those currently uninsured or under-insured, into integrated healthcare models would both improve health outcomes and lead to substantial cost savings. The resulting cost savings could then be used to cover all remaining uninsured in the state, who are disproportionately undocumented immigrants. Drs. Scheffler and Shortell led discussions of the white paper at a series of stakeholder meetings.