Many County Poor Shun Free Services

It should be an easy sell, especially to the needy: free medical care, food coupons and other government benefits.

But more than 400,000 Los Angeles County residents eligible for such aid--mostly children--have not signed up. Many families even pass on free immunizations and treatment of communicable diseases.

The principal reason, say experts, is that immigrants fear receipt of such services may jeopardize their legal status or keep loved ones out of the United States. Some are afraid they will be deported.

Health advocates say new federal rules issued last week should end such fears by providing explicit protection for immigrant families.

Martha Guardado is among those who will have to be convinced. Born and raised in East Los Angeles, Guardado is a U.S. citizen who eschews public medical insurance for herself and her U.S.-born daughter. She worries that the government would deport her husband, a Mexican national, in retaliation for using the service.

“I don’t need the hassles,” Guardado said.

With the new guidelines in place, officials and health advocates are gearing up for a massive publicity campaign to spur enrollment in Medi-Cal--the joint federal and state health insurance plan for the poor--and Healthy Families, which targets uninsured children.

“In the last few years, immigrants have been educated that government-sponsored health benefits aren’t for them,” said Rodolfo Diaz, executive director of the Community Health Foundation of East Los Angeles, a private care provider. “Now we have to convince them otherwise.”

Federal law has long held that noncitizens likely to rely on public benefits can be deported or barred from entering the United States.

During the 1990s, officials of the Immigration and Naturalization Service and the State Department as well as federal immigration judges increasingly have cited past receipt of public aid as a barrier for immigrants, sparking abandonment of many services.

“Immigrants have lived in a culture of fear for many years now,” said Viola Gonzales, executive director of the Latino Issues Forum, a statewide public policy institute.

The problem is most severe in Los Angeles County, home to 40% of California’s 7 million uninsured people, mostly working poor Latinos, according to Assembly Speaker Antonio R. Villaraigosa (D-Los Angeles). He estimates that more than 500,000 uninsured children statewide are eligible to be enrolled in the Healthy Families program alone.

“We’re going to do whatever we can to get the word out,” said Villaraigosa.

Officials declined to release details on the outreach campaigns until later this week. Community-based clinics and other medical groups are expected to participate.

A state blueprint produced last month envisioned a multi-pronged campaign including community forums, mailers, radio and TV ads, and a 24-hour hotline. Financing remains unclear, though Villaraigosa said there are untapped state and federal funds.

The new federal rules say eligible noncitizens may use, without penalty, health and nutrition programs, including food stamps, as well as day care, disaster relief and other initiatives.

Receipt of welfare checks, however, can be cited as a reason to deny permanent residence status to immigrants, or make them ineligible to bring a relative into the United States.

Fear and need contribute to the steady business at the Community Health Foundation of East Los Angeles, one of the state’s busiest private clinics.

Genoveva Rodriguez, a 53-year-old grandmother of 14, said she dropped out of Medi-Cal a few years ago because she was afraid it would hamper her application for U.S. citizenship. The Pico Rivera woman, a longtime legal resident, says she pays cash or seeks free services in clinics such as this one.

“People said Medi-Cal could cause you problems in the future, so I don’t use it,” Rodriguez said as she waited to see a physician about pains in her side.

Guardado, 25, said Medi-Cal paid for the birth of her daughter, Juliana, 3. But she says she hasn’t used the plan since, fearing consequences for her husband, who recently obtained his green card. “So I should sign up for Medi-Cal and get my husband deported?” asked Guardado as she waited in the clinic for a checkup for her child. “No thanks.”

The belief that the government would retaliate against immigrants seeking public aid is a legacy of the rancorous debate over Proposition 187. The 1994 state ballot initiative sought to bar illegal immigrants from receiving most government services, including public education.

The 1996 congressional welfare overhaul signed into law by President Clinton mandated deep cuts in aid for all noncitizens, including legal immigrants.

A study last year by the Urban Institute, a Washington-based organization, showed a 71% drop in approved applications for health and welfare benefits by legal immigrant households in Los Angeles County between 1996 and 1998.