Santa Barbara County Health Looking to Move 7,500 Patients to Other Providers

The Santa Barbara County Public Health Department is giving itself just 100 days to engineer a mass hand-off of no fewer than 7,500 patients — all of whom are immigrants without documentation — now enrolled for regular care at any one of the county’s five public health clinics.

Driving this logistical nightmare are new federal rules announced by Robert Kennedy Jr., Donald Trump’s Health and Human Services Secretary, with much fanfare on July 10. They bar undocumented immigrants from receiving any federal care. Kennedy stated he was protecting benefits that should be for hardworking Americans and that it would eliminate an incentive for undocumented immigrants to cross the border illegally.

In so doing, Kennedy set into motion a sweeping reversal of complex federal administrative rules and practices that have been in effect for 30 years.

Although a coalition of 21 states, including California, and the District of Columbia have since succeeded in getting a court injunction blocking this order from taking effect, Santa Barbara County is taking precautionary steps to be able to comply by January 1 since injunctions against Donald Trump’s policies have had a tendency to be overruled in higher federal courts.

Kennedy’s administrative edict was slated to go into effect immediately, so if the injunction should be reversed, the edict’s impact might also be immediate.

“We don’t want to be suddenly forced to find new care options for our patients,” said County Public Health Director Mouhanad Hammami. “What we want is to ensure the continuity of care for all our patients. If something happens along the way to maintain the injunction, great. But if not, we’re prepared.”

Because the county’s public health clinics are legally designated as Federally Qualified Health Centers, an obscure but highly remunerative federal classification that rewards health providers targeting low-income patients, county health officials fear that the county’s Public Health Department could find itself in cataclysmic financial jeopardy legally should the injunction be repealed.

Kennedy’s edict does not spell out the consequences of noncompliance. But Hammami’s not inclined to roll the dice. If found out of compliance, he said, the worst-case scenario would be that medical care for 100 percent of the clinics’ patients would be jeopardized.

The 7,500 people in question only make up 25 percent of county health patients. By reassigning those 25 percent, he reckons, the county can keep the funding needed to care for the other 75 percent.

It’s the hardest decision he’s made in his long professional career, Hammami said. “Everyone is being uprooted, and it’s nobody’s fault,” he said. The loss of 7,500 patients will cost Hammami’s department $8.2 million a year as a result, 40 current employees will have to be laid off, and even more positions, now vacant, will be left indefinitely unfilled.

Laura Robinson, union chief of Service Employees International Union Local 620, noted that the county had a $14 million surplus at the end of last fiscal year and that her colleagues in Sacramento said that Santa Barbara is one of the first California counties to reassign its undocumented patients.

But county spokesperson Kelsey Buttitta noted that Santa Barbara is committed to spend $14 million annually to build the $165 million addition to the North County jail. She also added that not all counties have the same needs and vulnerabilities as Santa Barbara. All that will be hashed out on October 7, when the county supervisors will be asked to approve the issuance of layoff notices.

Right now, Hammami is collaborating with Marina Owen, CEO of CenCal — the public health-care agency responsible for connecting all Medi-Cal recipients in Santa Barbara and San Luis Obispo counties to medical offices that take Medi-Cal, a state funded insurance available to low-income individuals. The state, unlike the federal government, provides care to undocumented individuals.

Hammami’s department is also working with Cottage Health COO Lisa Moore and Mahdi Ashrafian of Santa Barbara’s Neighborhood Health Clinics. Similar meetings are taking place up in North County with Marian Medical Center. According to Moore, CenCal’s Owen is moving heaven and earth to identify providers who can pick up the slack. But assuming they exist, connecting them with patients is another matter.

The trickle-down repercussions are starkly obvious. If these 7,500 patients do not connect with alternate care providers, their level of ongoing care and treatment will suffer. “It’s a serious shift … and we’re concerned,” said Moore. Cottage has 13 urgent care centers and three ERs. “We are here to serve everyone in our community,” she said. But when people don’t get ongoing preventative care, she noted, “Their outcomes can be compromised.”

Whether there’s an adequate supply of clinic alternatives available and whether the patients will feel safe enough to make the transition is the most concerning question. To succeed, Moore said, requires, good planning, good coordination, and good collaboration.”

It’s worth noting that there are several other Federally Qualified Health Centers in Santa Barbara County. Representatives from two of the best known — the Santa Barbara Neighborhood Clinics and American Indian Health — expressed reservations about commenting for this article, explaining that the legal situation remained too fluid. Neither one of them, however, is currently looking to transfer their undocumented patients.