CA farmworkers avoid medical clinics over immigration fears

By Larry Valenzuela, CalMatters

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On a scorching summer day, dozens of farm laborers paused their work picking banana peppers in a remote field 26 miles from Fresno and filed into a pop-up medical clinic. It was a chance to pick up medication and take basic health assessments, such as blood pressure and glucose monitoring. 

For almost a decade, the University of California San Francisco has been fielding mobile clinics like this one in rural Fresno County to support a hard-to-reach population of unauthorized immigrants who otherwise would avoid routine health care. 

The program gathered steam through the COVID-19 pandemic and during California’s decade-long expansion of health care to immigrants who are in the country without authorization. But this year, doctors are starting to notice that laborers aren’t showing up for care like they used to. 

The doctors sense the decline in participation is connected to the Trump administration’s aggressive immigration enforcement activity. UCSF mobile health clinic director Dr. Kenny Banh said patient visits to his rural mobile health vans started dropping at the beginning of the year, when President Donald Trump took office for his second term, vowing to crack down on illegal immigration.

“There’s a lot of distrust. I come from the university, I have a white coat; people are worried. We do as much as we can to tell them how we protect their data,” Banh said. 

According to UCSF, visits to their mobile clinics dropped by around 36% as enforcement activity increased in California. In 2024, the mobile clinics would see on average 34 patients per outing, but in the past few months, the number of patients had dropped to around 22 per outing. People are also less willing to sign up for Medi-Cal, the state’s health insurance program for lower-income households, because they fear giving the government their data if they aren’t authorized to be in the country, Banh said.

It could get worse. 

California scaled back the law that allows all income-eligible residents regardless of immigration status to receive health insurance through Medi-Cal by temporarily limiting enrollment next year. And, counties are bracing for Medicaid cuts under the budget law Trump signed earlier this year that they say will make it harder for them to sustain programs serving distinct populations, like the one that brings health care to rural farmworkers.

“It’s going to be more restrictive in terms of work requirements, more regular re-enrollments, and more stringent requirements on states to comply with federal mandates,” Maria-Elena De Trinidad Young, an assistant professor of public health at UC Merced. “This is a push-out. The policy is really designed to restrict people from accessing Medicaid, or you know, in California, we call it Medi-Cal.”

Getting health care to remote communities

The mobile clinic Banh leads is part of a larger initiative from the Fresno Department of Public Health to reduce chronic and communicable diseases among hard-to-reach populations in the county. It gained funding most recently through a COVID-19 relief law that Fresno County steered to the clinics, which were led by UCSF and Saint Agnes Medical Center.

The COVID-19 money is running out, but the program has another year of funding locked in.

Clinics from both organizations can be found at community events, food distribution drives in rural communities, schools, and sometimes at farm working sites. The Saint Agnes mobile clinic van has two exam rooms inside for patients to receive care. 

According to Ivonne Der Torosian, vice president of community health and well-being with Saint Agnes Medical Center, the program is designed to provide medical school students an opportunity to serve the community and create access to health care. 

“We are explicitly contracted to go out to rural Fresno County and serve agricultural workers, partner with employers of those farming workers, and also provide services to their families.”

Community health workers also provide health education and make referrals to nearby primary care providers for individuals who cannot be treated on-site. 

“We do basic screenings, including primary and preventive care, for many of the families we serve. We’re looking at connecting them to primary care providers,” Der Torosiran said. “We are providing vaccinations, we are providing glucose monitoring, and looking at their hypertension and blood pressure readings. So, really basic services they would get in a primary care setting.”

No nearby hospital

Dr. Navdeep Lehga, a resident physician, recently began a shift in the Saint Agnes medical van in Mendota’s Rojas Pierce Park. It’s an agricultural community just less than one hour west of Fresno. A line of people awaited her on the curb to pick up food from the distribution center and to see her and her team for a check-up. 

As the morning progressed, Navdeep saw patient after patient in the mobile clinic’s exam room or went outside to see patients in the parking lot, checking blood pressure with a gauge strap on their patients’ arms and glucose levels with finger pricks. 

She said most of the patients she sees are farm workers and immigrants. Much of the rural population doesn’t have easy access to medical care — the nearest hospital is 35 miles away. Some of her patients may seek out the medical van for primary care because they don’t know where else to go. 

 “That’s why they come here. We give them the gist of what’s going on. But we’re limited on our supplies and what we can check,” she said.

Lehga says the number of people coming to the van has slowed down since immigration enforcement has kicked up. She has heard patients speaking to staff during the intake session talk about their fears of coming to the van and seeking out health care after a summer of intensified immigration raids.

“We did notice there used to be a lot more patients coming before they have gotten scared and they don’t want to because they’re not sure who will show up,” Lehga said. “They did feel comfortable before coming here because they knew it was safe. Now I think patients are more scared to come in general just because they don’t know who can show up.”

Dr. Arianna Crediford, chief resident physician with Fresno St. Agnes Rural Mobile Health, said that visits to the van have dropped by 15 to 20% this year. 

“We can speculate that it’s because of the issues with immigration at this time, that seems to be a big influence with farmworkers and food packing,” she said.

Crediford said she’s heard some patients mention the worry about seeking care and what that might imply for them but they have made it clear that they don’t collect immigration information and that they don’t need to talk to them about it at all. 

“The idea that people have to be scared to receive health care is heartbreaking. It would really put their health conditions at risk, conditions that require weekly sometimes monthly follow-up. We’re the last line of defense that they’re able to go to besides emergency rooms when they come in with an actual life-threatening event. The day this population can’t comfortably and safely seek care their health is going to be put in danger because of that,” said Crediford.

The population, which is often uninsured, suffers from high rates of hypertension, diabetes or high blood sugar, and high cholesterol, oftentimes without treatment, Banh said. Frequently, the rural health team is the only health care provider patients see.

With fewer patients showing up for preventive care, Banh said, people will inevitably get sicker and end up in the emergency room. That costs more money and threatens to overwhelm the health system.

“People don’t disappear because you changed policy. They still need care. What you’re doing is delaying care until the outcomes are worse, and there’s not much you can do but hospitalize the patient,” he said.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.