Helping families navigate the complexities of today’s health care system is essential to building a healthy community. Community Health Initiative of Orange County (CHIOC) is a non-profit agency dedicated to reducing the number of uninsured children and families in Orange County. CHIOC screens families for health care and social services programs, determines their eligibility and assists them with the enrollment process. Once their application in submitted, CHIOC staff members follow-up with the families, help them utilize their benefits and make sure that their coverage is renewed every year.

We spoke with Georgina Maldonado, executive director of CHIOC, to learn what challenges our communities are facing when it comes to accessing health care. Among other things, Maldonado explained that a major misconception people have is that accessing health care services is easy. It is not, especially for the most vulnerable populations. Our conversation with Georgina Maldonado has been lightly edited and condensed for clarity.

A big barrier to health care access is one’s immigration status. Though all undocumented children are now eligible for Medi-Cal, their parents might not enroll them fearing they might be labeled a public charge.
Georgina Maldonado

Can you briefly tell us about CHIOC? What is your mission and who do you serve?

Georgina Maldonado: Our mission is quite simple. We want every single individual in our county to have access to quality and affordable health care. We want people to have a piece of mind when it comes to their health. We want everyone to feel taken care of when they get sick, as opposed to overwhelmed, scared and worried.

Our organization was first launched in 2005, when there was a significant number of uninsured children. We were called Children's Health Initiative and we exclusively served children. But, as national and statewide policies expanded access to health care, we decided to serve everyone who was eligible for health care coverage. In 2013, with the release and the implementation of the Affordable Care Act, we embraced everyone and changed our name to Community Health Initiative of Orange County.

What makes CHIOC’s approach unique or different?

Georgina Maldonado: What's unique about our work is that our enrollees are embedded in the community. They either live there, or they've grown up there, or they reflect the communities that we serve. The truth is, when you see someone who looks like you and has had similar experiences, you are much more likely to trust them and seek their help.

What's fascinating about our work is that most of our clients don't know the name of our organization. Instead, they know the name of the individual who helped them enroll into health insurance coverage. So, they'll say to one another, "Call Bertha, call Crystal, call Fernando, call Danielle." And that's what makes our work truly profound. Community members are able to identify with our employees and not our mission.

Meanwhile, we have beautiful flyers, a mission statement, a website, and a newsletter. Sometimes, I think, "We should revamp our website and make it more effective.” But then I remember that our clients know Bertha, know Joe, know Mauricio. I could invest in more sophisticated marketing, but at the end of the day, it's Mauricio that our community members trust. It’s Mauricio who makes the difference, not our website.

One of your goals is to reduce the number of uninsured children in Orange County. How many children are currently uninsured and why?

Georgina Maldonado: The statistics on uninsured children are constantly changing given the world we are currently living in. At the moment, there are reports that differ slightly between the Insure the Uninsured Project and the Annual Report on the Conditions of Children in Orange County. But, roughly 8 percent of Orange County residents are uninsured, which means that between 2.5 percent and 2.9 percent of Orange County children are uninsured, which is approximately 8,000 children under the age of 19. This compares to 3.1 percent statewide and 5.2 percent nationwide.

Of greatest concern for us are the continuing health disparities. Hispanic children continue to have higher uninsured rates than any other race and ethnicity group. 3.9 percent of Hispanic children were uninsured in 2018 compared to Asian children at 2.5 percent, white children at 1.9 percent, and other races at 1.1 percent.

The most common reason children are uninsured is that the parents think their child is not eligible for coverage due to the family's income level. Another common reason is that parents don’t know about the available low-cost and no-cost programs. Even though we’ve produced many PSAs and do outreach in the community and our schools, some families still don't know that these programs exist.

Another barrier that families face, and thus children face, is the access barrier. The administrative hassle and all the paperwork that is required create a serious barrier for many. For example, to process applications, we must ask for a paycheck stub, birth certificates, proof of residency and many more documents.

Finally, a big barrier to access is one’s immigration status. Though all undocumented children are now eligible for Medi-Cal, their parents might be too afraid to enroll them. Consider a mixed immigration status household. Let's say I'm documented, my significant other is undocumented, one of my children was born here, but then the little one wasn't born here. That dynamic creates fear within that family and many choose not to enroll for health insurance coverage because of public charge. They don't want to jeopardize their immigration status in any way.

I'm hearing you say that the lack of information and fear might be the main reasons why many residents don't have health insurance.

Georgina Maldonado: Yes, a lot of what we do at CHIOC is educate and dispel fear. And even though our clients trust us, many will nevertheless forego obtaining coverage. That’s because we can't guarantee anything. We’re stuck between a rock and a hard place. We are educating them, but we can't guarantee that Immigration or ICE or Homeland Security will not knock on their doors. Or, when they're able to have some type of legal status in this country, that receiving Medi-Cal will not hinder that process.

I know this from personal experience. My family became permanent residents and we got our green cards when I was 10 or 11 years old. But I didn't have any health coverage until then. And even after, after we all had our permanent residency, I wasn’t able to get full-scope Medi-Cal because my mom owned our home. Back then, there was a rule that you couldn't apply for Medi-Cal if you had any assets. That barrier was thankfully removed through the Affordable Care Act.

What do you think needs to happen structurally in order to achieve your vision of quality and affordable health care for all Orange County residents?

Georgina Maldonado: One, we need to invest in and increase our community-based outreach and enrollment support so that we can better reach underserved and hard-to-serve communities. Hard-to-serve populations are, for example, homeless people, monolingual speakers, undocumented immigrants, and what we call, Medi-Medis. These are people who qualify for both Medicare and Medi-Cal, but do not know that they qualify and are not utilizing these two lifesaving programs.

Two, we need to simplify the income eligibility rules. It’s such a convoluted process. With the Affordable Care Act and its expansion, your income determines which program you qualify for. The more you make, you qualify for Covered California. The less you make, you qualify for Medi-Cal. And all that has to do with the Federal Poverty Level and the graph that they provide for us to determine eligibility.

Three, we think the state should experiment with automatic enrollment. The existing administrative processes are complex. There are so many systems and agencies—county, state and federal—in play. And all are reliant on each other, yet the processes between them are not streamlined and often challenging to navigate.

What is the number one misconception people have about your work? And would you like to dispel it for our readers?

Georgina Maldonado: One, there's a big misconception that navigating health care is easy and it's not. Like I mentioned before, our communities are facing many barriers. Two, we're not just an organization that simply helps enroll people into health care coverage. We have a truly holistic approach and our model encompasses education and basic needs triage. That means that we connect our clients to all other social services like CalFresh (food stamps), CalWorks (cash aid) and other programs.

For example, as a response to COVID-19, United Way was providing financial assistance to low-income families. So, while enrolling them into health insurance coverage, we also helped our clients apply for this assistance. All on one phone call.

What would you say was one of your proudest achievements in the last couple of years?

Georgina Maldonado: I’m most proud of launching our social enterprise. We were looking to diversify our funding sources in order to achieve long-term sustainability. We loved the model that our sister organization Community Health Initiative-Napa County pioneered and we were able to successfully replicate it.

How does our social enterprise work? I'm sure you've heard of insurance brokers. Similarly, we now have an insurance arm of our organization. We are able to generate income from our approved applications from Covered California—and soon Medicare. In a few years, we’re hoping to earn up to 20 percent of our yearly budget this way.

Thankfully, we have an entrepreneurial board and very supportive funders. Once I explained our plan, they said, "You're going to get paid for the work that you’re already doing per application?” "Exactly," I said. “But," I added, "it’s going to take time and you can't stop funding us until we get there!”

CHIOC Connects Families to High Quality, Affordable Health Care and Social Services