Navigating Access to Health Care: A Life-Changing Story

Martin Martinez, 57, was in despair when he met Isabel Inzunza, a health care navigator at an affordable care clinic in Orange, California.

Martinez injured his knee while working on a farm in 2006. He hoped it would heal on its own, but the injury continued to worsen. His leg was completely bent outward, fluid oozed from his knee joint, the cartilage in his knee wore down and the bones rubbed against each other, causing a popping sound when he walked. Unable to afford to go to the doctor, Martinez took painkillers and used a cane to endure the discomfort. Now the pain is so bad he can barely get out of bed.

As an undocumented immigrant for many years, Martinez was ineligible for California’s health insurance program, Medi-Cal. His work as a carpenter’s assistant made him too little to cover his medical expenses, but the pain in his knee was so unbearable he had to take weeks off work without pay. Martinez struggled to pay rent and food, and he didn’t know how he would survive without help.

“It was a terrible situation,” he said in Spanish. “But thankfully, God didn’t abandon us and saved Isabel.” [Inzunza] On my way.”

Over the years, the state has steadily eliminated immigration status as a barrier to enrolling in full-scope Medicare. As of January, the program will be open to all low-income Californians, meaning no one will be denied coverage because they’re in the country illegally. Throughout these policy changes, navigators have played a vital role in helping people like Martinez get health insurance. Inzunza is one of at least 1,200 community health navigators who work in community health clinics and community organizations across the state, enrolling people in Medicare and other government programs.

The navigator can intervene

Many people newly eligible for Medicare don’t know they’re eligible or don’t know how to enroll. Immigration law, especially President Trump’s “protected living” rule overturned, has some people hesitant to enroll in Medicare because they worry about listing their immigration status on government documents. Others worry it will hurt their chances at lawful residency (it doesn’t). Others have difficulty understanding the enrollment requirements because of language, literacy, or other barriers. As a result, they may be mistakenly denied coverage, miss important notices in the mail, or not know how to use or keep the benefits they receive.

In any of these situations, the Navigator can intervene.

“We are committed to supporting our members. [health insurance enrollment] “It simplifies the process from initiating an application to accessing coverage and maintaining coverage,” said Stephanie Hernandez, program manager for Health Canada’s Health Care Operations Division. Orange County Community Health Centers AssociationThe coalition supports health navigation and other services at 27 low-cost health centers across Orange County, and partners with more than 70 community organizations for outreach and enrollment efforts.

In addition to connecting people to Medicare, the navigators also help them enroll in CalFresh, formerly known as food stamps, and CalWORKs, cash assistance. Employee Benefits PortalThey can connect them to community resources they need, such as legal assistance. Some navigators are certified enrollment counselors who can help enroll people in plans on their state’s health insurance marketplace. Covered CaliforniaOnce a client enrolls in health insurance, the navigator helps them choose a primary care physician, schedule medical appointments, fill out insurance renewal paperwork and more.

Navigators help anyone who needs services, but they also work hard to reach people who are often missed by the register, including immigrants, people with limited English proficiency, low-wage workers, youth of color, the homeless, people with disabilities and seniors. They often visit family resource centers, schools, libraries and other locations for outreach and enrollment efforts. Hernandez said navigators spend as much time as necessary with clients, explaining health insurance options and answering questions in person or over the phone. The service is free.

Life-changing envelopes

Martinez learned about the coalition’s medical navigation service after seeking help at La Amistad Health Center, one of the coalition’s member clinics. He was able to see his family doctor there, but because he didn’t have health insurance, he couldn’t get the care he needed from an orthopedic specialist or surgeon. A staff member gave him a card with Inzunza’s phone number. He called.

The two met at the clinic in December. Before their appointment, Inzunza instructed Martinez, like any other patient, on the documents he needed to bring: photo ID, proof of income, proof of address. For an hour, she patiently answered questions in Spanish and filled out an application. Once the application was submitted, she walked Martinez through the plan.

Ms. Martinez remembers how excited she was when a big envelope arrived in the mail a few weeks later from CalOptima, the organization that oversees Medicare in Orange County. It was exactly what Mr. Inzunza had told her to look out for. He called her right away.

“That’s great,” she said. “It means they’ve accepted you.”

A sense of relief washed over him.

“Imagine my enormous surprise and joy after all that hard work,” he said. “At last, I succeeded.”

Serve your community

Hernandez said navigators are typically from the communities they serve and understand the backgrounds and language of the people they serve, which helps them build trust with clients and make them feel at ease. They are familiar with the anxiety and frustration that people in their communities often experience when trying to access health care. Clients often turn to navigators for help each year with health insurance issues.

“Having passion and heart is crucial to being a health care navigator,” Hernandez says. “Navigators feel a personal connection to the people they serve.”

For Hernandez, becoming a navigator and certified registered counselor in 2013 felt like a calling. Growing up in an immigrant family in Santa Ana, she had to translate medical documents and letters into Spanish for her parents and accompany them to doctor’s appointments as an interpreter. She remembers them struggling to get health insurance and facing discrimination. Now, her clients face similar challenges, and she tries to treat them the same way she treated her own parents, she said.

“It doesn’t matter if it’s legal or illegal,” she said of her approach, “you deserve to be treated fairly and you deserve to get the help you need.”

Hernandez said team members are doing their best to put clients at ease by hosting workshops with immigration lawyers who can answer people’s legal questions.

In other cases, undocumented clients make too much money to qualify for Medi-Cal, but their legal status means they can’t get subsidized health insurance through Covered California. Navigators work with these clients to identify low-cost clinics and health insurance plan options they can use, if available.

But state funding for navigators has been cut because California faces a huge budget deficit for 2024-2025. Hernandez worries that without continued support for the profession, more people will lose out on life-changing health coverage and immigrant parents will again turn to their children to help them fill out insurance paperwork instead of seeking the help of trained professionals.

After receiving Medicare coverage, Martinez was able to meet with an orthopedic surgeon. On Jan. 16, he underwent total knee replacement surgery. He began physical therapy soon after. He says his life has changed. He now walks easily, his legs are straight and he’s pain-free. He’s back at work and able to pay his bills.

“I’m walking slowly, but I’m getting closer,” Martinez said. “If we didn’t have Medicare, I don’t know what would have happened.”