Santa Clara County staff help farmworkers get their second dose of the COVID-19 vaccine at Monterey Mushrooms in Morgan Hill, California on March 31, 2021. (Jana Kadah/Pagransen)

California farmworkers are likely to have increased health care needs as the population ages and settles, especially after facing the compounding effects of the COVID-19 pandemic, according to a recent study by the Public Policy Institute of California.

Research Fellow Paulette Cha presented her findings at a panel discussion on Thursday, accompanied by head experts on health care for farmworkers. She said Medi-Cal expansion efforts in recent years have proven to improve health care access for documented farmworkers, though most undocumented farmworkers are still not eligible for coverage that goes beyond medical emergencies.

The average age of an immigrant farmworker is now 40 years old, and farmworkers are increasingly living with their families in the U.S. This means farmworkers are likely to need more advanced care, she said.

“While my study focuses on farmworkers access to health care, the shift towards settling and living here with families suggests that there are broader questions of farm worker health needs that include women's health concerns, prenatal and pediatric care,” said Cha.

The study looked at three different policies that had the potential to affect farmworkers: the federal expansion of Medi-Cal to most low-income adults in 2014, the federal mandate for companies with 50 or more workers to offer health insurance in 2015 and California's expansion of Medi-Cal to some young undocumented immigrants in 2020 and low-income individuals over 50 in May 2022.

Researchers concluded that the 2014 expansion led more documented farmworkers to enroll in Medi-Cal, though the employer mandate did not increase the number of farmworkers enrolling in employer plans. Neither policy insured more undocumented farmworkers. However, California's plan to expand Medi-Cal in 2022 will likely affect one-fifth of the state's undocumented farmworkers.

Looking forward, Gov. Gavin Newsom's proposal to expand Medi-Cal to undocumented, low-income adults below age 50 in his January 2022 budget proposal could significantly improve access, as 75 percent of undocumented farmworkers statewide fall into this group, according to the most recent data.

Despite increased eligibility, the greatest barriers for farmworkers to receive health care, regardless of immigration status, are still cost and lack of insurance. The COVID-19 pandemic especially exacerbated these issues, said Estella Cisneros, legal director of the Agriculture Worker Program.

“They were working in person throughout the entire pandemic,” Cisneros said. “It really showed us the preexisting problems and how difficult it is for farmworkers to access health care, due to several reasons — their physical isolation, language access issues, as well as just the higher incidences of COVID infection in the workplace.”

The COVID-19 pandemic also challenged agricultural organizations to rethink how they offer health and safety programs, said panelist Theresa Keihn, who oversees the non-profit AgSafe. The training program, offered to agricultural employers and farmworkers on safety and health, had to shift gears to consider the risks migrants were facing both at home and at work.

“So prior [to the COVID-19 pandemic], we were talking about heat illness prevention, pesticide safety, tractor safety, all of those topics. Then when COVID-19 hit, we were having these conversations about no just what you do at work, but what happens at home as well, which was really an interesting place that we had never been before.”

Assemblymember Joaquin Arambula, D-Fresno, said expanding health care access to more older adults in May is already a step in the right direction, but more needs to be done to address the “social determinants of health,” beyond the “four walls of health care.”

“I was an ER doctor for a decade, and far too often I saw people who came in the last minutes or seconds of their life. I knew that there was so much more we could do for undocumented community in advance if we could get them health care. It's one of the drivers that brought me here to our state capitol. And I'm grateful that we've been able to move so far.”