Santa Clara County looks to fund Latino ‘health promoters’

Latino community health workers in Santa Clara County, known as promotores de salud or “health promoters,” have for years knocked on doors that others couldn’t. Now the county needs them again — and has plans to make them a permanent part of the region’s public health system.

The Board of Supervisors on Tuesday voted unanimously to pursue options for funding a permanent system of culturally competent, one-on-one clinicians for the county’s most vulnerable Spanish speakers. Officials will look to three Medi-Cal providers in the region — the county’s own Family Health Plan, as well as private insurers Anthem and Kaiser Permanente — to help pay for it. Health officials say an expanded, full-scale army of promotores across East San Jose, South County and San Jose’s Cadillac-Winchester neighborhood would reduce hospital visits and prevent further strain on overflowing emergency departments.

It’s become especially urgent amid a tide of federal funding cuts threatening Northern California’s largest public hospital system.

“We are tapping on them once again to respond to this crisis,” District 1 Supervisor Sylvia Arenas said at the meeting.

Promotores have become an integral backbone of public health in Silicon Valley. They drove efforts to immunize Spanish speaking residents and prevent the spread of COVID during the pandemic. They also helped the county avoid federal funding losses by counting hard-to-reach households after President Donald Trump cut the decennial U.S. Census short in 2020.

But promotores are underpaid, and their work has historically lived at the whim of grant cycles — at the end of which trained workers leave and programs diminish in size. At the same time, each clinical worker providing care coordination, chronic disease management and patient navigation generates an estimated $278,000 in healthcare savings every year, according to the findings of an April county Public Health Department study.

Promotores’ services are billable under Medi-Cal, though many don’t get reimbursed because they aren’t registered as a national health provider as required to submit claims, or cannot meet the licensed clinical supervision requirement. The county is exploring the creation of a centralized agency or “hub” — possibly located at a county library or clinic — to coordinate billing and credentialing.

“I’m asking the board: give us support,” Heiny Gonzalez, another promotora with SOMOS Mayfair, said at the meeting.

A new sense of urgency underlines their work. A landmark, multiyear study on the systemic health threats to Latino residents published last year prompted county leaders to declare a public health crisis, after troubling surges in deaths by suicide and diabetes. The report also identified higher rates of opioid overdose deaths among Latinos in South County than any other region.

“We are providing these services to very devastated communities,” Monica Mahecha, a promotora with SOMOS Mayfair, said in public comments at the meeting.

Promotores don’t just do clinical work. They also do community outreach, connecting residents with specific services available in their area. Sharon Luna, a neighborhood leader in the unincorporated South County community of San Martin, said promotores have had a noticeable effect on getting residents into healthy cooking, sports and academic tutoring.

“It is one of the most impressive programs I have seen in South County,” Luna said at the meeting.

The program cannot fund itself with those savings because not all of it directly benefits the county. Officials are looking toward a “blended” mix of funding from the county, grants and the region’s three managed care plans under the county, Anthem and Kaiser, with no single source exceeding 40% of the proposed system’s total budget.

“One of my recommendations is we urge the three Medi-Cal managed care plans in our county – Family Health Plan, Anthem and Kaiser – to … consider an appropriate level of investment, because those plans will have tangible savings in health costs avoided that will be bankable for them in a way that’s not true for county budget,” County Executive James Williams said at the meeting.

Williams added members of the Family Health Plan governing board — which the county moved to consolidate control over last year — have already voiced support for pitching in to fund the expansion of promotores.

“I don’t think Kaiser and Anthem should be off the hook,” Williams said. “We need to put a little fire under them to step up to the plate as well. We know exactly the kind of concrete investment that needs to be made.”

Arenas said the county’s promotores have risked their lives for the community time and time again.

“What other crisis are we going to wait for to finally integrate a framework that is fiscally proven?” she said.

Contact Brandon Pho at [email protected] or @brandonphooo on X.