CT health care centers serve thousands of undocumented residents. It’s not just medical care.

No one is asked their immigration status.

With 113,000 undocumented immigrants in Connecticut, Fair Haven Community Health Care serves their need for health care in New Haven, as do Charter Oak Health Center and Community Health Services in Hartford.

Everyone receives equal care, says Dr. Suzanne Lagarde , CEO of Fair Haven health care.

But Fair Haven, with its main base at 374 Grand Ave. in the heavily Hispanic Fair Haven section of the city, goes way beyond treating illnesses and offering preventive, maternity, pediatric, dental and behavioral health care.

“In 2023, we served over 34,000 unique individuals at least once,” Lagarde said. “We did over 140,000 visits. … We don’t ask people’s immigration status. We don’t want to know.”

Fair Haven Community Health Care has become a hub for the undocumented population in New Haven and surrounding towns.

Its 300-member staff helps children and youth get onto Husky , a state health insurance program for kids, offers low-cost medicines, housing and food assistance and helps with school-required physicals.

There are Fair Haven staff members in eight New Haven schools, two in the East Haven middle and high schools and in two Branford primary schools.

“We have full-time staff in all of those schools,” Lagarde said. “They have a nurse practitioner, so someone who’s a prescriber. We have behavioral health therapists who can help kids with those sorts of issues. …  One of the big pushes we’re doing is getting kids their school physicals.”

Expanding, including a new pharmacy

Now Fair Haven health care is building an expanded 35,000-square-foot headquarters next door to its Victorian houses on Grand Avenue, “the first-ever major capital campaign in our 53-year history,” Lagrande said.

And on Monday, Aug. 26, the agency plans to launch a new venture, with the old Grand Apizza building transformed into Grand Pharmacy, where patients of Fair Haven Community Health Care can get their drugs at extremely low prices.

Lagarde said her care-coordination team works with anyone who doesn’t have insurance to help them become insured “by one means or another. And so we know those, by definition, those for whom we can’t, it’s because they don’t have a Social Security number, that you know they’re clearly undocumented.”

She said 14% of the 34,000 people Fair Haven saw in 2023 were uninsured, which pretty much matches the undocumented population in the state.

“It’s a very, very good marker, because we are very aggressive in making sure our patients get coverage,” she said. “I have a whole staff of people who are care coordinators … people who know how to get people on insurance. So if you come here and we determine you’re uninsured, you meet with somebody and we work very hard to get you coverage. The place where we can’t is if you’re undocumented. So they’re virtually synonymous.”

While Lagarde’s team helps clients get onto Medicaid and the state’s ConneCT and Access Health CT programs, undocumented individuals are not eligible. But there’s one exception.

“The legislature in 2022, which went into effect in 2023, said all kids up to the age of 12, we don’t care about your immigration status, as long as your family fits the income eligibility criteria, you can get Medicaid,” Lagarde said. “And then they upped it just July 1. So July 1 of this year, that age went from 12 to 15.”

In the first year, Fair Haven enrolled almost 350 young people “who otherwise would not have had insurance,” Lagarde said. “It’s not easy, because the way the state of Connecticut is set up to get somebody enrolled, you have to go through Access Health CT, and although in theory the patient can do it themselves, in practice many of these folks, because of language barriers, literacy barriers, have a hard time, and the state won’t let us just do it, so we have to do it with the person in front of us.”

‘Taking from Peter to pay Paul’

While the undocumented patients are uninsured, their care still costs money, and Lagarde said she is “really good at taking from Peter to pay Paul.”

“No one, no one, zero — and that needs to be emphasized — no one is ever denied care,” she said. “And we do not provide two levels of care. We provide one level of care. … Where do we get our funding? It’s a mishmash, right? As a federally qualified health center, we do get some federal funds, but it’s less than 10% of my annual budget. So, I mean, it’s not like this windfall.”

The agency also bills Medicare, Medicaid and commercial insurance for its documented patients, and some payments bring in more than Fair Haven’s costs.

“Not all,” Lagarde said. “Something like dental, we lose our shirts on, because the state, most of that is either Medicaid or uninsured, and Medicaid grossly underpays for dental, but it’s a needed service, so we’re always taking from Peter to pay Paul.”

Lagarde also takes advantage of the federal 340B prescription drug-pricing program , which allows Fair Haven to buy medications at government prices. While she doesn’t mark up those drugs to under- or uninsured patients, those with commercial insurance are billed.

“It also is a program that generates funds as well, because when we provide prescriptions for patients who have, let’s say, commercial insurance, we actually make a profit on that, and that profit is fed back into the organization,” she said.

Beyond those sources, “grants come, grants go. It’s never the same,” Lagarde said. “You’re always juggling, but again, no one is denied care. Everyone is welcome. We urge everyone to come and get care, and the care is not different. We treat all people the same.”

Housing, food, legal assistance

Lagarde has 80 to 90 medical caregivers, not all of whom are full time. “We’re just about to welcome a cardiologist who’s going to do that for us one session, one afternoon a week on a volunteer basis,” she said.

Beyond health care, Fair Haven Community Health Care helps people with housing as well. “That’s a huge problem in Connecticut, housing is, affordable housing,” Lagarde said.

“We wish we could help more. I really do, but what we can do is connect people with the right resources,” she said. “So whatever their circumstances may be, connecting them with CBOs (community-based organizations) who do deal with trying to get housing, trying to get Title 8 vouchers, trying to work with them.

“We have some programs actually. Depending on if you’re in a program, we actually have some discretionary dollars to help with rent,” she said. “Depends on the circumstances. It’s not huge, but we have some.”

Another basic need Fair Haven assists with is food.

“One of the things that COVID really exposed was hard to believe,” Lagarde said. “We’re in Connecticut, one of the richest states in the country, in one of the richest countries in the world, and yet people have incredible food insecurity where they don’t have enough money to buy food. That became really floridly obvious during COVID.”

“We have something called a basic needs fund, where a family can come to us, and it’s really basically what they tell us and in our relationship with that family that they really are struggling for funds, we might give them a gift card to either Stop & Shop or Walmart, where they have food,” Lagarde said.

One of the plans for the new building is to use part of the space to work with CitySeed and Haven’s Harvest and other nonprofits to help with food programs.

Fair Haven also has a partnership with New Haven Legal Assistance , so, for example, “if they’re renting a space and there’s mold or there’s safety issues, we can help in that respect,” Lagarde said.

From pizza to medicine

The new pharmacy, where New Haven apizza once was served, will offer big savings to Fair Haven clients, Lagarde said, but anyone can use it.

“Our prices are going to be as good as any Walgreens or any other pharmacy,” she said. “We have same-day delivery. Our services are English and Spanish, but for those who really are needing some relief from the steep cost of drugs, if it works for them, they become our patient. Then we can get them this resource which allows us to give them drugs at government prices, which in many instances, is ridiculously cheap.”

As an example, Lagarde said, “We’re all hearing about how Biden has changed for seniors, no one’s going to spend more than 30 bucks a month for insulin. Today, and for the last number of years, I can buy a month’s supply of … one particular type of insulin for 15 cents — 15 cents — and I can pass that along to my patients. I can pass those savings on. I mean, that’s a dramatic example.”

After 11 years as CEO, Lagarde said, “I won’t lie, it’s hard. I mean, where you know you’re always making decisions that you can’t do everything for everybody. You’re working with government. That’s never easy, when they don’t pay their fair share.

“But in general I was really thrilled that, on the plus side for government, they decided in Connecticut to let kids now through the age of 15 be eligible for Medicaid. That’s a huge win.”

A hub for undocumented

In Hartford, Charter Oak sees more than 17,500 individuals a year, which translates into 107,000 visits, according to Vernette Townsend, chief nursing officer.

“We’re committed to anyone … who is in need of health care services (and) falls in an underserved community,” Townsend said. “And then we provide the highest level of care regardless of their ability to pay or regardless of their immigration status.”

Charter Oak’s main location is at 21 Grand St. It has five satellite offices in Hartford and one in Bloomfield.

Townsend said, like Fair Haven, Charter Oak has “to navigate a fine line between social services and being a health care center.”

“Hartford is becoming a new hub for undocumented,” Townsend said. “They’re traveling roads and finding themselves in Hartford, and they are in need of health care and other services, so we’re providing that care. First and foremost, we are seeing a growth. And the places that these patients are coming from are South and Central America primarily.”

But she said patients are also coming from Jamaica, Haiti, Eastern Europe, including Bosnia and Serbia, as well as Vietnam and China.

“And so Hartford is becoming a new hub,” Townsend said. “Why? Don’t know, but we are seeing a growth in these populations. So what it means for us is we have to be very focused on making sure that we can communicate in languages that these new immigrants are arriving with, because you can only imagine that they’re now monolingual. … We can say that our three top languages after English are Spanish, Portuguese and Creole.”

Charter Oak’s community health workers are navigating available social resources “because we can’t get them to health unless we address the social services,” she said.

‘Basic things needed to live’

“It’s housing insecurity, it’s food insecurity, it’s financial insecurity, it’s educational insecurity, it’s transportation insecurity,” she said. “So you’re thinking about it’s just the foundational basic things needed to live.”

While Fair Haven, Charter Oak and Community Health Services, as well as New Haven’s Cornell Scott-Hill Health Center are officially federally qualified health centers , “it’s just that the social needs are growing faster than any funding was ever set up to take care of,” Townsend said.

In addition to basic health care, including dental, pediatric and behavioral health services, Charter Oak has an urgent care center.

“We have expanded hours on the urgent care,” Townsend said. “And so our providers that are working in the urgent care are also our providers that work in our primary internal medicine center, and then we do have a sliding fee program here.

“So you can only imagine if a patient that’s undocumented is not going to get Medicaid, so we work with them, and then we put them on a sliding fee schedule and charge accordingly,” she said.

Charter Oak also is in the Hartford schools, offering primary and behavioral health care.

And then we have our own outreach health care that we’re very proud of,” Townsend said. “We have a mobile van, and we go to spots in Hartford where we know our homeless are, where their tents are set up. We take a provider out there and a medical assistant, and we provide care and try to get them back to our facility for care if they will come.”

The agency also has agreements with homeless shelters in the city, she said.

“We have maternity care, and we’re looking to expand our services to actually delivering babies,” Townsend said. “So we’re working with a local hospital on that right now as we speak.

Charter Oak employs a midwife and an obstetrician. “Now we do all prenatal care,” she said. “We do all postpartum care, and in between, we transfer them to the hospital. We’ve been asked by the state, because of the increase in maternal deaths in the minority community, to begin to take over all of the care.”

The plan is eventually to do labor and delivery at Charter Oak as well, she said.

Ed Stannard can be reached at estannard@courant.com .