Medi-Cal Expands for Undocumented Kids: We've Got to Get It Right

Amy Adams, Senior Program Officer, Improving Access

May 16, 2016
Amy Adams
Amy Adams

Thanks to the tireless work of advocates, community members, and policymakers, state legislation was passed last year to expand full-scope Medi-Cal to all low-income children in California regardless of immigration status. Today, that law goes into effect. Authorizing the expansion was a historic achievement. Now comes the next big challenge: making sure the law is implemented effectively.

Researchers estimate that 250,000 undocumented children are now newly eligible for full-scope Medi-Cal, but enrollment could be hampered by a variety of factors. These include the understandable fears of families around disclosing immigration status, the impact of language barriers, and the consequences of complex and potentially confusing application and enrollment procedures. There are still many points during the enrollment process when newly eligible children can fall through the cracks, leaving them without coverage.

The first few months of implementing the expansion are critical: early success in signing up children will build momentum and encourage other families to follow suit. Similarly, early failures will have a chilling effect.

Much work has already been done to lay the foundation for a strong implementation. The California Department of Health Care Services (DHCS), advocates, community-based organizations, foundations, local Children's Health Initiatives, county agencies, clinics, immigration rights groups, and others have come together to prepare for this day. They've been conducting outreach and education, disseminating information to the affected communities, and putting systems and processes into place to handle the influx of new children. We must keep up the intensity and continue working together in the coming months.

The California Health Care Foundation (CHCF) will support the use of multiethnic media to get the word out to families about the new opportunity to enroll their children in Medi-Cal. We'll be working with The California Endowment (TCE) on this as part of its #Health4AllKids campaign. CHCF will also support training and technical assistance for frontline county eligibility workers to help them address the many complex issues unique to this expansion. As the implementation unfolds, CHCF looks forward to sharing what we learn from our grantees and partners about what's working and to identify opportunities for improvement.

Three things are particularly important to successful implementation in the coming months:

  1. Accurate information. We can't let misperceptions or misinformation about the law hamper enrollment. The Health4AllKids website provides fact sheets, FAQs, toolkits, webinar recordings, events, and more for families and organizations that could be touched by the expansion. Other #Health4AllKids collateral is available through TCE. A new guide from the Western Center on Law and Poverty is a great resource for those helping to enroll people in Medi-Cal. Please visit these websites to learn more, and share them with your networks today.
  2. Data. Getting accurate county-level enrollment data from DHCS as early and as continuously as possible will aid our understanding of patterns and trends across geographies and populations.
  3. Dialogue. To the extent that problems arise during the implementation, we must identify them, learn from them, and make quick course corrections that can be shared broadly. We hope the DHCS AB 1296 subgroup's immigration workgroup can continue to be the venue for that honest dialogue, and CHCF looks forward to continuing our participation. As the rollout continues, we hope DHCS will consider other forums as needed. It will be vital that conversation and coordination occur at the local level as well — among county social service agencies, local community groups, Children's Health Initiatives, and others assisting in enrollment.

Approval of this expansion started California on an important journey, and we all can be proud of how far we've come. But we still have a long way to go to fulfill the promise of providing quality health care coverage to all of California's low-income children regardless of immigration status.