California Takes Historic Step Toward Universal Coverage

close up-photo of latina woman in mid 20s with man in background
Young adults who are undocumented and in California would be eligible for Medi-Cal benefits under a budget passed by the state legislature. Photo: Juan Monino.


California has taken a historic step toward universal coverage by making sure all young people with low incomes are eligible for Medi-Cal and by making it easier for many Californians who purchase their own insurance to afford coverage.

On June 13, the California Legislature voted on a budget that would allow all Californians with low incomes under the age of 26 to enroll in Medi-Cal — the state’s Medicaid program — regardless of immigration status. It would also raise the income eligibility threshold for seniors and people with disabilities seeking to enroll in Medi-Cal; offer new financial help to low- and middle-income Californians who purchase coverage on the state’s health insurance marketplace; and reestablish an individual mandate to buy insurance or pay a fee — an Affordable Care Act provision until Congress removed it in 2018. UPDATE: Governor Gavin Newsom signed the budget bill on June 27.

At a time when the federal administration continues to erode health coverage for Americans and threaten hardworking immigrants, California is showing a different path is possible. With the latest budget, California becomes the only state in the country to open its Medicaid program to all residents with low incomes, regardless of immigration status, under the age of 26. The state also closed a small but important coverage gap by raising Medi-Cal’s income eligibility level for seniors and people with disabilities to align with that of most adults under age 65. These bold actions speak to our state’s values of inclusion. Californians recognize that our future prosperity depends on the health and well-being of all our residents.

Californians recognize that our future prosperity depends on the health and well-being of all our residents.

California leaders have also recognized the challenges that too many of our residents and small businesses face in trying to afford health insurance on their own. The budget adds protection for those with the lowest incomes who struggle to purchase their own insurance, and it recognizes that, in a state with a high cost of living, Californians with moderate incomes also need help. Reestablishing the individual mandate penalty will encourage more Californians to maintain health coverage, which benefits all of us.

While these decisions are surely worth celebrating, we must acknowledge the work ahead. We must find a way to cover all Californians, including the undocumented adults and seniors with low incomes who remain ineligible for Medi-Cal. We must rein in the cost of coverage for consumers. And we must protect access to care in the face of harmful federal actions, including the federal administration’s proposed changes to the public charge rule.

We are still a long way from a health care system that works for all Californians, but the state budget shows that progress is possible. Step by step, staying true to our values, we will get there.

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