Governor Gavin Newsom wants to make California the first state to remove immigration status as a barrier to eligibility for Medicaid (called Medi-Cal in California), making health insurance accessible to all undocumented residents with low incomes.

In his proposed state budget released on January 10, Newsom included Medi-Cal coverage for an estimated 700,000 undocumented, uninsured adults (PDF) with low incomes age 26–49, the last remaining group excluded from enrolling in the program.

Undocumented people pay taxes yet are excluded from receiving health benefits, Farida Jhabvala Romero noted on KQED News. “Undocumented immigrants in the United States pay billions of dollars in taxes and often do essential work in agriculture, food services, health care, and other industries,” Jhabvala Romero said. “But they are excluded from the Affordable Care Act and they cannot purchase subsidized coverage through Covered California, the state’s ACA health exchange.”

The proposal is an important step in creating universal health care for all Californians, Sandra Hernández, MD, president and CEO of CHCF, wrote on The CHCF Blog. “When it comes to making sure everyone has security and health opportunities that coverage provides, the future starts now,” Hernández wrote.

California already insures all people with low incomes under age 26 thanks to changes enacted by state lawmakers in 2016 and 2020. Last year, the state also agreed to cover people with low incomes age 50 and up, regardless of immigration status, a change that will take effect this May.

Isabel, a 76-year-old former farmworker who did not want her last name used because of her immigration status, told KQED that her new eligibility for Medi-Cal in May will be life-changing. “I am so thankful. I’m very excited,” she said. “We worked so much in the fields and we never got any benefits.”

According to a recent CHCF report, “The uninsured rate among Latinx Californians remains almost three times as high as that of their White counterparts (10.5% compared to 3.8%). And noncitizen adults are uninsured at more than three times the rate of their citizen counterparts (18.4% compared to 5.6%).”

Newson’s proposal is “the fulfillment of a long progressive fight to cement the state’s place at the vanguard of immigrant rights,” Tal Kopan and Dustin Gardiner wrote in the San Francisco Chronicle.

Widespread Support for Changing Eligibility Status

A poll conducted by the Public Policy Institute of California (PPIC) in March 2021 found that most Californians (66%) supported health care coverage for undocumented immigrants. Support has increased since 2015, when a PPIC poll showed that 54% of Californians supported removing barriers to Medi-Cal based on immigration status, Soumya Karlamangla reported in the New York Times.

Inequities in rates of COVID-19 infection and deaths from the illness highlight in stark relief the necessity of removing immigration status as a barrier to Medi-Cal eligibility, said Anthony Wright of Health Access California, a leading advocacy group for expanded coverage.

Wright said the pandemic showed why Medi-Cal is crucial for low-income Californians. “Our health is connected to our neighbors, to our community, including the people who deliver our food, the people who drive the bus, the people who make the society function,” Wright told Karlamangla. “I think it changed hearts and minds.”

Latinx people have accounted for “more than 50% of infections and 45% of COVID-related deaths in California, where they make up less than 39% of the population, according to the state Department of Public Health,” Kopan and Gardiner reported.

Sarah Dar, director of health and public benefits policy at the California Immigrant Policy Center, told Gutierrez that the pandemic “has brought clarity to the fact that if only some of us have access to health care, that doesn’t work. We are all healthier when we all have access to health care.”

Will Other States Follow California?

California has long thought of itself as a national trendsetter in politics and policy, and Newsom’s proposal is the latest example of that, as Dan Walters recently observed in CalMatters. Yet advocates disagree on what this move could mean for immigrants in other parts of the US.

“We are positioned with this budget to be able to deliver on what we’ve been promoting: universal health care for all,” Newsom said at a news briefing outlining his budget proposals. “I’m proud to be here — I hope we see this replicated across the country.”

The proposed policy is an outlier compared to immigration policies in most other states. New York has also moved to extend insurance to undocumented people, but “the rest of the country is not California. And I say that as a Californian,” Ali Noorani, president of the National Immigration Forum, a centrist immigration advocacy group, told the San Francisco Chronicle.

Angelica Salas, executive director of Coalition for Humane Immigrant Rights of Los Angeles, a pro-immigrant-rights advocacy group based in Los Angeles, is more optimistic than Noorani. She told Kopan and Gardiner that Newsom’s decision to remove eligibility restrictions despite a potential political backlash is a model for other states inclined to do the same.

Costs of Expanded Coverage

Coverage would begin January 1, 2024, and would cost the state an ongoing $2.3 billion annually, Nadia Lopez reported in the Sacramento Bee.

The cost of removing immigration status as a barrier to Medi-Cal eligibility falls entirely on California because federal law prohibits spending federal Medicaid dollars to cover Americans who are undocumented.

California’s revenues far exceeded expectations and Newsom’s administration projects a $21 billion discretionary surplus for 2022–23. The proposed budget, at $213 billion (PDF), will be directed toward several Newsom priorities, including better access to health insurance for undocumented people.

Heather Tirado Gilligan

Heather Tirado Gilligan is a journalist who has written for publications including Slate, The Nation, CNN, and the Washington Post. Previously, she was executive editor of the California Health Report, a news nonprofit covering disparities in health and access to health care. Heather received a master’s degree in journalism from UC Berkeley and a PhD in English from Rutgers University, where she studied race in American culture.

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