Key Takeaways
- Medi-Cal provides peace of mind, and losing it would delay care. Participants described Medi-Cal as both a health and financial lifeline, enabling them to manage chronic conditions and seek care before problems escalate. Without it, they would delay care, self-treat, or turn to the emergency room only when symptoms become severe.
- Fear and lack of information are shaping how people use care. Concerns about immigration enforcement, data sharing, and public charge rules are leading many to avoid or delay care. Most participants had little accurate information about the coming Medi-Cal changes. In the absence of reliable information, participants described generalized anxiety about losing coverage and confusion about what would be required of them.
- Willingness to stay enrolled is high, but the administrative burden could drive avoidable coverage loss. Many participants said they would pay modest premiums to keep their coverage, while acknowledging that doing so would be a financial strain. But more frequent renewals, work reporting requirements, and tight documentation deadlines pose real risks, particularly for gig workers and those paid in cash.
In 2024, California became the first state in the nation to open full-scope Medi-Cal to all income-eligible adults, regardless of immigration status. Today, roughly 1.6 million undocumented Californians rely on Medi-Cal for their health care. That progress is now under pressure. A wave of federal and state policy decisions stands to reshape access to care for these Californians. Changes include an enrollment freeze, a transition to Medi-Cal fee-for-service, new monthly premiums, more frequent eligibility renewals, work reporting requirements, and the rollback of most adult dental benefits.
To learn how these shifts are being felt on the ground, CHCF partnered with Culture IQ Group to conduct in-depth interviews with 39 undocumented adults currently enrolled in full-scope Medi-Cal. The conversations took place in January 2026 in Mandarin, Spanish, and English. They included Latino/x and Chinese-speaking Californians living in Greater Los Angeles, the Central Valley, the Monterey region, and the Bay Area. Their experiences offer a clear-eyed view of how undocumented Californians are weighing risk, making decisions about their health, and trying to protect their families amid rising uncertainty. Their experiences also point to actionable steps policymakers, health care providers, and community partners can take to protect coverage and preserve trust — detailed in the full report.
Why It Matters
The people interviewed for this study are parents, workers, and caregivers who contribute to California’s economy and communities every day. Their voices reveal both the fragility and the promise of California’s coverage expansion and offer insight into the factors that will influence how the changes unfold.
California’s coverage expansion was a decade in the making. Whether it endures and whether the people it was designed to serve can use it will depend on what happens next.
Explore the full findings and recommendations for policymakers, health care providers, and community partners.
