Undocumented Californians Newly Eligible for Medi-Cal Share Their Experiences

In January 2024, California started the final phase of its multiyear expansion of full-scope Medi-Cal coverage to all Californians with low incomes, regardless of immigration status. This qualitative research study examined the experiences of pre­viously ineligible adult undocumented immigrants as they navigated enrollment and began accessing health care services through Medi-Cal. Eighteen focus groups were conducted in the summer of 2024 with nearly 100 Latino/x, Chinese, and Korean participants across California.

Key findings include these:

• High enrollment rates. Seven in 10 study par­ticipants (70%) had successfully enrolled in full-scope Medi-Cal.
• Prior Medi-Cal experience matters. Those pre­viously enrolled in restricted-scope Medi-Cal had much higher enrollment rates than those who had not been in restricted-scope Medi-Cal.
• Strong utilization. Almost 9 in 10 enrolled par­ticipants (88%) had accessed health care services at least once. The most popular services were primary and preventive care as well as dental.
• High satisfaction. Participants reported positive experiences accessing care and strong satisfac­tion with services.
• In-person, in-language assistance is critical for the remaining unenrolled. Even after multiple exposures to information about Medi-Cal in prior focus groups, the unenrolled respondents still had questions and doubts about where to go to apply, what paperwork to provide, how to deal with variable income, whether they qualify under the income requirements, and more. Community organizations effectively provided this support, but not everyone knew how to access help.
• Limited political concerns. Asked about the upcoming presidential election, most partici­pants, especially the Latino/x participants, felt protected in California regardless of federal immigration politics. Mostly, they said they would stay enrolled and keep accessing services until something concrete happened that prevented them from doing so.

Although these positive results are encouraging, it should not be assumed that they are generalizable to all undocumented enrollees in full-scope Medi-Cal. Under a second Trump administration, it will be important to monitor if this population does, in fact, stay enrolled and keep accessing services — or if they disengage from the program out of fear.