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California Expands Health Coverage for Undocumented Immigrants

California is the first state in the nation to provide health coverage to all eligible low-income adults regardless of immigration status. The expansion extends Medi-Cal coverage to undocumented adults aged 26 to 49 and completes earlier initiatives that covered undocumented groups aged 19 to 25 and those 50 and older. The initiative adds 300,000 individuals to Medi-Cal, resulting in coverage for approximately 700,000 undocumented immigrants, and, per advocates, provides a payment mechanism to compensate hospitals and medical providers for previously unpaid costs.

Program description and cost

California is the first in the nation to expand state Medicaid healthcare eligibility to all undocumented immigrants, a population of approximately 700,000. As of January 1, undocumented adults between the ages of 26 and 49 who meet income, household size, and California residency requirements are now eligible for Med-Cal, the state's Medicaid insurance program for low-income residents.

The initiative, which adds 300,000 adults to the program that previously covered undocumented children between 19 and 25 and adults of 50 years and older, was approved by the legislature in May and received an additional $835.6 million in funding from the California Department of Health Care services. Going forward, Medi-Cal will cost $2.6 billion annually to cover all eligible recipients regardless of immigration status.

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Benefits available for undocumented immigrants through Medi-Cal

A Feb. 2019 brochure published by the California Health Foundation titled "The Medi-Cal Program: An Overview, states California's undocumented immigrants will have access to the following scope of services:

  • Primary, specialty, and acute care.
  • Home- and community-based services that help with activities of daily living and allow people to remain in their homes.
  • Institutional care (such as nursing homes).
  • Pediatric and adult dental services.
  • Comprehensive behavioral health coverage, including behavioral health treatment for children with autism spectrum disorders.
  • Substance use disorders.

In addition, the plan covers essential services such as Emergency services, hospitalization, maternity care, and prescriptions.

Application process

Undocumented immigrants can apply for Medi-Cal in one of four ways:

  • In person at the local county social services office where applicants can get personal assistance completing their applications.
  • Mail in a single streamlined application available in English and other languages. Completed and signed applications can be mailed to the local county social services office.
  • Via telephone by calling their local county social service office.
  • Online at www.CoveredCA.com. Applications are securely transferred directly to the local county social services office since Medi-Cal is provided at the county level.

Health coverage for undocumented immigrants in other states

Undocumented immigrants face eligibility restrictions barring them from joining federal health insurance programs such as Medicaid, Children's Health Insurance Program (CHIP), Affordable Care Act (ACA) Marketplace coverage, and Medicare in most other states. Legislation has been discussed at the federal level but lacks the support to pass.

Some states provide limited coverage to undocumented children and pregnant women, such as Illinois and Texas. Two states, Colorado and Washington, have debuted programs allowing undocumented immigrants to enroll in the ACA exchange and will subsidize costs for low-income applicants. Maryland is debating initiatives to add undocumented immigrants to its state ACA health exchange for 2025 with plans for state subsidies.

Program rational and opposition

Advocates promote the expansion as an investment in the health of all individuals resulting in more stability for workers and their families. Gavin Newsom, the state’s Democratic governor, also promotes the expansion as a cost-saving measure, citing how unforeseen emergency care drains hospitals that are uncompensated for care due to uninsured patients. However, the Republican Caucus disagrees, stating the following after a 2022 budget analysis: Medi-Cal is already strained by serving 14.6 million Californians — more than a third of the state’s population. Adding 764,000 more individuals to the system will certainly exacerbate current provider access problems.”

Program goals

Studies demonstrate undocumented immigrants face barriers that limit their access to healthcare, including eligibility and language barriers, resulting in 50% being underinsured compared to 8% of U.S.-born citizens. In addition, undocumented adults work in industries lacking in health benefits and often fail to qualify for federal programs.

The same group often avoids seeking care because of a fear of being reported by authorities and the risk of deportation. However, the population of undocumented immigrants also demonstrates the use of many preventive services at the same rate as Medi-Cal recipients, including flu shots, the shingles vaccine, and cancer screenings, all being appropriate preventative services for older recipients.

In addition, the non-profit institution Public Policy Institute of California, PPIC, found at least one chronic condition within the population of older undocumented immigrants, which is like that of the general population of Medi-Cal recipients.


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