California becomes first state to offer health insurance to all eligible undocumented adults

In summary

Undocumented Californians are leaving health care clinics smiling after learning they are newly eligible for Medi-Cal insurance. The health insurance expansion was in the pipeline for immigrant advocates for decades.

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Perla Lopez hands a stack of papers to Baudeilio, a 44-year-old illegal immigrant and day laborer. She has just helped him apply for Medi-Cal at the benefit center at St. Johns Community Healths in South Los Angeles.

If you see something in the county that you don’t understand, come back here, Lopez tells Baudeilio in Spanish.

The application takes less than 20 minutes. Although brief, the paperwork is a significant milestone in California’s decades-long expansion of health care for undocumented immigrants.

Starting Jan. 1, undocumented immigrants of all ages will have access to Medi-Cal, the state’s health insurance program for very low-income people, for the first time. It makes California the only state to fund comprehensive health care for undocumented immigrants.

Baudeilio, who has been denied coverage in the past and has asked that his last name not be released to protect him from immigration officials, joins more than 700,000 undocumented immigrants ages 26 to 49 who are eligible for Medi-Cal as part of the event. states that the final expansion of the program to realize the long-awaited dream of Californians without legal status.

This is the culmination of literally decades of work, and it’s huge, said Sarah Darr, policy director for the California Immigration Policy Center. It’s huge because of all the work and effort and advocacy that went into making this possible, and it’s also huge because of the impact it’s going to have.

Gov. Gavin Newsom and the state’s Democratic-led legislature have committed more than $4 billion to Medi-Cal expansion each year. The Newsoms 2022 budget allowed for the latest expansion, and even though the state is now headed for a $68 billion deficit, advocates say Medi-Cal’s positive impact on individual health is priceless.

The change resonated deeply with Lopez, who is undocumented herself.

Last year, when the state expanded Medi-Cal to immigrants over 50, Lopez’s mother finally got her diabetes medication and a blood test. This year, in a brightly lit office surrounded by tinsel and other Christmas decorations, Lopez is happy to share good news with undocumented patients.

It really touches me, said Lopez, who is eligible to work through the Deferred Action for Childhood Arrivals program. The stress factor that we take away from them. For people with health problems, Medi-Cal really makes a big difference.

Medi-Cal documents at St. John’s Community Health in Los Angeles on December 19, 2023. Undocumented adults are eligible for Medi-Cal medical care in the new year. Photo by Lauren Justice for CalMatters

The clinic where Lopez works estimates about 13,000 of its patients will be eligible for Medi-Cal in the new year. They are part of the largest group in California that plans to close the insurance gap. Los Angeles County alone accounts for about half of the enrollees expected to qualify for Medi-Cal.

It’s an exciting time for both our patients and us, said Annie Uraga, St. Johns Community Health Advocacy Coordinator. They are ready. Many of them need or expect to see a specialist.

California Health Insurance Extension

The final expansion will take place nine years after the then-Gov. Jerry Brown signed legislation making illegitimate children eligible for government insurance in 2015, thanks to the efforts of advocates who trek to the Capitol to plead their case.

“When we talk to the people who are affected by this, it makes a difference in their lives that actual numbers and words can’t even describe,” said Darr of the California Immigrant Policy Center. In many cases, people have lived for decades without any form of health care.

Full coverage Medi-Cal, which provides access to primary and preventive care, specialists, medications and other comprehensive services, changes lives, Darr said. California does not share immigration information with federal authorities, and enrolling in Medi-Cal does not jeopardize chances of obtaining legal residency, which is called the public payment rule.

The California Immigrant Policy Center and the consumer advocacy group Health Access California have been a leading force in the campaign to eliminate Medi-Cal’s citizenship requirements. The job was not easy, even in left-leaning California. Many moderate Democrats voted against the bill or abstained from participating in the debate in the early days, Darr said, but slowly public opinion and political will changed.

About 66 percent of California adults supported health care for undocumented immigrants in March 2021, up from 54 percent in 2015, according to a survey by the Public Policy Institute of California.

Former Republican President Donald Trump decried California’s expansion to young adults in 2020, arguing that California and other states would bankrupt our nation by providing free taxpayer-funded health care to millions of illegal aliens. Elected California Republicans, while less harsh in their condemnation of state immigration policies in recent years, have accused Newsom of overburdening the state budget and Medi-Cal system.

Medi-Cal is already stretched thin, serving 14.6 million Californians, more than a third of the state’s population. Adding 764,000 people to the system will certainly exacerbate existing provider access problems, the Senate Republican Caucus said in a January 2022 budget analysis.

Benefits counselor Perla Lopez assists an undocumented adult at St. Johns Community Health in Los Angeles on December 19, 2023. Undocumented adults are eligible for Medi-Cal medical care in the new year. Photo by Lauren Justice for CalMatters

Newsom, for her part, has played a critical role in advancing the movement, said Rachel Linn Gish, director of communications for Health Access California. Newsom, who took office in 2019, campaigned on a promise to establish universal health care in California, and advocates have used his time as governor to pressure him to keep his promise.

You can’t talk about coverage for everyone if you don’t talk about coverage for everyone, regardless of their immigration status, Linn Gish said. Governor Newsom made it an important platform from the beginning, and I think it’s hard to separate those two things.

Still, Newsom has faced pressure to do more for undocumented immigrants, and to do it faster. Supporters and some lawmakers lobbied Newsom to enact this final extension sooner, in part because of the disproportionately large number of essential workers, many of whom are undocumented, who have been affected by COVID-19.

This expansion is projected to cost more than $835 million over the next six months and $2.6 billion every year after that. Previous expansions, which opened the door to more than 1.1 million undocumented enrollees, cost the state about $1.6 billion a year, according to previous Legislative Analysis Office reports. The $4 billion total price tag, while significant, represents a fraction of Medi-Cals’ vast $37 billion budget.

Yet many undocumented Californians do not qualify for health insurance. About half a million immigrants make too much money to qualify for Medi-Cal, but still can’t afford private insurance. Advocates want to expand Covered California to cover this population, but the states’ growing deficits make that unlikely in the near future.

Health disparities among undocumented immigrants

Undocumented immigrants often avoid medical care, making it difficult to compare their health to other Californians. Some studies show that they have more chronic diseases such as heart disease, asthma and high blood pressure. Immigrants without legal status in California are also more likely to suffer from mental health problems and self-reported poor health.

Dr. Efrain Talamantes, chief operating officer of AltaMed in Los Angeles, California’s largest federally qualified medical center, said he often sees young, undocumented individuals who feel healthy but already suffer from undiagnosed chronic conditions.

The change will allow Talamantes and others serving these communities to provide patients with affordable, high-quality care. While California offers emergency assistance to many undocumented immigrants, and some counties fund their own programs, services can be scattered due to months-long wait times.

When these patients now receive Medi-Cal and are part of a managed health plan with us, we are responsible for their entire care, from primary and specialty to inpatient care, Talamantes said.

Benefits counselor Perla Lopez assists Wilder, 41, at St. John’s Community Health in Los Angeles on Dec. 19, 2023. Wilder will be eligible for Medi-Cal medical care in the new year. Photo by Lauren Justice for CalMatters

Miriam Pozuelos is one such person. The Los Angeles-area mother said the expansion will lift a huge financial burden on her family. She and her husband pay for all medical services on their own initiative and often go without. Both have already applied for full Medi-Cal for January.

“When me and my family heard about this extension, we really hoped that it would actually happen and we could start getting the care we need and not worry that I have to pay this huge bill,” Pozuelos said in Spanish.

Back at St. Johns Community Health, Lopez is helping another illegal immigrant renew his emergency Medi-Cal, which will automatically go into full effect next month. Wilder, 41, who asked that his last name be withheld to protect him from immigration officials, said he needed two root canals totaling $8,000. He has been searching for months for a cheaper alternative without success, Wilder said. He also needs medication for high blood pressure, but can’t always afford it.

The Medi-Cal extension means Hell can finally take care of her health, she said.

It’s great to see them leave happy and smiling, Lopez said. Even if it takes us three hours, they leave relieved to be able to see a doctor.

Supporting the California Health Care Foundation (CHCF) working to ensure this people get the care they need, when they need it, at a price they can afford. Visit to learn more.

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