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

Perla Lopez handed a stack of papers to Baudeleo, a 44-year-old undocumented immigrant and day laborer. They helped him apply for Medi-Cal at St. John’s Community Health Benefits Center in South Los Angeles.

“If you see something about the county you don’t understand, come back here,” López says to Baudelío in Spanish.

Application takes less than 20 minutes. This process, though brief, is an important milestone in the decades-long expansion of health care for undocumented immigrants in California.

Starting Jan. 1, for the first time, undocumented immigrants of all ages will qualify for Medi-Cal, the state health insurance program for extremely low-income people. Makes California the only state to provide funding for comprehensive health care for undocumented immigrants.

Baudillio, who was previously denied coverage and asked that his last name not be published to protect him from immigration officials, will join more than 700,000 undocumented immigrants between the ages of 26 and 49 who are eligible for Medicare. -Will be eligible as part of Cal. Program. The final expansion of the state program: the realization of a long-awaited dream for Californians without legal status.

“This is literally the culmination of decades of work, and it’s huge,” said Sarah Darr, policy director of the California Immigrant Policy Center. “It’s huge because of all the work, effort and promotion that went into making it possible, and it’s also huge because of the impact it’s had.”

Governor Gavin Newsom and the Democratic-led state legislature have committed more than $4 billion annually to Medi-Cal expansion. Newsom’s 2022 budget makes the latest expansion possible, and though the state is now headed for a $68 billion deficit, advocates say the positive impact Medi-Cal will have on individual health is invaluable.

This change closely matches Lopez’s, which has also not been documented.

Last year, when the state expanded Medi-Cal to immigrants over the age of 50, Lopez’s mother was finally able to get medication and blood-testing equipment for her diabetes. This year, surrounded by tinsel and other Christmas decorations in a brightly lit office, Lopez is happy to be able to deliver good news to undocumented patients.

“It really affects me,” said Lopez, who is eligible to work through the Deferred Action for Childhood Arrivals program. “It’s a stress that we relieve…For people with health problems, Medi-Cal really makes a difference.”

Medi-Cal document at St. John's Community Health in Los Angeles on December 19, 2023.  Undocumented adults will be eligible for Medi-Cal health care coverage in the new year.  Photo by Lauren Justice for CalMatters

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

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

“This is an exciting time for both our patients and us,” said Anne Urga, benefits consultant coordinator for St. John’s Community Health. “They’re ready. Many of them need or expect to meet with experts.”

California’s health insurance expansion

The last expansion took place nine years after the then government. Jerry Brown signed legislation making undocumented children eligible for state insurance in 2015, and it’s thanks to the efforts of advocates who went to the Capitol to make their case.

“When we talk to people affected by this, the difference it makes in their lives really can’t even be described in numbers and words,” said Darr of the California Immigrant Policy Center. “In many cases, people live without any health care for decades.”

Full-scope Medi-Cal will provide access to primary and preventive care, specialists, pharmaceuticals and other comprehensive services that will change lives, Dar said. California does not share immigration information with federal authorities, and enrolling in Medi-Cal will not jeopardize your chances of obtaining legal residency, known as the public charge rule.

The California Immigrant Policy Center, along with the consumer advocacy group Health Access California, has been a leading force in the campaign to eliminate citizenship requirements for Medi-Cal. The task was not easy even in left-leaning California. Many moderate Democrats voted against the legislation or refrained from intervening in the debate in the early days, but public opinion and political will gradually changed, Darr said.

According to a survey by the Public Policy Institute of California, about 66% of California adults supported health coverage for undocumented immigrants in March 2021, up from 54% in 2015.

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

“Medi-Cal is already under pressure to serve 14.6 million Californians, more than a third of the state’s population. Adding 764,000 more people to the system would certainly exacerbate current provider access problems, the Senate Republican Caucus said in a January 2022 budget analysis.

Benefits counselor Perla Lopez helps an undocumented adult at St. John's Community Health on December 19, 2023 in Los Angeles.  Undocumented adults will be eligible for Medi-Cal health care coverage in the new year.  Photo by Lauren Justice for CalMatters

Benefits counselor Perla Lopez helps an undocumented adult at St. John’s Community Health on December 19, 2023 in Los Angeles. Undocumented adults will be eligible for Medi-Cal health care coverage in the new year. Photo by Lauren Justice for CalMatters

Newsom has played a key role in driving the movement on its behalf, said Rachel Lynn Gish, communications director for Health Access California. Newsom, who took office in 2019, campaigned on a promise to establish universal health care in California, and his advocates have spent the duration of his tenure as governor pressuring him to follow through on that promise .

“If you don’t talk about coverage for everyone, regardless of their immigration status, you can’t talk about coverage for everyone,” Lynn Gish said. “Governor Newsom made this one of his main platforms from day one and I think it’s hard to reconcile those two things.”

Still, Newsom has faced pressure to do more for undocumented immigrants, and to do it fast. Advocates and some lawmakers pressed Newsom to enact this latest extension as soon as possible, in part because COVID-19 has taken a disproportionate toll on essential workers, many of whom are undocumented.

The expansion is expected to cost more than $835 million over the next six months and $2.6 billion each year thereafter. 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 reports from the Office of Legislative Analysis. The total $4 billion price tag, while significant, represents a fraction of Medi-Cal’s massive $37 billion budget.

Still, many undocumented Californians will remain ineligible for health insurance. Nearly half a million immigrants earn too much money to qualify for Medi-Cal but still can’t afford private insurance. Advocates want to expand Covered California to include that population, but that is unlikely in the near future due to the state’s growing deficit.

Health disparities among undocumented immigrants

Undocumented immigrants often avoid medical care, making it difficult to compare their health with that of other Californians. Some studies indicate that they experience higher rates of chronic diseases such as heart disease, asthma, and high blood pressure. Immigrants without legal status in California are also more likely to suffer mental distress and report poor health.

Dr. Efrain Talamantes, chief operating officer of AltaMed in Los Angeles, California’s largest federally qualified health center, said he often sees young, undocumented people who feel healthy but “are already suffering ” not found.”

This change will allow Talamantes and others serving those communities to provide high-level, affordable care to patients. Although California provides emergency Medi-Cal to many undocumented immigrants and some counties fund their own programs, services can be isolated with wait times of months.

“When these patients now receive Medi-Cal and are part of a managed care plan with us, we will be responsible for all of their care, from primary and specialty care to hospital care,” Talamantes said.

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

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

Miriam Pozuelos is one of those people. The Los Angeles-area mother said the expansion has placed a heavy financial burden on her family. She and her husband pay for medical services out of their own pockets and often go without it. Both have already applied for full Medi-Cal for January.

“When my family and I found out about this expansion, we were really hoping that it would actually come true and we could start getting the care that we need and not have to worry about ‘I have to pay this huge bill,'” Pozuelos said.

Back at the St. John’s Community Recovery Center, Lopez helps another undocumented immigrant renew her emergency Medi-Cal, which will automatically renew next month. Wilder, 41, who asked that his last name be withheld to protect himself from immigration officials, said he needed two root canals for a total of $8,000. Wilder said he searched for a cheaper alternative for months without success. You also need high blood pressure medicine, but you can’t always afford it.

The expansion of Medi-Cal means he will finally be able to take care of his health, he said.

“It’s good to see him go away happy and smiling,” Lopez said. “Even if it takes us three hours, they leave with a sense of relief that they can see a doctor.”

This note was prepared in collaboration with the California Health Care Foundation (CHCF), which works to ensure People get access to the care they need, when they need it, and at a price they can afford. Visited www.chcf.org for more information.

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