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

Perla Lopez hands a stack of papers to Baudeilio, a 44-year-old undocumented immigrant and day laborer. She had just helped him apply for Medi-Cal at St. John’s Medical Center in South Los Angeles.

“If you see something in the area that you don’t understand, come back here,” López Baudaelio says in Spanish.

Completing an application takes no more than 20 minutes. The process, although short-lived, marks an important milestone in the decades-long expansion of health care coverage for undocumented immigrants in California.

Starting Jan. 1, for the first time, undocumented immigrants of all ages will be eligible for Medi-Cal, the government health insurance program for people with extremely low incomes. Makes California the only state to fund comprehensive health care for undocumented immigrants.

Baudailio, who was previously denied coverage and asked that his last name not be published to protect him from immigration authorities, will join more than 700,000 undocumented immigrants ages 26 to 49 who will be eligible for Medi-Cal under the Medi-Cal program. program. the state’s final expansion of the program: realizing a long-awaited dream for Californians without legal status.

“This is the culmination of literally decades of work, and it’s huge,” said Sarah Darr, policy director at the California Immigration Policy Center. “It’s huge because of all the work, effort and promotion that has gone into making this possible and the impact it will have.”

Gov. Gavin Newsom and the Democratic-led state Legislature are committing more than $4 billion annually to expand Medi-Cal. Newsom’s 2022 budget made the latest expansion possible, and although the state is now heading toward a $68 billion deficit, advocates say Medi-Cal’s positive impact on human health is priceless.

It’s a change that resonates deeply with Lopez, who is also undocumented.

Last year, when the state expanded Medi-Cal to immigrants over 50, Lopez’s mother was finally able to get medications and blood testing equipment to treat her diabetes. This year, surrounded by tinsel and other Christmas decorations in her brightly lit office, Lopez welcomes the opportunity to deliver good news to undocumented patients.

“It really touches me,” said Lopez, who is eligible for the Deferred Action for Childhood Arrivals program. “It’s a stressor that we’re removing… For people with health problems, Medi-Cal really makes a difference.”

The clinic where Lopez works estimates that 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’s ambitious plan to eliminate the insurance gap. Los Angeles County alone accounts for about half of the enrollees expected to be eligible for Medi-Cal.

“This is an exciting time for both our patients and us,” said Annie Uraga, benefits coordinator at Saint John Public Health. “They are ready. Many of them need or expect visits from specialists.”

California Health Insurance Expansion

The final expansion would occur nine years after then-Gov. Jerry Brown signed legislation making undocumented children eligible for public insurance in 2015, thanks to the efforts of advocates who headed to the Capitol to make their case.

“When we talk to people who are affected by this, we see that the changes this makes in their lives cannot even be described in numbers and words,” said Darr of the California Immigration Policy Center. “In many cases, people lived for decades without any medical care.”

A comprehensive Medi-Cal program offering access to primary and preventive care, specialists, pharmaceuticals and other comprehensive services would change lives, Darr 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 Immigration 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 job wasn’t easy, even in center-left California. Many moderate Democrats voted against the law or refrained from intervening in the debate in the early days, but gradually public opinion and political will changed, Darr said.

About 66% of California adults supported health insurance for undocumented immigrants in March 2021, up from 54% in 2015, according to a Public Policy Institute of California poll.

Former Republican President Donald Trump opposed California’s youth expansion in 2020, saying California and other states would “bankrupt our country by providing free, taxpayer-funded health care to millions of illegal aliens.” California’s elected Republicans, while less vocal in their condemnation of the state’s immigration policies in recent years, have blamed Newsom for straining the state budget and Medi-Cal system.

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

Newsom, for his part, played a critical role in developing the movement, said Rachel Lynn Gish, director of communications for Health Access California. Newsom, who took office in 2019, campaigned on a promise to create universal health care in California, and his supporters throughout his term as governor pressured him to deliver on that promise.

“You can’t talk about coverage for everyone unless you talk about coverage for everyone, regardless of their immigration status,” Lynn Gish said. “Governor Newsom has made this one of his core platforms from day one, and I think it’s hard to separate the two.”

Still, Newsom has faced pressure to do more for undocumented immigrants and to do it faster. Advocates and some lawmakers have pressured Newsom to implement this latest expansion more quickly, in part because of the disproportionate toll Covid-19 has taken 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 students, cost the state about $1.6 billion a year, according to previous reports from the Office of Legislative Analysis. The total price tag of $4 billion, while significant, represents only a fraction of Medi-Cal’s vast $37 billion budget.

However, many undocumented Californians will still not be eligible for health insurance. About half a million immigrants earn too much money to qualify for Medi-Cal but still cannot afford private insurance. Advocates want to expand Covered California to include this population, but growing staffing shortages make that unlikely in the near future.

Health Disparities Among Undocumented Immigrants

Undocumented immigrants often avoid health care, making it difficult to compare their health to other Californians. Some studies show they have 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 have mental health problems and report poor health.

Dr. Efrain Talamantes, chief operating officer of AltaMed in Los Angeles, California’s largest federally chartered medical center, said he often sees undocumented young people who feel healthy but are “already suffering from harm.” ”

This change will allow Talamantes and others serving these communities to provide patients with a high level of affordable care. Although California offers an emergency Medi-Cal program for many undocumented immigrants, and some counties fund their own programs, services can be splintered with months-long wait times.

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

Miriam Pozuelos is one of those people. The Los Angeles mother said the expansion takes a huge financial burden off her family. She and her husband pay for health care out of pocket and often go without. Both have already applied for full Medi-Cal benefits for January.

“When my family and I heard about this expansion, we were really hopeful that it would actually come to fruition and that we could start getting the help we needed and not worry about, ‘I’m going to have to pay this huge bill,’” Pozuelos said.

Back at the St. John’s Health Care Center, Lopez is helping another undocumented immigrant renew his emergency Medi-Cal program, which will automatically renew next month. Wilder, 41, who asked that his last name not be used to protect him from immigration authorities, said he needs two root canals for a total cost of $8,000. According to Wilder, he spent several months looking for a cheaper option without success. You also need medication for high blood pressure, but you can’t always afford it.

He says the expansion of Medi-Cal means he can finally take charge of his health.

“It’s nice to see them leave happy and smiling,” Lopez said. “Even if it takes us three hours, they leave feeling relieved that they can see a doctor.”

This post was produced with support from the California Health Care Foundation (CHCF), which works to people have access to the care they need, when they need it, and at a price they can afford. Visited www.chcf.org To get more information.