New Year’s Eve: California to Expand Health Coverage for Low-Income Migrants

More than 700,000 migrants living in California illegally will have access to free health care starting Monday in one of the state’s most ambitious expansions of coverage in a decade.

The measure would cost the state about $3.1 billion a year and would bring California closer to the Democratic Party’s goal of providing universal health care to its nearly 39 million residents.

Democratic Gov. Gavin Newsom and lawmakers agreed in 2022 to provide access to health care to all low-income adults, regardless of immigration status, through the state’s Medicaid program known as Medi-Cal.

California is the most populous state to guarantee such coverage, but it’s not the first: Oregon began doing so in July.

Republicans and other conservative groups are concerned that the new expansion will put more pressure on an already overburdened health care system.

When he proposed the changes two years ago, Newsom called the expansion “a transformative step toward strengthening the health care system for all Californians.”

Newsom made the pledge while the state was running the largest budget surplus in its history. But by the time the program takes effect next week, California will face a record $68 billion deficit, raising questions and concerns about the economic impact of the expansion.

“Regardless of your position on this issue, it makes no sense for us to continue to increase our deficit,” said Republican Sen. Roger Niello, vice chairman of the House Budget and Fiscal Review Committee.

Immigration and health care advocates who have spent more than a decade fighting for change said expanding coverage would close gaps in access to health care and save public money in the long run. Those living there illegally often delay or avoid seeing a doctor because they can’t afford the costs, making their treatment more expensive when they finally go to the emergency room.

“This is a sure win because it allows us to provide comprehensive care, and we believe it will help keep our communities healthy,” said Dr. Efrain Talamantes, chief of operations for AltaMed Los Angeles, the largest skilled nursing center in the state.

The update would be California’s largest health care expansion since former President Barack Obama’s Affordable Care Act was passed in 2014, allowing states to enroll adults living below the federal poverty level in their Medicaid programs. The percentage of uninsured people in California rose from about 17% to 7%.

But a significant portion of the population has been left behind: adults living in the United States without proper permits, who cannot benefit from most government programs, even though many have jobs and pay taxes.

Some states have used their taxes to cover part of the health care costs of some low-income migrants. In 2015, California expanded coverage first to low-income children without legal status and then to young adults and people over 50.

The final group pending — adults ages 26 to 49 — will now be able to access the state’s Medicaid program.

The state doesn’t know exactly how many people will enroll under the expansion, but officials said more than 700,000 people will receive comprehensive health coverage that will allow them access to preventative care and other treatments. This is larger than the entire Medicaid population in several states.

“We had this asterisk based on immigration status,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group. “Just from a numbers standpoint, it’s a big deal.”

Republicans and other conservative groups are concerned that the new expansion will put more pressure on an already strained health care system and have criticized the cost of the expansion.

State officials estimate the expansion will cost $1.2 billion in the first six months and $3.1 billion annually thereafter. Medi-Cal’s allocation, now about $37 billion a year, is the second-largest in California’s budget, according to an analysis by the nonpartisan group Legislative Analyst’s Office.

Many migrants avoid accepting any government programs or benefits, fearing that over time this will prevent them from regularizing their situation under the State Responsibility Law. Federal law requires those seeking to become permanent residents or gain legal status to prove they will not be a burden or “public charge” to the United States. Under President Joe Biden’s administration, Medicaid is no longer seen as one of those factors, but fear remains, said Sarah Dar, policy director at the California Immigration Policy Center.

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