In May 2022, about 235,000 California undocumented immigrants over 50 will have access to Medi-Cal, the state’s public health insurance program. Signed in to law in July 2021 by Governor Gavin Newsom, this expansion of the program is the third wave of statewide legislative action targeted specifically at healthcare for California’s undocumented community.
According to a report published by the Public Policy Institute of California (PPIC), California is home to between 2 and 2.6 million undocumented immigrants. Health insurance for this community has been a long-standing policy concern – 46% of low-income undocumented immigrants are uninsured. During the COVID-19 pandemic, this population was hit especially hard because their immigration status limits their access to California’s safety-net programs.
“[COVID-19 has] made much more visible the magnitude of racial health disparities,” said Linda Nguy, a policy advocate for the Western Center on Law and Poverty, “disparities result in deadly outcomes for undocumented Californians who don’t have access to our safety net.”
In order to be eligible for Medi-Cal, an individual’s income must be under 138% of the Federal Poverty Level (FPL). Anyone in this group, regardless of immigration status, is eligible for restricted-scope Medi-Cal. This limited program is designed to give anyone access to emergency services who need it.
“If there is a life-threatening health condition, then it’s meant to stabilize, not necessarily actually treat the underlying cause of it,” said Nguy.
Restricted-scope Medi-Cal does not cover primary or specialty care and is only designed for emergency use. Conversely, full-scope Medi-Cal has much more robust coverage for medical care. Benefits include access to primary, dental, vision, and mental health care, as well as prescription drugs and addiction treatment.
California has previously expanded full-scope Medi-Cal coverage to undocumented income-eligible minors in 2015 with the Health4All Kids initiative, a group that expanded to include young adults through age 26 in 2019.
According to Nguy, the legislative move to target individuals over 50 for Medi-Cal eligibility was inspired by the young adults who received eligibility through previous Health4All programs. “There was prioritization among the community that they would have rather seen their parents or grandparents receive coverage.”
The impact of this expansion on California’s healthcare system is difficult to anticipate, according to Anna Gorman, director of community partnerships at the Los Angeles County Department of Health Services (LADHS). However, she says that many members of the undocumented population are already receiving care without great strain on the system.
“They may be going to safety net health systems like the Department of Health services, and they may be going to other public hospitals and clinics throughout the state – they are already receiving care at hospitals when necessary. So, it’s not as though we’re having this gigantic influx of people that we didn’t know about.”
Los Angeles County has programs like MyHealthLA that provide more expansive medical care than the restricted state option, regardless of insurance or immigration status. Despite these programs existing, the expansion of Medi-Cal will theoretically provide the most coverage.
“MyHealthLA is a pretty robust program,” said Gorman, “but it’s not health insurance.”
All income-eligible undocumented individuals over 50 that are already authorized for restricted-scope Medi-Cal will immediately roll over into full-scope Medi-Cal coverage in May 2022. The challenge is to reach the remaining income-eligible community that may have worries about enrolling.
“I do believe that there is still an aspect of trying to overcome a culture of fear when it comes to accessing public and social services,” said Phinney Ahn, executive director for Medi-Cal at L.A. Care Health Plan, “There were a lot of policies that were put in place over the last couple of years, including public charge.”
Public charge was a policy expanded under the Trump administration that said if an applicant for a visa or green card was found ‘likely’ to rely on government benefits in the future, that person would not receive a visa or green card. The Biden administration ended public charge in March 2021, but fears about the consequences of accessing public benefits may still linger.
In spite of this, Gorman remains confident that widespread outreach is possible. “There’s going to be really comprehensive outreach efforts between clinics, hospitals, advocacy organizations, immigrant rights organizations, to make sure that everybody knows that they’re eligible for this new Medi-Cal expansion.”
After the May 2022 expansion, the only group of income-eligible undocumented immigrants left uncovered are those 26 to 50, which is a large population.
“You build a bridge, that’s a one-time cost…This is an ongoing cost,” said Nguy, “but we think it’s important that all people are covered. The health system works better when all people are covered.”