Perla Lopez offers Baudeilio, a 44-year-old undocumented immigrant and day laborer, a stack of documents. She had just assisted him in applying for Medi-Cal at St. John’s Community Health in South Los Angeles’ benefits department.
“If you see anything you don’t understand from the county, come back here,” Lopez says in Spanish to Baudeilio.
The application takes less than 20 minutes to complete. The paperwork, while simple, represents a significant step forward in California’s decades-long expansion of health care for illegal immigrants.
Undocumented immigrants of all ages will be eligible for Medi-Cal, the state’s health insurance program for the severely low-income, for the first time on January 1. As a result, California is the only state that provides complete health care to unauthorized immigrants.
Baudeilio, who has previously been denied coverage and has requested that his last name not be published in order to protect him from immigration authorities, will join more than 700,000 undocumented immigrants between the ages of 26 and 49 who will become eligible for Medi-Cal as part of the state’s final expansion of the program, bringing a long-awaited dream for Californians without legal status to fruition.
“This is the culmination of literally 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 and effort and advocacy that went into making this possible, and it’s also huge because of the impact that it’s going to have.”
Gov. Gavin Newsom and the state’s Democratic-led Legislature have pledged more than $4 billion in yearly funding for Medi-Cal expansion. The current expansion was made possible by Newsom’s 2022 budget, and while the state is now facing a $68 billion deficit, proponents believe the good impact Medi-Cal will have on individual health is priceless.
The change resonates deeply with Lopez, who is herself undocumented.
Lopez’s mother was finally able to acquire diabetic medicine and blood testing equipment when the state expanded Medi-Cal to older immigrants over the age of 50 last year. Lopez is thrilled to offer good news to undocumented patients this year, surrounded by tinsel and other Christmas decorations in the brilliantly lit workplace.
“It really touches me,” Lopez, who is qualified for employment under the Deferred Action for Childhood Arrivals program, said. “It’s a stressor we remove from them…Medi-Cal makes a significant difference for persons with health problems.”
Lopez’s clinic anticipates that around 13,000 of its patients will become Medi-Cal eligible in the coming year. They are among the most numerous participants in California’s ambitious strategy to bridge the insurance gap. Los Angeles County alone accounts for about half of the Medi-Cal participants who are likely to qualify.
“It’s an exciting time for both our patients and us,” Annie Uraga, benefits counselor coordinator at St. John’s Community Health, said. “They’re prepared. Many of them require or are awaiting professional appointments.”
California’s Health Insurance Expansion
The final expansion comes nine years after then-Gov. Jerry Brown signed legislation in 2015 making illegal children eligible for state insurance, and is the result of campaigners journeying to the Capitol to urge their cause.
“When we talk to people who are impacted by this, the difference it makes in their lives is something that truly numbers and words cannot even describe,” said Darr of the California Immigrant Policy Center. “In many cases people have lived for decades without any kind of health care whatsoever.”
The California Immigrant Policy Center, in collaboration with the consumer advocacy group Health Access California, has been a driving force in the push to repeal Medi-Cal citizenship restrictions. Even in left-leaning California, the work was difficult. Many moderate Democrats voted against the measure or did not participate in the discussion in the beginning, according to Darr, but public opinion and political will gradually altered.
According to a study conducted by the Public Policy Institute of California, around 66% of California people supported health care for unauthorized immigrants in March 2021, up from 54% in 2015.
Former Republican President Donald Trump slammed California’s 2020 expansion for young adults, claiming the state and others will “bankrupt our nation by providing free taxpayer-funded healthcare to millions of illegal aliens.” Elected California Republicans have accused Newsom of overburdening the state’s budget and Medi-Cal system, despite being less severe in their condemnation of the state’s immigration policy in recent years.
“Medi-Cal is already overburdened because it serves 14.6 million Californians — more than a third of the state’s population.” “Adding 764,000 more people to the system will almost certainly exacerbate current provider access issues,” the Senate Republican Caucus stated in a January 2022 budget review.
According to Rachel Linn Gish, communications director for Health Access California, Newsom has played a vital role in moving the cause ahead. Newsom, who took office in 2019, campaigned on the goal of achieving universal health care in California, and activists have pushed him to maintain that commitment during his administration.
“You cannot talk about coverage for all if you’re not talking about coverage for everyone regardless of their immigration status,” Gish added. “Gov. Newsom made it a major platform of his from day one, and I think it’s hard to untie those two things.”
Nonetheless, Newsom has been under pressure to do more and do it faster for unauthorized immigrants. Advocates and lawmakers pressed Newsom to implement this last extension sooner, citing the disproportionate impact COVID-19 had on key workers, many of whom were illegal.
This expansion is expected to cost more than $835 million in the first six months and $2.6 billion in subsequent years. Previous expansions, which allowed more than 1.1 million illegal enrollment, cost the state around $1.6 billion per year, according to previous Legislative Analysis Office studies. The entire cost of $4 billion, while large, is a fraction of Medi-Cal’s broad $37 billion budget.
Even yet, many illegal California residents will continue to be denied health insurance. Approximately 500,000 immigrants earn too much to qualify for Medi-Cal yet cannot afford private insurance. Advocates want Covered California to be expanded to encompass that group, but the state’s growing deficit makes it unlikely in the foreseeable future.
Health Disparities Among Undocumented
Undocumented immigrants frequently avoid medical care, making it difficult to compare their health to that of other Californians. Some studies show that they have higher rates of chronic conditions such as heart disease, asthma, and high blood pressure. Immigrants without legal status in California are also more likely to suffer from mental distress and self-report poor health.
Dr. Efrain Talamantes, chief operating officer of AltaMed in Los Angeles, California’s biggest federally certified health facility, said he routinely meets young, undocumented people who appear healthy but “already are having the end damage of chronic conditions that have not been detected.”
The shift will enable Talamantes and others who serve such neighborhoods to provide patients with low-cost, high-quality treatment. Although California provides emergency Medi-Cal to many illegal immigrants and some counties fund their own programs, services can be fragmented, with monthslong wait periods.
“When these patients now receive Medi-Cal and are part of a managed care health care plan with us, then we’re responsible for their entire care from primary and specialty to hospital care,” Talamantes went on to say.
Miriam Pozuelos is one such individual. The mother from the Los Angeles area said the expansion relieves her family of a significant financial load. She and her spouse pay for any medical care out of pocket and frequently go without. Both have already applied for full-scope Medi-Cal coverage beginning in January.
“When me and my family heard about this expansion, we were just really hoping that it would actually come true and that we can start getting the care that we need and not be worried about ‘I have to pay this enormous bill,'” Pozuelos, who speaks Spanish, said.
Lopez returns to the St. John’s Community Health benefits facility to assist another illegal immigrant in renewing his emergency Medi-Cal, which will automatically renew to full-scope next month. Wilder, 41, who wanted that his last name be suppressed to protect him from immigration officials, stated that he need two root canals costing $8,000 in order to be released. Wilder stated that he had been looking for a cheaper solution for months with no results. He also requires high blood pressure medicine, which he cannot always afford.
According to him, the Medi-Cal expansion means he’ll be able to finally take care of his health.
“It’s nice seeing them leaving happy and smiling,” Lopez went on to say. “Even if it takes us three hours, they leave with a sense of relief that they can see the doctor.”
CalMatters is a public interest journalism project dedicated to explaining how and why California’s state Capitol functions.
The California Health treatment Foundation strives to guarantee that individuals have access to the treatment they need, when they need it, and at a price they can afford. For additional information, go visit www.chcf.org.
