California on Thursday became the first state to guarantee free health care to all low-income immigrants living illegally in the country, a move that will provide coverage to an additional 764,000 people at a possible cost of about $ 2.7 billion a year.
Governor Gavin Newsom signed an operating budget of $ 307.9 billion, committing to making all low-income adults eligible for the state’s Medicaid program by 2024, regardless of their immigration status. It is a long-sought victory for health and immigration activists who have been calling for change for more than a decade.
Nationwide, federal, and state governments are joining forces to provide free health care to low-income adults and children through Medicaid. But the federal government will not pay for people living in the country illegally. Some states, including California, have used their own tax dollars to cover part of the health care costs of some low-income immigrants.
Now California will be the first to do it for everyone.
About 92% of Californians currently have some form of health insurance, which places the state in the middle of the herd nationally. But that will change when this budget is fully implemented, as adults living in the country illegally make up one of the largest groups of people without insurance in the state.
“This will represent the largest expansion of coverage in the country since the inception of the Affordable Care Act in 2014,” said Anthony Wright, CEO of Health Access California, a state-wide advocacy group for consumer health care. “In California, we recognize (that) everyone has benefits when everyone is covered.”
People who lived illegally in the country accounted for about 7% of the nationwide population by 2020, or about 22.1 million people, according to the Kaiser Family Foundation, a nonprofit organization in the health care sector. They are not entitled to most public services, although many have jobs and pay taxes.
Immigrants have slowly gained access to some health programs. Eighteen states now provide prenatal care to people regardless of their immigration status, while the District of Columbia and five states – California, Illinois, New York, Oregon and Washington – cover all children from low-income families regardless of their immigration status. California and Illinois have expanded Medicaid to cover older adult immigrants.
In California, Republicans and conservative groups have opposed expanding the health care system to immigrants living illegally in the country. Jon Coupal, president of the Howard Jarvis Taxpayers Association, said the offer of free health care would make California “a magnet for those not legally authorized to enter the country.”
“I think many of us are very sympathetic to the immigrant community, but we really wish we had better control over who comes into this nation and this state,” Coupal said.
California’s expansion of Medicaid will not be easy. A confluence of events, including the state’s slow rollout of enlargement and the end of some federal pandemic policies, means that about 40,000 low-income immigrants are likely to lose their health coverage for up to a year in 2023 before being eligible to return it – illustrates the difficulty of to navigate the state-run health insurance system to make it easier for people to get coverage.
Beatriz Hernandez came to the United States in 2007 as an 11-year-old. She received health care through Medicaid when she was a child. She lost that coverage when she turned 19 due to her immigration status, but it was restored in 2020 when the state began covering low-income immigrants aged 26 and under.
Hernandez turned 26 in February. She has not yet lost her coverage due to federal emergency rules during the pandemic. But those rules could expire later this year, making her one of an estimated 40,000 people who will temporarily lose their coverage before California’s new program begins Jan. 1, 2024, according to an analysis by the non-partisan Legislative Analyst’s Office.
Hernandez lives in Merced, California’s Central Valley, and works as an organizer for the California Immigrant Policy Center. She said her mother would benefit most from the expansion, as she had never had health insurance since she moved to the United States.
But for Hernandez, she’s worried that a hole in her coverage would cause her to lose access to the medication she’s taking to treat depression. In the meantime, she plans as many appointments as she can this year – including to the dentist, optometrist and dermatologist – before she loses coverage.
“It’s amazing that California is taking that step to set this example for other states,” said Hernandez, who said she does not have a work permit or other permit to live in the United States. “I believe we can do better by ensuring that people like myself and hundreds of others, thousands of others, do not drop out of their health care just because they turn 26.”
Previous expansions of California’s Medicaid system have taken six months to a year to implement. But the Newsom administration says it needs a year and a half to complete this expansion because it is so much bigger than the previous ones.
Health advocates say the gap in coverage is significant for low-income immigrants living illegally in the country because they have no other options. Citizens who lose their Medicaid coverage can purchase coverage from Covered California, the state-run health insurance exchange, and are likely to qualify for a significant discount.
“But for this population, it’s it. (Medicaid) is the only public program available to them,” said Sarah Dar, director of health and public service policy for the California Immigrant Policy Center.
Democrats in the state legislature say they are working with the Newsom administration to speed up the process.
“We are doing everything we can. We are talking to the administration, talking to the management of the (California) Department of Health, to make sure we do it as quickly as possible and that no one loses it in the meantime,” said Democratic Senator Maria Elena Durazo. “It does not make sense to lose them and then pull them back in.”
