California became the first state on Thursday to guarantee free health care to all low-income immigrants living in the country illegally, providing coverage for an additional 764,000 people at an estimated cost of $2.7 billion per year.
Gov. Gavin Newsom signed a $307.9 billion operating budget that commits to making all low-income adults, regardless of immigration status, eligible for the state’s Medicaid program by 2024. It’s a long-awaited victory for healthcare and immigration activists who have been campaigning for change for over a decade.
Through Medicaid, the federal and state governments collaborate to provide free health care to low-income adults and children across the country. However, the federal government will not pay for people who are in the country illegally. Some states, including California, have used their tax dollars to cover a portion of low-income immigrants’ healthcare costs.
California now wants to be the first to do so for everyone.
Currently, approximately 92 percent of Californians have some form of health insurance, placing the state in the middle of the pack nationally. However, once this budget is fully implemented, adults living in the country illegally will make up one of the state’s largest groups of people without insurance.
“This will be the largest expansion of coverage in the country since the Affordable Care Act’s inception in 2014,” said Anthony Wright, executive director of Health Access California, a statewide consumer health care advocacy group. “In California, we recognize that when everyone is covered, everyone benefits.”
According to the Kaiser Family Foundation, a health care nonprofit, people living in the country illegally made up about 7% of the total population in 2020 or about 22.1 million people. Even though many of them work and pay taxes, they are ineligible for most government programs.
Immigrants are gradually gaining access to some healthcare programs. Prenatal care is now available to people regardless of immigration status in eighteen states, while the District of Columbia and five states — California, Illinois, New York, Oregon, and Washington — cover all children from low-income families regardless of immigration status. Medicaid coverage for older adult immigrants has been expanded in California and Illinois.
Republicans and conservative groups in California have opposed expanding health care to illegal immigrants. According to Jon Coupal, president of the Howard Jarvis Taxpayers Association, providing free health care will make California an “attraction for those who are not legally authorized to enter the country.”
“I believe many of us sympathize with the immigrant community, but we wish we had more control over who enters this country and this state,” Coupal said.
Medicaid expansion in California will be difficult. A confluence of events, including the state’s slow rollout of the expansion and the end of some federal pandemic policies, means that approximately 40,000 low-income immigrants will likely lose their health coverage for up to a year in 2023 before becoming eligible for it again, illustrating the difficulty of navigating the government-run health insurance system that is supposed to make it easier to get coverage.
Beatriz Hernandez arrived in the United States as an 11-year-old in 2007. When she was a child, she received health care through Medicaid. Because of her immigration status, she lost that coverage when she turned 19, but it was restored in 2020 when the state began covering low-income immigrants 26 and younger.
In February, Hernandez turned 26. Because of the pandemic’s emergency federal rules, she hasn’t lost her coverage yet. However, those rules may expire later this year, making her one of an estimated 40,000 people who will lose coverage temporarily before California’s new program begins on Jan. 1, 2024, according to a nonpartisan Legislative Analyst’s Office analysis.
Hernandez works as an organizer for the California Immigrant Policy Center in Merced, California’s Central Valley. She stated that her mother would benefit the most from the expansion because she has never had health insurance since moving to the United States.
Hernandez, on the other hand, is concerned that a gap in her coverage will prevent her from receiving the depression medication she requires. Meanwhile, she’s making as many appointments as she can this year, including visits to the dentist, optometrist, and dermatologist, before losing coverage.
“It’s fantastic that California is taking that step to set an example for other states,” Hernandez said, adding that she does not have a work permit or other legal authorization to live in the United States. “I believe we can do better by ensuring that people like myself and hundreds, if not thousands, of others, do not lose their health insurance simply because they turn 26.”
Previous Medicaid expansions in California took six months to a year to implement. However, the Newsom administration claims that because this expansion is so large, it will take a year and a half to complete.
According to health care advocates, the coverage gap is significant for low-income immigrants living in the country illegally because they have no other options. Citizens who lose Medicaid coverage can purchase coverage through Covered California, the state-run health insurance exchange, and are likely to qualify for a substantial discount.
“But that’s it for this population.” “(Medicaid) is the only public program available to them,” said Sarah Dar, the California Immigrant Policy Center’s director of health and public benefits policy.
Democrats in the state legislature have stated that they are collaborating with the Newsom administration to expedite the process.
“We’re doing everything we can.” “We’re talking to the administration, we’re talking to the leadership in the (California) Department of Health, to make sure we get it done as soon as possible and nobody loses it in the meantime,” Democratic Sen. Maria Elena Durazo said. “It makes no sense to lose them and then bring them back in.”