California will become the first state to guarantee free health care to all low-income immigrants living illegally in the country, a measure that will cover an additional 764,000 people at a possible cost of about $2.7 billion a year.
It’s part of a $307.9 billion operating budget Governor Gavin Newsom was expected to sign off on Thursday. It pledges to make low-income adults eligible for the state’s Medicaid program by 2024, regardless of their immigration status. It’s a victory long sought by health and immigration activists, who have been calling for change for more than a decade.
National, federal, and state governments are joining together to provide free health care to low-income adults and children through Medicaid. But the federal government will not pay for people who live illegally in the country. Some states, including California, have used their own taxes to cover some of the health care expenses of some low-income immigrants.
Now California wants to be the first to do it for everyone.
About 92% of Californians currently have some form of health insurance, putting the state in the middle of the pack nationally. But that will change once this budget is fully implemented, as adults living illegally in the country make up one of the largest groups of uninsured people in the state.
“This will represent the largest coverage expansion in the country since the Affordable Care Act began in 2014,” said Anthony Wright, executive director of Health Access California, a consumer health care advocacy group at statewide. “In California, we recognize (that) everyone benefits when everyone is covered.”
People living illegally in the country made up about 7% of the national population in 2020, or about 22.1 million people, according to the Kaiser Family Foundation, a nonprofit health care organization. They are ineligible for most public benefit programs, although many have jobs and pay taxes.
Immigrants are slowly gaining access to some health care programs. Eighteen states now provide prenatal care to people regardless of immigration status, while the District of Columbia and five states – California, Illinois, New York, Oregon and Washington – cover all children from low-income families. income, regardless of their immigration status. California and Illinois expanded Medicaid to cover older adult immigrants.
In California, Republicans and conservative groups have opposed the extension of health care to immigrants living illegally in the country. Jon Coupal, president of the Howard Jarvis Taxpayers Association, said the free healthcare offer would make California “a magnet for those who are not legally allowed to enter the country.”
“I think a lot of us are very sympathetic to the immigrant community, but we really want to have more control over who comes into this nation and this state,” Coupal said.
Medicaid expansion in California will not be easy. A confluence of events, including the state’s slow rollout of expansion and the end of some federal pandemic policies, means that about 40,000 low-income immigrants will likely lose their health coverage until one year in 2023 before being eligible to recover it. illustrating the difficulty of navigating the government-run health insurance system that is supposed to make it easier for people to get coverage.
Beatriz Hernandez came to the United States in 2007 when she was 11 years old. California taxpayers covered her health expenses when she was a child. She lost that coverage once she turned 19 due to her immigration status, but it was reinstated in 2020 when the state began covering low-income immigrants 26 and younger.
Hernandez turned 26 in February. She has yet to lose 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 coverage before California’s new program begins on Jan. 1, 2024, according to an analysis by the Office of the Legislative Analyst. partisan.
Hernandez lives in Merced in California’s Central Valley and works as an organizer with the California Immigrant Policy Center. She said her mother would benefit the most from the expansion, having never had health insurance since moving to the United States.
But for Hernandez, she fears a gap in her coverage could cause her to lose access to the medications she takes to treat depression. In the meantime, she’s scheduling as many appointments as she can this year — including dentist, optometrist and dermatologist — before she loses her coverage.
“It’s great that California is taking this step to set this example for other states,” said Hernandez, who said she doesn’t have a work permit or other permission to live in the United States. “I believe we can do better by ensuring that people like me and hundreds of others, thousands of others, don’t lose their health care just because they’re 26.”
Previous extensions to 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 previous ones.
Health care advocates say 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 from Covered California, the state-run health insurance exchange, and likely receive a steep discount.
“But for this population, that’s it. (Medicaid) is the only public program available to them,” said Sarah Dar, director of health policy and public benefits at the California Immigrant Policy Center.
Democrats in the state Legislature say they are working with the Newsom administration to expedite the process.
“We’re doing everything we can. We’re talking to the administration, to the leadership of the (California) Department of Health, to make sure we’re doing it as fast as we can and nobody loses it in the meantime.” said Democratic Senator Maria Elena Durazo. “It doesn’t make sense to lose them and then bring them back.”
