SACRAMENTO, Calif. (AP) — California on Thursday became the first state to guarantee free health care for all low-income immigrants living in the country illegally, a measure that will provide coverage for an additional 764,000 people at a final cost of about $2. 7 billion a year.
Gov. Gavin Newsom signed a Operating budget of $307.9 billion that promises to make all low-income adults eligible for the state’s Medicaid program by 2024, regardless of their immigration status. It’s a long-sought win for healthcare and immigration activists, who have been calling for the change for more than a decade.
State, federal and state governments are working 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 in the country illegally. Some states, including California, have used their own tax dollars to cover some of the health care costs of some low-income immigrants.
Now California wants to be the first to do that for everyone.
About 92% of Californians currently have some form of health insurance, putting the state at the center 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 people without insurance in the state.
“This will be the largest expansion of coverage in the country since the inception of the Affordable Care Act in 2014,” said Anthony Wright, executive director of Health Access California, a statewide consumer health advocacy group. “In California, we recognize (that) everyone benefits from having everyone covered.”
According to the Kaiser Family Foundation, a nonprofit health care organization, in 2020 people living illegally in the country made up about 7% of the nation’s population, or about 22.1 million people. They do not qualify 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, regardless of immigration status. California and Illinois have expanded Medicaid to older adult immigrants.
In California, Republicans and conservative groups oppose expanding health care for immigrants living in the country illegally. Jon Coupal, president of the Howard Jarvis Taxpayers Association, said California’s provision of free health care “will create a magnet for those not legally authorized to enter the country.”
“I think a lot of us are very sympathetic to the immigrant community, but we really wish we had more control over who comes into this nation and this state,” Coupal said.
The expansion of Medicaid in California will not be easy. A confluence of events, including the state’s slow roll-out of expansion and the end of several federal pandemics, means that about 40,000 low-income immigrants will likely lose their health insurance for up to a year by 2023 before being eligible to take it. to get back – illustrating the difficulty of navigating the government-run health insurance system that should 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 because of her immigration status, but it was reinstated 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 regulations 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 Jan. 1, 2024, according to an analysis by the impartial Legislative Analyst’s Office.
Hernandez lives in Merced in California’s Central Valley and works as an organizer at the California Immigrant Policy Center. She said her mother would benefit the most from the expansion, as she had never had health insurance since moving to the US.
But for Hernandez, she fears a gap in her coverage would prevent her from accessing the medication she takes to treat depression. In the meantime, she’s scheduling as many appointments as possible this year — including for the dentist, optometrist, and dermatologist — before losing coverage.
“It’s great that California is taking that step to set that 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 really believe we can do better by making sure people like me and hundreds of others, thousands of others, don’t drop out of their health care simply because they turn 26.”
Previous extensions to California’s Medicaid system have taken six months to a year to implement. But the Newsom government says it will take a year and a half to complete this expansion because it is so much bigger than the previous one.
Health care proponents say the gap in coverage is significant for low-income immigrants living in the country illegally 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 likely qualify for a significant discount.
“But for this population, that’s it. (Medicaid) is the only public program available to them,” said Sarah Dar, director of health and public benefits policy at 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’re talking with the government, with the (California) Department of Health leadership, to make sure we do it as quickly as possible and that no one loses in the meantime,” Democratic Senator Maria Elena Durazo said. “There’s no point losing them and then bringing them back in.”