California came one step closer to becoming the first state to extend Medicaid to adult undocumented immigrants this week.
After the state senate proposed expanding coverage to undocumented young adults and seniors, Governor Gavin Newsom proposed an amended version, which would cover only undocumented immigrants ages 19 to 25. Then on Tuesday, the California assembly passed a bill expanding Medicaid coverage to undocumented adults of all ages. The senate still has to weigh in, but some estimates show a full expansion could make as many as 1.15 million people eligible.
This isn't the first time California has tried to expand Medicaid to reach undocumented immigrants, who make up the largest group of uninsured people in the state. But the change would be significant, particularly as the Trump administration has proposed several policies that would keep immigrants—both legal and undocumented—from receiving government benefits, including health care.
Although Deferred Action for Childhood Arrivals recipients and undocumented children in California are already allowed to enroll in Medicaid (known in the state as Medi-Cal), federal policy bars adult undocumented immigrants from receiving Medicaid or purchasing plans through the Affordable Care Act's marketplace. Instead, they must rely on a patchwork of health-care services that do not cover a wide array of health conditions. Those undocumented immigrants who are able to enroll in a limited Medi-Cal plan do not have coverage for chemotherapy or care to manage asthma, diabetes, or high blood pressure, according to an analysis from the University of California–Berkeley Labor Center.
California's expansion, even watered down, could help close this coverage gap: 90 percent of low-income undocumented adults in California are uninsured, a University of California–Los Angeles analysis has found. As a result, they're more likely to have less access to care or worse care than their native-born counterparts.
Laurel Lucia, health-care program director at the UC–Berkeley Labor Center, estimates that a full expansion could reduce the state's uninsured population by as much as a quarter. But Lucia also found that the Trump administration's ongoing crackdown on public benefits and immigration could dramatically reduce these efforts.
In one scenario, over a million undocumented adults—90 percent of those eligible—could enroll in full coverage through Medi-Cal. In another, the Trump administration's public-charge rule is finalized, discouraging people applying for green cards or visas from using public benefits. This would have a chilling effect on enrollment, with a projected decline of 35 percent. "If the public charge rule is finalized, it would mean that any Medi-Cal expansion the state adopts would be less effective in getting people covered," Lucia says.
California can still use its own funds for the expansion, but experts expect Trump's agenda will dampen participation overall.
The policy would also put the state in conflict with the administration's recent proposals that seek to limit immigrants' use of public programs, including legal immigrants, who might avoid enrolling out of fear of deportation or jeopardizing a green card. "A range of policies focused on increased immigration enforcement have contributed to an increasing level of fear among the immigrant community broadly, that is leading them to turn away from services," says Samantha Artiga, an analyst at the Kaiser Family Foundation.
California, in addition to several other states, has already extended Medicaid eligibility to low-income undocumented children, covering more than 250,000 children as of 2018. Now, research shows that Trump's policies restricting benefits could once again widen the gap.