California Poised to Offer Public Health Care to Undocumented Elders in 'Historic Moment'

Laura, 76, has not seen a doctor for years.

The former farmworker, who did not want her last name used because of her immigration status, said she is losing her eyesight and her feet are often swollen and in pain.

A grandmother, Laura also suffers from headaches and shortness of breath, months after she became seriously ill with COVID-19 during the winter surge. Through it all, she has relied on home remedies and not sought medical care because she lacks health insurance, she said, in Spanish.

“I don’t have any money. And at my age, there’s no work,” said Laura, who picked watermelon, zucchini, pumpkin and other crops for more than 20 years in fields in Southern California.

But Laura may soon get access to the medical services she desperately needs, at little or no cost.

California is on the verge of a historic step to offer public health insurance to low-income undocumented older adults — a population that has been particularly vulnerable during the COVID-19 pandemic but left out of federal assistance programs and other safety nets.

Gov. Gavin Newsom and legislative leaders are expected to announce an expansion to the Medi-Cal program in the coming days as part of a final deal on the state budget, according to advocates and legislative aides.

The most recent negotiations in Sacramento have centered on the lower age limit for those who will be newly eligible: 50 and older, as lawmakers have previously proposed; 60 and older, as Newsom offered; or somewhere in between.

“We are as certain as we can be that there will be something that comes into the final budget,” said Sarah Dar, who directs health and public benefits policy at the California Immigrant Policy Center. “And it's really just a matter of ‘What's the age they land on?‘”

In 2014, then-state Sen. Ricardo Lara introduced the first (unsuccessful) bill to make undocumented immigrants eligible for public health coverage.

Since then, California has enrolled undocumented children in full-scope Medi-Cal, offering free or low-cost preventative care, doctor visits, prescriptions, dental care, vision care and other services. Last year, the state became the first in the nation to offer health coverage to undocumented young adults through age 25.

But more than 1.3 million undocumented Californians are projected to lack health insurance next year, remaining the largest uninsured group in the state, according to a report by the UC Berkeley Labor Center.

Estimates vary, but depending on the final age cutoff that Newsom and legislative leaders decide for this year’s budget, roughly 80,000 to more than 200,000 undocumented Californians could gain access to Medi-Cal, including many who have worked essential jobs that are key to the state's economy.

Immigrant and health advocates who have pushed California for years to extend health coverage to undocumented immigrants savored the realization that finally, older adults will most likely be eligible for coverage.

“At last, justice does prevail. We are in a historic moment as Californians,” said Luz Gallegos, the executive director of TODEC, a legal center and immigrant justice organization in the Inland Empire and Coachella Valley.

“California continues to step up and defend all Californians, especially those who are most vulnerable, who don’t have any access to safety nets, but who contribute to our state economy, have been paying taxes … and have seen nothing in return,” she added.

The governor’s budget revision from May includes nearly $860 million in annual state funds to expand Medi-Cal to low-income undocumented adults age 60 and older, with some of that funding available next year. The Legislature’s proposal dedicates $1.3 billion in annual funds to cover undocumented adults age 50 and older once the program is fully established.

Gallegos, who was born in the U.S. to farmworker immigrant parents, said this likely win is personal for her. In recent years, her undocumented uncle died from cancer, she said, after he delayed seeking medical care because he was uninsured. During the pandemic, farmworkers she knows died from COVID-19 while several others became ill with the virus.

“We honor their lives by continuing the struggle so we don't see no more lives taken away from our communities,” said Gallegos, her voice breaking.

Currently, low-income undocumented immigrants who are 26 and older are eligible for limited Medi-Cal, which only covers health care emergencies or prenatal care if they are pregnant. Undocumented immigrants are excluded from the Affordable Care Act, and cannot purchase coverage through Covered California, the state’s ACA health exchange.

If they are not insured by an employer or able to purchase a private plan, they must generally rely on county health programs, which vary greatly throughout the state.

Last year, Gov. Newsom proposed offering full-scope Medi-Cal to undocumented seniors age 65 and older. But the plan didn’t go through, as the state projected a severe economic downturn and tax losses in the billions of dollars.

But the financial picture for California is starkly different this year, with the state logging an eye-popping budget surplus of $76 billion. In addition, the pandemic highlighted how “interconnected” public health really is, with all of us having to think about whether people around us wore masks, stood far enough apart, or were vaccinated, said Dar, with the California Immigrant Policy Center.

“And so to give health care access to this community would mean a healthier and stronger state for all Californians,” said Dar. “Increased productivity, better health outcomes, better public health.”

Some opponents have argued that funds to provide health coverage to undocumented people would be better spent on other needs, such as helping struggling U.S. citizens afford their own health insurance.

About two in three Californians support the idea of providing health coverage to undocumented immigrants, according to a recent survey by the Public Policy Institute of California. But many Republicans oppose it, with nearly eight in 10 saying that they are not in favor.

This year, Illinois became the first state to extend health insurance to undocumented seniors age 65 and older.

Former farmworker Laura hopes she will gain access to health coverage — and low-cost medical care — in California, where she has lived since the late 1980s, most recently in Riverside county.

“It would help me a lot to go to the doctor and get my eyes checked out,” Laura said. “It would be the best.”