'So Thankful’: California to Offer Medi-Cal to 235,000 Undocumented Adults

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TODEC Executive Director Luz Gallegos holds a sign reading ‘COVID-19 Vaccine’ before conducting a vaccine information clinic for farmworkers on March 30, 2021 in Winchester, California. TODEC is an immigrant advocacy organization which has been traveling to agricultural sites to educate farmworkers while dispelling myths about the vaccines. She called the expansion of Medi-Cal benefits to undocumented elders 'a historic moment' for California. (Mario Tama/Getty Images)

Nearly a quarter of a million undocumented adults and seniors in California – many of whom are or have been essential workers – will gain access to low-cost or free medical services as early as next year under a groundbreaking budget deal approved Monday by the Legislature.

California is now positioned to officially become the first state in the nation to offer public health insurance to low-income, undocumented residents ages 50 and older, a highly vulnerable population which has been made even more vulnerable by the deadly COVID-19 pandemic.

Gov. Gavin Newsom is expected to sign the agreement into law before July 1.

State Insurance Commissioner Ricardo Lara, who as senator introduced the first (unsuccessful) bill in 2014 to end the exclusion of undocumented immigrants from full Medi-Cal benefits, applauded the news as “a dream come true.”

“California’s immigrants have given so much to our state and now they’ll have the dignity of accessing health care,” Lara said. “Today the state Legislature and the governor will be erasing a vestige of discrimination against our immigrant communities that so many of us have fought for years to overcome.”

The whopping $262.6 billion state budget deal includes spending on a range of programs with an eye toward social equity, including other projects like universal transitional kindergarten, enhanced after-school and summer learning programs and an effort to make the state’s top public universities more accessible to in-state students.

Assembly Budget Chair Phil Ting, D-San Francisco, said the record-breaking budget presents a once-in-a-lifetime opportunity.

“This is a budget that really demonstrates that our values are protecting the most vulnerable families, the families who need our help the most in the time of the pandemic. But also well into the future,” Ting said.

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One of the estimated 235,000 undocumented immigrants who could benefit from low or no-cost health care is Isabel, a 76-year-old former farmworker who did not want her last name used because of her immigration status.

“I am so thankful. I’m very excited,” she said, her voice breaking. “We worked so much in the fields and we never got any benefits.”

Isabel, who picked crops for more than three decades, said she feared for her life after she became seriously ill with COVID-19. But she did not seek medical care because she lacked insurance and worried about the cost of seeing a doctor, she said in Spanish.

“It was very, very difficult,” said Isabel, adding that her daughter, who lives with her, also got sick with the virus. “When we went to sleep, we thought we wouldn’t rise in the morning.”

Nearly 1.5 million unauthorized immigrants lacked health insurance last year, the largest group of uninsured in the state, according to a report by the UC Berkeley Labor Center.

Undocumented immigrants in the United States pay billions of dollars in taxes and often do essential work in agriculture, food services, health care and other industries. But they are excluded from the Affordable Care Act and they cannot purchase subsidized coverage through Covered California, the state’s ACA health exchange.

In recent years, the state began offering full-scope Medi-Cal – covering doctor’s visits, prescriptions, eye and dental care and other services – to low-income undocumented children and young adults up to age 26. But older immigrants have only been eligible for limited Medi-Cal, which only covers prenatal care and health emergencies.

The earliest newly eligible seniors and older adults could access full coverage is May 2022, according to state Sen. María Elena Durazo, D-Los Angeles, who championed the program’s expansion. It will cost up to $1.3 billion per year, once the changes are fully established, according to the budget agreement.

Durazo and other advocates stressed that because most undocumented adults ages 50 and older are already enrolled in restricted Medi-Cal, the state is responsible for paying the cost of emergency room visits, which are much more expensive than preventive care.

“That’s not a smart use of our funds,” said Durazo. “It’s much better to use our funds for preventative, primary health care. And that really matters not only to the individuals, but it matters in terms of dollars and cents.”

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The budget deal also includes resources to begin offering regular food assistance benefits to low-income residents, regardless of immigration status.

Lawmakers approved funds – up to $280 million by 2023 – to expand the California Food Assistance Program. CFAP currently provides food aid to thousands of legal immigrants and refugees who have been excluded from federally funded food stamps.

“We are grateful to state leaders for seizing this historic opportunity to take tangible steps toward ensuring that undocumented immigrants – our neighbors, friends, colleagues, and important members of our California communities – are no longer denied basic food assistance,” said Jared Call, senior policy advocate with Nourish California, in a statement.

Call, whose organization co-leads the Food for All campaign, said California is set to become the first state to offer food assistance to undocumented immigrants via a permanent program.

Even before the COVID pandemic in California, children in families that include undocumented immigrants were three to four times more likely to grow up with unmet basic needs compared to children in non-immigrant families, according to a report by the California Budget and Policy Center.

Advocates say that the process for newly eligible undocumented people to sign up for state-funded health coverage or food aid will be no different than for others applying for Medi-Cal or CalFresh. Enrollment for food assistance benefits is set to start in 2023.

This story includes reporting from KQED's Katie Orr.