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How California Will Expand Medi-Cal to Include More Low-Income Immigrants

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A nurse wearing glasses with their hair tied up administers a vaccine into a person's left arm.
A nurse administers a COVID-19 vaccine to a woman at a vaccine rollout targeting immigrants and the undocumented organized by the St. John's Well Child and Family Center in Los Angeles on March 25, 2021. Undocumented immigrants 50 or older will soon be eligible for Medi-Cal, thanks to a legislation signed by Gov. Gavin Newsom this Tuesday. (Frederic J. Brown/AFP via Getty Images)

Californians who are at least 50 and living in the country without permission are newly eligible for state health care coverage under legislation signed by Gov. Gavin Newsom on Tuesday, part of a record state budget that includes major investments in mental health, homelessness and housing.

The legislation to expand Medi-Cal coverage to low-income adults regardless of immigration status builds upon proposals pushed by Democrats to extend the state’s version of federal Medicaid to children in 2016 and to young adults under 26 in 2020.

Around 235,000 people are expected to benefit from this legislation.

“It’s a point of pride, it’s a point of principle, and it’s what marks our values here in the state of California,” Newsom said at the Clinica Sierra Vista Elm Community Health Center in Fresno.

“We believe in living together, and advancing and prospering together across every conceivable difference.”

The program will begin in May 2022. The income threshold to qualify for Medi-Cal is 138% of the federal poverty level or lower. To be eligible, individuals must earn less than $​17,609 a year and $36,100 for a family of four.

Newsom added that the expansion will have an initial cost of $48 million and eventually cost $1.3 billion per year when the program is fully up and running

About 3.2 million people in the state of nearly 40 million are projected to not have health insurance next year, according to the Labor Center at the University of California, Berkeley. Roughly 1.5 million are unauthorized immigrants, making them the largest uninsured group in the state.

California is among a small, but growing, group of states that are expanding health coverage to immigrants without legal status. Advocates of expanded coverage say that health care is a basic need and that the coronavirus pandemic underscored just how essential immigrants are in agriculture, food processing and other critical industries.

Detractors say taxpayer money should not be spent on unauthorized immigrants.

But immigrants residing without authorization in the United States pay billions of dollars in taxes and often do essential work in agriculture, food services, health care and other industries.

This population is also excluded from the Affordable Care Act and many missed out on pandemic-related stimulus checks because they file federal taxes using what’s called an Individual Taxpayer Identification Number and not through a Social Security number.

Advocates also point out that throughout the pandemic, immigrants residing in the country without authorization, many of them above 50, have served in essential occupations that put them at greater risk of contracting COVID-19.

Related Coverage

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.

Beatriz Hernandez, a fellow with the California Immigrant Policy Center, said at the signing event that she is undocumented and knows what it feels like to be denied health care. She is grateful for the new policy.

“We all need this access to health care now and when we recover from the pandemic. It doesn’t matter the color of our skin, or where we were born. We all deserve this, and we all contribute to the social fabric of this state,” she said.

While this specific Medi-Cal expansion does not begin till May 2022, you can review how to apply for Medi-Cal through the Covered California website in English, Spanish, Chinese and Tagalog. Other languages are also available.


This post includes reporting by KQED's Farida Jhabvala Romero and The Associated Press.

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