“You cannot talk about coverage for all if you’re not talking about coverage for everyone regardless of their immigration status,” Linn Gish said. “Gov. Newsom made it a major platform of his from day one, and I think it’s hard to untie those two things.”
Newsom has faced pressure to do more for undocumented immigrants and to do it faster. Advocates and some legislators lobbied Newsom to roll out this last expansion sooner, in part because of the disproportionate toll COVID-19 took on essential workers, many of whom are undocumented.
This expansion is projected to cost more than $835 million in the next six months and $2.6 billion every year after that. Previous expansions, which opened the door to more than 1.1 million undocumented enrollees, cost the state approximately $1.6 billion annually, according to past Legislative Analyst’s Office reports. The total $4 billion price tag, though significant, represents a fraction of Medi-Cal’s expansive $37 billion budget.
Still, many undocumented Californians will remain ineligible for health insurance. Roughly half a million immigrants make too much money to qualify for Medi-Cal but still can’t afford private insurance. Advocates want to expand Covered California to include that population, but the state’s ballooning deficit makes that unlikely in the near future.
Health disparities among undocumented immigrants
Many undocumented immigrants avoid medical care, making it difficult to compare their health to other California residents. Some studies indicate they experience higher rates of chronic conditions like heart disease, asthma and high blood pressure. Immigrants without legal status in California are also more likely to suffer from mental distress and self-report poor health.
Dr. Efrain Talamantes, chief operating officer at AltaMed in Los Angeles, the largest federally qualified health center in California, said he frequently sees young, undocumented individuals who feel healthy but “already are having the end damage of chronic conditions that have not been detected.”
The new Medi-Cal expansion will allow Talamantes and others who serve undocumented communities to give patients affordable, high-level care. Although California offers many undocumented immigrants emergency Medi-Cal, and some counties fund their own programs, services can be disjointed with monthslong wait times.
“When these patients now receive Medi-Cal and are part of a managed care health care plan with us, then we’re responsible for their entire care from primary and specialty to hospital care,” Talamantes said.
Miriam Pozuelos is one such potential beneficiary. The Los Angeles-area mother said the expansion lifts a huge financial burden from her family. She and her husband now pay out-of-pocket for any medical services and often go without. Both have already applied to full-scope Medi-Cal for January.
“When me and my family heard about this expansion, we were just really hoping that it would actually come true and that we can start getting the care that we need and not be worried about ‘I have to pay this enormous bill,’” Pozuelos said in Spanish.
Back at the St. John’s Community Health benefits center, Lopez helps another undocumented immigrant renew his emergency Medi-Cal, which will automatically roll over to full-scope next month. Wilder, 41, who requested his last name be withheld to protect him from immigration authorities, said he needs two root canals totaling $8,000. He has searched for months for a cheaper option without success, he said. He also needs medication for high blood pressure but can’t always afford it.
The Medi-Cal expansion means he’ll finally be able to take care of his health, Wilder said.
“It’s nice seeing them leaving happy and smiling,” Lopez said. “Even if it takes us three hours, they leave with a sense of relief that they can see the doctor.”
