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Blog Post · April 18, 2024

California’s Medi-Cal Expansion Is Lowering Poverty among Undocumented Immigrants

photo - Closeup of stethoscope on patient's chest

Safety net programs substantially lower poverty, but federal eligibility rules often exclude undocumented immigrants, who have the highest poverty rates in the state (27%). At the beginning of this year, undocumented adults ages 26 to 49 became eligible for Medi-Cal (federally known as Medicaid), marking the culmination of a multi-phased state-funded expansion that began in 2016, when eligibility was extended to low-income undocumented children. How could Medi-Cal eligibility impact poverty among undocumented Californians?

Researchers from PPIC and Stanford recently developed a health-inclusive California Poverty Measure that incorporates insurance needs and costs. Based on the latest data (from fall 2021), the annual amount required to meet the basic needs of a family of four was about $36,000; when health insurance costs were included in the measure, this threshold was $17,000 higher. When we factored in health coverage, poverty was much higher among noncitizens (those who reside legally in the US as well as those who are undocumented) and families with mixed citizenship statuses than among citizens.

We estimate that the state-funded expansion of coverage to all undocumented immigrants could lower poverty among non-citizens by as much as 2.9 percentage points, equivalent to 125,000 people moved out of poverty (assuming that all income-eligible, uninsured undocumented residents enroll in Medi-Cal). In addition to helping individuals who are non-citizens, this expansion benefits all members of all non-citizen and mixed-status families. Among members of mixed-citizenship families, poverty could be reduced by up to 2.5 percentage points (or about 192,000 people), while poverty among all non-citizen families could be reduced by 1.5 percentage points. Californians in mixed-citizenship families make up a quarter of all Californians, while those in non-citizen families make up only 4%.

In recent years, California has moved to close several other gaps in health and social safety net program eligibility that are based on immigration status. During the pandemic, the state extended several temporary relief measures to undocumented immigrants—including the Golden State Stimulus, Golden State Grant, and Disaster Relief Assistance for Immigrants. The state also permanently expanded the California Earned Income Tax Credit to include tax filers with Individual Taxpayer Identification Numbers (ITINs), who are often undocumented immigrants. And in 2025, California is planning to expand CalFresh nutrition assistance to undocumented adults ages 55+ through the state-funded California Food Assistance Program (CFAP). This will offer an opportunity to reduce both food insecurity and poverty among this group.

While California is currently grappling with difficult budget decisions, there has been no proposal to roll back Medi-Cal expansion to all income-eligible residents regardless of immigration. Policymakers and stakeholders looking to reduce poverty can learn from California’s Medi-Cal expansion and other measures that have expanded eligibility to immigrant families.


California Poverty Measure Health & Safety Net health insurance Immigrants in California Medi-Cal Political Landscape Poverty & Inequality safety net undocumented immigrants