As efforts to create a state-based single-payer health system confront complex questions of costs and federal uncertainty, advocates and state lawmakers are pushing forward with incremental policy measures to expand access to health coverage. The largest group of Californians that remain without comprehensive health insurance are undocumented immigrants, who were largely excluded from the coverage expansions created by the Affordable Care Act. Estimates suggest that almost 60% of uninsured Californians are undocumented.
Today, the Senate Health Committee is holding a hearing on SB 974 (Lara), which would allow all income-eligible California residents, regardless of immigration status, to enroll in comprehensive coverage through Medi-Cal (the state’s Medicaid program). California has already extended Medi-Cal coverage to undocumented children under 19, who have been eligible for comprehensive health benefits since May 2016. At the end of last year, nearly 220,000 undocumented children were enrolled in Medi-Cal, with costs estimated at $280 million in the recent fiscal year’s budget. No cost estimates are available yet for covering undocumented adults. But comprehensive coverage for the undocumented population must come from state funds, since federal Medi-Cal funding can only be used to support emergency services for undocumented immigrants.
In previous research, we estimated that about half of California’s undocumented population would likely qualify for Medi-Cal based on their income levels if restrictions on immigration status were removed. But this varied across regions. In Los Angeles County and parts of the Central Valley, more than half of undocumented immigrants had incomes below the Medi-Cal eligibility threshold of 138% of the federal poverty level, or FPL ($34,600 for a family of four). Bay Area counties had lower shares of income-eligible undocumented immigrants.
Currently, undocumented adults rely on the health care safety net—including community clinics, public hospital systems, and emergency departments—to access needed medical care. These providers play an integral role in caring for both those that remain uninsured and those covered by our vastly expanded Medi-Cal program. As policymakers consider ways to expand comprehensive health coverage, it is important that they continue to support the state’s safety net providers.