Compared to other immigrants, undocumented immigrants face limited options for health insurance and health care. PPIC researcher Paulette Cha discussed these and other insights from a report examining what health coverage and care now looks like for undocumented immigrants in California along with how policy and public opinion are changing. “Californians are increasingly recognizing undocumented immigrants as important members of the state’s workforce, communities, and families,” Cha said.
Low-income undocumented immigrants are less likely to be insured as compared to naturalized citizens and green-card holders. This is likely because undocumented immigrants may not have insurance through their jobs; are ineligible to purchase coverage through Covered California, the state’s health insurance marketplace; and typically are ineligible for Medi-Cal. Those who say they have coverage may be referring to a limited version of Medi-Cal.
Meanwhile, undocumented immigrants use less—and spend less on—health care compared to other groups, and concern about costs may lead to missed exams or not picking up a prescription. When they do access health care, it tends to be primary care from safety net providers—public hospitals, community clinics, or ERs. “Yet the ER by itself does not emerge as a usual source in meaningful way,” Cha said. Furthermore, undocumented immigrants do not report more ER use than other immigrants.
In recent years, immigration-related concerns, including efforts by the past administration to expand the federal public charge rule, depressed take-up of safety net programs even among those who were eligible. A reluctance to engage with public health care may have had consequences for children: in mixed-status families, where at least one member is an undocumented immigrant, children are 11% less likely to have a usual source of health care.
Less interaction with health care providers also means adults are self-reporting their health. “People may not have full information about their health status,” Cha said. For example, immigrants who have been avoiding health care or are unable to access care may have undiagnosed conditions they cannot report to a survey. “What’s needed is more clinical data, more expert opinion or diagnoses, or medical records or encounter data on actual patients who are likely to be undocumented—and not self-reported information.”
The PPIC Statewide Survey indicates that public opinion around health coverage and care is evolving, as Californians increasingly support health insurance for undocumented immigrants. In 2021, 66% of adults favored providing health care to undocumented immigrants, up from 54% in 2015. Recent policy efforts in California include an expansion to Medi-Cal that covers senior citizens regardless of immigration status and a bill to expand some private insurance plans to cover undocumented parents of US citizens.
“During the pandemic we learned that immigrant communities were hit very hard by COVID-19,” Cha said. “We also learned, due to the pandemic and the way that it spread, that lack of testing, treatment options, preventive care—including vaccinations—affected whole communities, not just individual undocumented immigrants.”