During the pandemic, Medi-Cal relaxed certain policies to improve access to health care for many low-income Californians. These changes may have especially benefitted California’s immigrant farmworkers, a group who kept the food supply moving amid the public health emergency. In a briefing last week, PPIC researcher Paulette Cha discussed the impact of pandemic changes to Medi-Cal along with upcoming Medi-Cal expansions for immigrant farmworkers.

“We found out during the pandemic that those who do not have health insurance or access to vaccines or treatments are the weak link in our public health care and our population’s health,” Cha said. Providing specific health services to farmworkers and all Californians during the pandemic period helped the entire community.

In exchange for continuous enrollment, the federal government offered states additional funds for keeping Medicaid enrollees on the program for the entire emergency. Continuous enrollment in Medi-Cal—California’s version of Medicaid—paused reviews to confirm eligibility. Enrollees had to complete less paperwork about their income, and this change may have especially benefitted immigrant farmworkers with multiple employers.

The public health emergency also allowed providers to pivot to telehealth and use platforms such as Zoom and Apple FaceTime. Furthermore, Medi-Cal reimbursed providers for telehealth at the same rates as in-person visits. The policy change included audio-only telehealth, which helped providers reach the lowest-income individuals in the state as well as those without fast internet or a reliable cell signal.

The move to telehealth boosted access to health care for those in rural areas who face work or transportation constraints around visiting a clinic or doctor, a concern for many farmworkers. Cha noted that the federal government has permanently approved telehealth for delivery of mental health and substance-use disorder services.

Continuous enrollment in Medi-Cal ended on March 31, and the federal public health emergency will end May 11. As eligibility checks resume, some individuals will be disenrolled from Medi-Cal—some because they no longer qualify and others because administrative hurdles will be high or their contact information is out of date. Medi-Cal will continue to cover COVID-19 testing and vaccines, but the federal government is still determining how to make COVID-19 treatments available to the uninsured.

The largest group of uninsured in California are undocumented immigrants who don’t fall into current age categories under recent state expansions of Medi-Cal—this is about 78% of undocumented, uninsured farmworkers. In January 2024, that group, ages 26 to 49, will be able to enroll in Medi-Cal if they meet income eligibility requirements.

Even with that expansion, some individuals will still fall through the gaps—the expansion does not translate into universal health coverage, Cha noted. While about a third of insured farmworkers report getting private coverage through employers, all workers may not have access or coverage may not be offered.

“We’re making a pretty big dent in the uninsured population in California by bringing this final group of undocumented into Medi-Cal eligibility,” Cha said. “I wouldn’t quite call it universal coverage—but the state is getting closer.”