SAN FRANCISCO, November 9, 2015—California’s undocumented immigrants make up a sizable share of residents without health insurance. Half of them—about 1.4 million—have incomes low enough to qualify for full Medi-Cal benefits should legislative proposals to offer coverage to the undocumented be enacted. This is among the key findings of a report released today by the Public Policy Institute of California (PPIC). The report examines current policy options to provide health coverage to California’s undocumented immigrants, who are currently excluded from the Affordable Care Act.
The undocumented immigrants who could qualify for Medi-Cal based on their low-incomes are concentrated mainly in Los Angeles, Orange, and Santa Clara Counties, the Inland Empire, and the San Joaquin Valley. Those with incomes too high for Medi-Cal are concentrated in the San Francisco Bay Area, where health insurance premiums are highest and likely too costly for many of them.
With California already preparing to extend Medi-Cal coverage to undocumented children, the PPIC report looks at two legislative proposals to further expand coverage to undocumented immigrants. One would provide comprehensive Medi-Cal benefits to those whose incomes are low enough to qualify. The second would authorize the state to seek a federal waiver that would allow those with higher incomes to pay full price for health plans through Covered California.
The PPIC report provides estimates of the number of undocumented immigrants across family income levels and the Covered California insurance regions. These estimates can help policymakers plan for the increase in Medi-Cal participants if the coverage expansion proposal is enacted—which will depend on the legislature, governor, and federal courts.
To qualify for Medi-Cal, a family of four must have an annual household income below 138 percent of the federal poverty level, or about $33,500. While low-income undocumented immigrants live in all of Covered California’s insurance regions, the share of undocumented immigrants likely to qualify for Medi-Cal is highest in Los Angeles County (58%); Imperial, Inyo, and Mono Counties (64%); Fresno, King, and Madera Counties (59%); and Kern County (59%). Other regions with substantial numbers of undocumented immigrants below the Medi-Cal poverty threshold are the Inland Empire and Orange County, each with more than 100,000. Regions with more than 50,000 include Santa Clara County; San Diego County; San Joaquin, Stanislaus, Merced, Mariposa, and Tulare Counties; and San Luis Obispo, Santa Barbara, and Ventura Counties.
If the state were to obtain a federal waiver, undocumented residents with incomes too high to qualify for Medi-Cal could purchase a health plan through Covered California. But the subsidies that insulate other Californians from the full price of premiums are unavailable to the undocumented under the ACA. The PPIC report shows that without financial assistance, many families are likely to find coverage unaffordable. In Monterey County, for example, a family of two undocumented parents and two children with a monthly household income of $4,000 (about 200% of the federal poverty level) would need to spend 15 to 20 percent of that income for coverage that would require considerable copays for primary and specialty care visits. In Orange or San Joaquin County, the same family would pay 10 to 15 percent of their income on insurance premiums.
In the absence of major reforms, many undocumented adults without health insurance will continue to rely on county indigent care programs. However, counties are not required to provide indigent care services to residents who are undocumented, and the report estimates that about 900,000 undocumented immigrants live in counties that do not give them access to these programs. This puts additional strain on safety net providers such as hospital emergency departments and community clinics, which serve patients regardless of immigration status and provide free and reduced-price care based on patients’ incomes.
“The expansion of health insurance coverage has been linked to multiple benefits for individuals, communities, and the state,” said Shannon McConville, coauthor of the report and a PPIC research associate. “Providing affordable insurance coverage for undocumented immigrants is a key component of any strategy to continue reducing the numbers of California’s uninsured residents.”
The report is titled Health Coverage and Care for Undocumented Immigrants. In addition to McConville, the report was authored by PPIC senior fellow Laura Hill and PPIC research associates Iwunze Ugo and Joseph Hayes.
PPIC is dedicated to informing and improving public policy in California through independent, objective, nonpartisan research on major economic, social, and political issues. The institute was established in 1994 with an endowment from William R. Hewlett. PPIC does not take or support positions on any ballot measure or on any local, state, or federal legislation, nor does it endorse, support, or oppose any political parties or candidates for public office.