California is set to extend free health care to every low-income immigrant living in the state without legal status — a first in U.S. history. The state’s $307.9 billion operating budget, signed by Gov. Gavin Newsom, makes low-income adults eligible for Medi-Cal, the state’s Medicaid program, regardless of immigration status, covering an estimated 764,000 additional people at an eventual cost of about $2.7 billion a year.
At a glance
- Medi-Cal expansion: California will become the first state to guarantee Medicaid coverage for all low-income adults regardless of immigration status, with the program set to launch Jan. 1, 2024 C.E.
- Uninsured immigrants: Adults living in the country without legal status make up one of the largest groups without insurance in California — about 92% of Californians currently have some form of coverage, but that figure is expected to rise significantly once the expansion is fully in place.
- Health care access history: Eighteen states now provide prenatal care regardless of immigration status, and five states plus Washington D.C. cover all low-income children regardless of status — but no state has gone this far for all low-income adults until now.
What this means for millions of people
For families like Beatriz Hernandez’s, this expansion is deeply personal. Hernandez came to the U.S. in 2007 C.E. as an 11-year-old. California covered her health care as a child, but she lost that coverage at 19 due to her immigration status. It was restored in 2020 C.E. when California began covering low-income immigrants 26 and younger — but she turned 26 in February.
Hernandez works as an organizer with the California Immigrant Policy Center in Merced, in California’s Central Valley. She says her mother, who has never had health insurance since moving to the U.S., stands to benefit the most. “It’s great that California is taking that step to set that example for other states,” Hernandez said.
Anthony Wright, executive director of Health Access California, called it “the biggest expansion of coverage in the nation since the start of the Affordable Care Act in 2014 C.E.” His view: “In California we recognize that everybody benefits when everyone is covered.”
A decade in the making
Health care and immigration advocates have pushed for this change for more than a decade. The federal government funds Medicaid jointly with states, but it does not pay for people without legal immigration status — meaning states that want to extend coverage must do so entirely with their own tax dollars.
California had already been moving in this direction. The state covers all low-income children regardless of immigration status, and had previously expanded Medi-Cal to cover older adult immigrants alongside Illinois. This new expansion completes that arc, closing the gap for working-age adults in between.
People without legal status make up about 7% of the U.S. population, or roughly 22.1 million people nationwide, according to the Kaiser Family Foundation. Many have jobs and pay taxes, yet remain ineligible for most public benefit programs at the federal level.
Real challenges remain
The expansion won’t take effect without turbulence. Due to the state’s phased rollout and the expected end of federal pandemic-era rules that temporarily protected coverage, an estimated 40,000 low-income immigrants are likely to lose their health coverage for up to a year in 2023 C.E. before becoming eligible again on Jan. 1, 2024 C.E. — a gap flagged by the nonpartisan California Legislative Analyst’s Office.
That gap matters because, unlike citizens who lose Medicaid and can turn to the Covered California marketplace, undocumented immigrants have no alternative public program. “For this population, that’s it. Medicaid is the only public program available to them,” said Sarah Dar, director of health and public benefits policy for the California Immigrant Policy Center.
Democratic state Sen. Maria Elena Durazo said legislators are working with the Newsom administration to speed up the process. “It doesn’t make sense to lose them and then pull them back in,” she said. The Newsom administration has said it needs roughly 18 months to implement the expansion given its scale — larger than any previous Medi-Cal rollout.
Opposition from fiscal conservatives has also been consistent. Jon Coupal of the Howard Jarvis Taxpayers Association argued the program could attract more unauthorized immigration, a concern that reflects ongoing national debates about the costs and scope of publicly funded benefits.
A model other states may follow
California’s size and political influence mean this expansion carries weight beyond its borders. The state has long functioned as a testing ground for U.S. health policy — its early Medicaid expansions under the Affordable Care Act were later replicated elsewhere, and advocates hope this move will nudge other states to act.
The road to implementation will require sustained attention from legislators, health officials, and the communities most affected. But the intent is clear: to treat access to basic health care as a matter of public health for everyone living in California — regardless of where they were born or how they arrived.
Read more
For more on this story, see: CBS News
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