Since January 1st, Medi-Cal, California’s state health insurance program, will become available to all low-income Californians between the ages of 26 and 49 — regardless of their immigration status. The state estimates that more than 700,000 undocumented immigrants will become eligible for comprehensive health care coverage through Governor Gavin Newsom’s near-$4 billion financial commitment of state funding. California is the largest state to begin guaranteeing coverage to this population; Oregon implemented a similar measure last summer.

Public health advocates are overwhelmingly supportive of extending coverage to undocumented immigrants. Proponents, like COO Dr. Efrain Talamantes of Los Angeles’ largest  Federally-Qualified Health Center (FQHC), argues the move is a “win-win” that will help them better provide comprehensive care. FQHCs often bear the brunt of providing comprehensive care to undocumented communities. Also, the expansion may help correct for depressed rates of coverage for legal immigrants, many of whom still avoid safety-net programs out of misplaced fear of being labeled a “public charge.” While the public charge rule does not consider Medicaid as a factor, it remains a point of misunderstanding.

Yes, but…

When Governor Newsom originally decided that California would seek the expansion, it was during a time when the state had the largest budget surplus ever seen. Currently, California faces a $68 billion budget deficit, raising the eyebrows of California Senate Republicans concerned about economic responsibility. California Republicans’ fiscal office estimates the expansion will cost $1.2 billion in the first half of this year, and $3.1 billion annually after that; Medi-Cal spending is the second-largest expense in California’s budget. The high price tag has prompted Sen. Cassidy to introduce a bill aimed at prohibiting federal tax dollars from being used to extend benefits to the undocumented.

This step is the just the latest checkpoint in the state’s overall goal of extending Medicaid to all low-income Californians. In 2015, California expanded coverage to undocumented children and in 2019 it took steps to cover undocumented adults over 50 years old. Before the rule took effect on January 1st, the last age group of undocumented adults only had access to emergency care services and obstetric-related care.