California opens Medi-Cal to older unauthorized immigrants
On Sunday, California will open Medi-Cal to older immigrants residing in the state without legal permission.
Unauthorized immigrants over age 49 who fall below certain income thresholds will become eligible for full coverage by Medi-Cal, California’s version of Medicaid, the federal-state partnership that provides health insurance to low-income people.
Unauthorized immigrants of all ages account for 40% of the state’s approximately 3.2 million uninsured residents. Official estimates put the number of newly eligible people as high as 235,000. Those who sign up will join more than 220,000 unauthorized immigrants ages 25 and under already enrolled in Medi-Cal.
And if Gov. Gavin Newsom gets his way, which seems entirely plausible considering the state’s rosy financial outlook, California could allow all remaining low-income unauthorized immigrants — an estimated 700,000 people — to join Medi-Cal by 2024, or sooner.
As I have explained previously, Medi-Cal has some well-known problems. But it is still far better than no insurance at all. Read on to learn about the new benefits and how you can enroll if you are eligible.
Under current law, all unauthorized immigrants who meet the financial criteria can get limited Medi-Cal coverage, including emergency and pregnancy services and, in some cases, long-term care. But when they sign up for full MediCal, they get comprehensive coverage that includes primary care, prescription drugs, mental health care, dental and eye care, eyeglasses, and much more. That’s no small thing for people who are getting gray.
“This is a key moment when you want to incorporate
all these aging undocumented immigrants into the health care system,” says Arturo Vargas Bustamante, a professor of health policy and management at UCLA’s Fielding School of Public Health. If you let their chronic conditions go unattended, he says, they’ll just end up in the emergency room and be more expensive to treat.
He calls it “a responsible way of investing.”
As Bustamante points out, it’s no longer the case that immigrants come to work temporarily in the United States and then return to their home countries. They are staying, raising families, and growing old in this country. And unauthorized immigrants play an important role in the labor force, paying an estimated $3.2 billion in state and local taxes a year in California and $11.7 billion nationally. Nobody benefits if they’re too sick to work.
While it will take time to roll out the new benefits, the task will be made easier by the fact that the vast majority of unauthorized immigrants who will become eligible for full coverage are already signed up for limited Medi-Cal benefits — so the
state has contact information for them.
Those already in limited Medi-Cal will be automatically upgraded to full-scope Medi-Cal. Assuming their contact details are current, they will receive packets in the mail explaining their expanded benefits and prompting them to choose a health plan and a primary care provider.
“We expect to see people who are already enrolled in restricted-scope MediCal go into full-scope MediCal right away,” says Ronald Coleman, managing director of policy at the California Pan-Ethnic Health Network, a nonprofit that promotes health access for communities of color. “The question is: Will they understand their benefits and know how to navigate the system?”
Those who are not signed up for restricted Medi-Cal may not be easily identified and, given cultural and language barriers, could be difficult to convince.
The Department of Health Care Services, which administers Medi-Cal, is working with county officials, consumer advocates, and the state health insurance exchange, Covered California, to reach eligible immigrants.
It has published notices with frequently asked questions in multiple languages. And the agency has an “older adult expansion” page on its website, available in English and Spanish.
Advocates have also been gearing up. The California Pan-Ethnic Health Network, for example, is sponsoring legislation, AB 2680, which would direct $30 million to community groups to conduct outreach and enrollment for people in underserved communities who are eligible for Medi-Cal. A similar program expires in June. Separately, the network is seeking an additional $15 million specifically for unauthorized adult immigrants, says Monika Lee, a spokesperson for the organization.
Even as advocates and health officials spread the word about the new eligibility rules, they expect to encounter deep distrust from immigrants who vividly remember the Trump administration’s public charge rule, which stoked fear that applying for public benefits might harm their immigration status or even lead to deportation. With elections looming, many fear those days are not entirely in the past.