California Now First State To Offer Health Insurance To Undocumented Immigrants – And New York Could Soon Follow

On January 1, 2024, California became the first state in US history to offer full-scope health insurance to all low-income individuals – regardless of age or immigration status. That means more than 1.8 million undocumented immigrants are now fully covered by the state’s Medi-Cal program – and New York could soon follow in their footsteps.

What Is Medi-Cal?

Most of us have heard of Medicaid – the healthcare program providing millions of low-income Americans with health insurance at a low cost (if not free). Medi-Cal is the same thing – it’s just California’s version, but rebranded to sound more local and trendy.

Medi-Cal was established in 1966 – a year that saw less than two million Californians enroll for coverage. That number rose to more than 12 million by 2014, but it now sits at more than 15 million with the 8-year expansion plan that took place between 2016 and 2024.

2016: CA Expands Coverage To Undocumented Children

In 2016, California made a drastic change to its Medi-Cal program. With the passing of Senate Bill 75 (SB 75), all undocumented children under the age of 19 now had access to full-scope Medi-Cal benefits – so long as they met all the other criteria.

The ‘Children’ expansion added an estimated 670,000 undocumented kids to the program – most of whom were upgrading from restricted scope to full-scope coverage. It was a historic expansion that had never been seen in the United States, up until that point.

2020: CA Expands Coverage To Undocumented Young Adults

The expansion continued in 2020. With the signing of Senate Bill 104 (SB 104), California was now expanding full-scope Medi-Cal coverage to anyone under the age of 26, regardless of legal status – once again, setting the tone for the many states that have followed in the years since.

The ‘Young Adults’ expansion added 133,000 undocumented enrollees to the program – the lowest of the four expansions. At this point, more than 800,000 illegal immigrants had access to full-scope health insurance as a result of Gov. Newsom’s efforts.

2022: CA Expands Coverage To Undocumented Adults 50+

Those efforts didn’t stop in 2021 when Gov. Newsom signed Assembly Bill 133 (AB 133) into law. The new bill, signed in July 2021 and effective in May 2022, granted full-scope Medi-Cal coverage to all Californians 50 and above – regardless of legal or immigration status.

The ‘Older Adults’ expansion included more than 368,000 undocumented adults 50 and above – nearly triple that of the ‘Young Adult’ expansion. Enrollees were still required to have a household income under 138% of the Federal Poverty Level (FPL) to apply.

2024: CA Expands Coverage To All Undocumented Immigrants

That brings us to 2024 – the expansion to end all expansions. With the passing of Senate Bill 184 (SB 184), full-scope health insurance was now available to all Californians – regardless of legal status or age. California is the first and only (as of January 2024) to do this.

The final expansion, which included all adults aged 26-49, will add more than 700,000 illegal immigrants to the program – some of whom already had restricted scope coverage, and some of whom are receiving health insurance for the first time.

How Much Will The New Expansion Cost?

The latest Medi-Cal expansion won’t come cheap – with some state officials estimating a cost of $1.4 billion ($1.2 billion of the state’s General Fund) over the first six months, and another $3.4 billion annually ($3.2 billion General Fund) beyond that.

California now spends more than $37 billion annually in Medi-Cal expenses, making it the second-largest expense in the state’s budget. As a result, many people are questioning the sustainability of this program – with some people even predicting a future federal bailout.

Who Is Paying For The New Expansion?

This is where things get a little frustrating for the Californian taxpayer. Federal law prohibits undocumented immigrants from receiving federally-funded Medicaid coverage. While states can extend coverage to people regardless of immigration status, the cost of that extension rests solely on the state.

So, that $1.2 billion being taken from the state’s General Fund – most of that is coming from the taxpayers. And the $3.1 billion in annual expenses – most of that is coming from taxpayer funds, as well. You can see why so many Californians are against these expansions.

Let’s Not Forget About The State’s $68 Billion Deficit

Another reason why so many people are furious with Newsom’s efforts is because California isn’t exactly in the best position to be handing out free health insurance to everyone. I mean, let’s not forget that California is currently facing a $68 billion deficit – a record number.

Earlier this month, Gov. Newsom proposed a budget for the upcoming year, but it only projected a deficit of about $38 billion – $30 billion less than that of the Legislative Analyst’s Office (LAO). Not long after he announced his plan, LAO doubled down on their projection and accused Newsom of being optimistic.

Gov. Gavin Newsom Argues That Health Care Is A Human Right

Despite the deficit, Newsom believes his healthcare expansions are necessary. In a Facebook post in January 2019, he said ‘healthcare should be a basic human right’ – bashing Republicans for trying to disrupt California’s mission to provide ‘quality, affordable healthcare to everyone who calls California home.’

He, again, called it a ‘fundamental right’ when reporters asked him about potentially delaying or canceling the newest expansion – confirming he had no plans of doing so. Of course, many people are arguing that healthcare shouldn’t be a ‘right’ because it’s a ‘service.’

How Does The Medi-Cal Expansion Affect Californians?

Not only are Californians seeing their leaders spend taxpayer dollars on Medi-Cal coverage for illegal immigrants, but many people who live in The Golden State are having a hard time finding quality healthcare as a result – something that is only going to worsen in 2024.

Longer wait times and a lack of provider availability are two of the biggest challenges for those in need of medical help. It’s essentially a matter of supply and demand – the demand continues to increase, but the supply isn’t evolving with it.

How Are Doctors Impacted By The Expansion?

Now that Medi-Cal is available to everyone, doctors are starting to limit the number of Medi-Cal patients they accept – which is driving the long wait times and poor availability discussed above. While this makes it hard for many to find coverage, you can’t blame the doctors.

When Medi-Cal reimburses doctors for the services they provide, it only covers about 70% of what Medicare would normally pay for. That means a lot of doctors are actually losing money when they treat Medi-Cal patients, which isn’t sustainable for their practice.

Some Lawmakers Agree With Gov. Gavin Newsom

As much as Medi-Cal is hurting California’s economy and healthcare system, many lawmakers are supporting Gov. Newsom and his vision. “This historic investment speaks to California’s commitment to health care as a human right,” said state Sen. Maria Elena Durazo.

Miguel Santiago, a state Assemblyman, called the newest expansion a ‘game-changer’ and ‘one of the most important pieces of legislation’ to come of the House. “The ability to give health care means the ability to live life without pain,” he said.

Health Experts Warn Of A Worsening Healthcare System

Not everyone is behind Gov. Newsom, though. Sally Pipes, the president and CEO of the Pacific Research Institute, was crystal clear in her warning – shining a light on the many challenges doctors and patients are facing right now.

“The expansion was a bad idea when the state’s coffers were flush. Now that California is struggling to make ends meet, using taxpayer money to cover non-citizens is simply irresponsible,” Pipes said – adding that low reimbursements are only making matters worse.

Is New York Following A Similar Path?

As of January 1, 2024, all undocumented adults who are age 65 and above will receive free healthcare through New York’s Medicaid program. Enrollees must have an income within 138 percent of the Federal Poverty Line (FPL) to apply.

New York already gives free healthcare to undocumented children (ages 0-19), and they have plans to expand that coverage even more in the near future – similar to what California has done these past few years. And now that CA and NY are in on it, it’s only a matter of time until more join – as some already have!