California opens Medicaid to older unauthorized immigrants

On May 1, California opened Medi-Cal to older immigrants residing in the state without legal permission.

Unauthorized immigrants over age 49 who fall below certain income thresholds are now 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 Medi-Cal, 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 Medi-Cal go into full-scope Medi-Cal 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.

"What advocates are trying to do on the ground is explain what county offices do with their information. It's not shared with immigration," says Tiffany Huyenh-Cho, a senior attorney at Justice in Aging. "We're really trying to allay some of those concerns people still have."

Modesto resident Alina Arzola, a 64-year-old unauthorized immigrant who came from Guanajuato, Mexico, says she is not afraid of the immigration police. She is hesitant to sign up for Medi-Cal for a different reason: She fears the quality of the care is not very good.

"Economically, perhaps it would help me," she says. But she says she has not heard good things from her 87-year-old mother, who is a U.S. citizen and a Medi-Cal enrollee. In December 2020, her mom had surgery scheduled to remove her cataracts. It was all confirmed, Arzola recalls, but when her mom arrived, the doctor wasn't there. He never showed up.

Arzola, who has diabetes, gets primary care at St. Luke's Family Practice, a clinic in Modesto that treats uninsured people at no charge. But the clinic is not allowed to provide free care to people who are able to obtain affordable insurance — and that means that Arzola will soon no longer be able to go to the clinic, which she deeply regrets.

So she will likely bite the bullet and sign up for Medi-Cal.

"I'm sure it wouldn't be convenient for me to be without medical care," Arzola says, "so I don't have any alternative."

The Department of Health Care Services and other resources are available to help you or a loved one learn about the new Medi-Cal benefits for older immigrants, including how to sign up and how to choose a health plan and provider.

The Health Consumer Alliance (888‑804‑3536 or www.healthconsumer.org) provides free consultations and has offices across the state. It also has a fact sheet — available in English, Spanish, Vietnamese, and multiple other languages — that explains the Medi-Cal expansion to older adults. It provides contact information for enrollment, whether through your county welfare office, Covered California, or your local community clinic.

The Latino Coalition for a Healthy California (916-448-3234 or www.lchc.org) offers a toolkit and fact sheets in English and Spanish. The advocacy groups Health Access and the California Immigrant Policy Center have put out a joint FAQ in English and Spanish.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.