California lawmakers are poised to offer low-income young adults living in the country illegally access to full health benefits, putting the state on track to become the first in the country to expand its insurance program to all working poor under the age of 26 regardless of immigration status.
The Democratic-controlled state legislature agreed on Sunday to allow 19 to 25-year-old undocumented residents to receive Medi-Cal, the state's health insurance program partly funded by federal dollars.
Gov. Gavin Newsom applauded negotiation efforts by committee chairs Sen. Holly Mitchell and Assembly member Phil Ting in a statement, saying the budget — which includes a $21.5 billion surplus for the state — "is structurally balanced and invests in a California for All."
State officials estimate the health care program would provide coverage for about 138,000 residents at a cost of $98 million in the first year. The vast majority — 75% — are already covered by the Medi-Cal system, and are either receiving restricted-scope benefits or services under SB 75, the Governor's Budget Summary states.
Efforts by some Democrats to include undocumented seniors in the plan were rejected by Gov. Gavin Newsom and other legislators.
Cynthia Buiza, executive director of the California Immigrant Policy Center, called the move a "wise investment in legal representation for immigrants facing deportation in a cruel and callous system."
But Buiza said lawmakers failed to achieve universal health care coverage, as they had pledged to do. "The exclusion of undocumented elders from the same health care their U.S. citizen neighbors are eligible for means beloved community members will suffer and die from treatable conditions."
The agreement is part of a sweeping $213 billion budget plan that includes another national first: It would stretch eligibility for health insurance subsidies under Covered California to middle-class families earning up to 600% of the federal poverty level. That means a family of four can earn up to $154,500 per year and still qualify for a discount.
The programs would be partially funded by tax dollars collected from fines paid by Californians who forego health insurance coverage. It is similar to the federal penalty imposed by the Obama administration's Affordable Care Act called the individual mandate, which was rolled back in 2017. Enrollment will begin in the fall and the plans will go into effect on Jan. 1.
Legislators cited a recent study favoring the expansion, saying that without state action "the uninsured rate will rise to 12.9 percent by 2023—a 24-percent increase from 2016."
Republicans pushed back on the idea, arguing that Californians enrolled in the Medicaid program already face difficulties getting in to see a doctor, Capitol Public Radio's Ben Adler told NPR.
"Reimbursement rates to doctors are so low that doctors aren't willing to take Medicaid patients," Adler said. Instead, Republicans lobbied for the governor to shore up the program as it exists now.
Immigrant children are already covered in California under Medi-Cal, as they are in six other states under their respective Medicaid programs, according to the Kaiser Family Foundation. California, the District of Columbia, Illinois, Massachusetts, New York, Oregon and Washington cover income-eligible children who are not otherwise eligible due to immigration status using state-only funds.
The full state Legislature is expected to vote and pass the budget later this week. California law sets a June 15 deadline to enact a budget, otherwise lawmakers face losing their pay.