California is facing a crushing budget deficit necessitating a state budget freeze.
Budget freeze for lawful residents, that is.
For years California has been expanding Medi-Cal to old and young illegal immigrants, as this December 2022 announcement from Gavin Newsom’s office reflected:
Today, Governor Gavin Newsom and the Department of Health Care Services (DHCS) announced that roughly 286,000 older adult Californians are receiving full scope Medi-Cal thanks to the expansion of comprehensive preventive care and other services to all income-eligible adults 50 years of age and older, regardless of immigration status. This follows Governor Newsom’s action in July 2021 to enact this expansion in collaboration with Senator María Elena Durazo and Asssemblymember Joaquin Arambula in the 2021-22 state budget.This latest expansion of Medi-Cal coverage brings California closer to Governor Newsom’s promise of universal access to health care coverage, regardless of age or immigration status.“We’re making sure that universal access to health care coverage becomes a reality here in California, and this expansion has gotten us one step closer – more than a quarter million undocumented Californians aged 50 and older now have good, quality health care,” said Governor Newsom.
The Los Angeles Times reports that the last hole in universal coverage, people aged 26-49, is being filled in the New Year, and the expansion is being aggressively marketed, Medi-Cal will soon be open to all, ‘papers or no papers.’ She wants her neighbors to know:
As parents hustled to pick up their kids from a school in South Los Angeles, Juana Dominguez greeted one after another with the same question in Spanish: “Do you have Medi-Cal?”“Don’t be afraid to get it,” she urged mothers pushing strollers in the afternoon sun. She paused to chat up street vendors hawking raspados and hot dogs, encouraging them as well, as she handed out fliers….It’s the culmination of a steady expansion of the California health insurance program, which has already grown to include children, young adults and seniors regardless of their legal status. As of last year, the uninsured rate among immigrants in California without U.S. citizenship was estimated to be 21% — lower than in 36 other states, according to a KFF analysis of data from the U.S. Census Bureau’s American Community Survey.Next year, California will extend Medi-Cal benefits to the last remaining group of undocumented people — those ages 26 to 49 — in what is expected to be its biggest expansion of coverage since key provisions in the Affordable Care Act were implemented in 2014. State officials have estimated that more than 700,000 people will be eligible to gain “full scope” coverage for the first time, helping them access important services such as preventative care and treatment for chronic conditions….California officials have estimated that more than 700,000 people will be able to transition from “restricted scope” to “full scope” Medi-Cal next year. Being in “restricted scope,” which helps reimburse hospitals for emergency care, means “they’re in the system, we know who they are … we know that they’re income-eligible for Medi-Cal,” said Anthony Wright, executive director of the healthcare consumer advocacy group Health Access California.“It is an incredibly useful way to automatically enroll” people who will now gain coverage for a range of care needed beyond the emergency room, Wright said. “We’re really glad the state has taken efforts to try to do this as automatically and seamlessly as possible.”California’s Department of Health Care Services said it’s unknown how many people who aren’t already in the “restricted scope” program will be newly eligible for Medi-Cal. The state has budgeted $1.4 billion for the expansion this fiscal year and $3.4 billion annually when it is fully implemented.
California is breaking new national ground with this expansion, as The San Francisco Chronicle explains:
Although Medicaid is a federal-state program, states cannot use federal funds to pay for full-scope Medicaid for non-citizens without what the state calls “satisfactory” immigration status. California, however, has been using state funds to phase in full-scope Medi-Cal for undocumented immigrants who meet its income and other requirements.Coverage was expanded to children lacking permanent legal status through age 18 in 2016, to young adults 19 through 25 in 2020 and to adults 50 and older on May 1, 2022. As of August, about 670,000 people gained full coverage thanks to those three expansions combined, according to the California Legislative Analyst’s office.Starting Jan. 1, adults between 26 and 49 will also qualify regardless of their immigration status, which could cover an estimated 700,000 more people.Before they could get full Medi-Cal coverage, undocumented immigrants could get restricted-scope Medi-Cal, which is generally limited to emergency and pregnancy services.Other states have expanded full Medicaid coverage to certain undocumented groups, but California will be the first to extend it to all, said Jennifer Tolbert, director of state health reform with KFF, a nonprofit organization focused on health care.
Does anyone think these budget estimates will hold? The previous estimate, just last spring, already has doubled The Chronicle reported:
As of May, the department estimated that the age 26-49 expansion would cost the state $1.2 billion in 2023-24, nearly double the previous cost estimate of $635 million.
Expect the actual costs to double or triple or quadruple once implemented, making California even more unlivable for the people “with papers.”
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