California could become the first state to extend full Medicaid benefits to undocumented immigrants up to age 26 after two key legislative committees last week approved money for such an expansion.
The Assembly and Senate budget committees both approved using some of the money from California’s recently passed tobacco tax to cover up to 80,000 unlawfully present young adults under the state’s version of Medicaid, known as Medi-Cal.
The committees approved different amounts of money for the next budget year — about $54 million in the Assembly and about $86 million in the Senate — and they must agree on a single amount before starting state budget negotiations with Democratic Gov. Jerry Brown, who would have the final say.
It isn’t a done deal, some immigrant advocates note, because there is still disagreement among lawmakers and the governor over other spending priorities for the tobacco tax money.
Brown wants to use the money to boost overall Medi-Cal spending, while consumer advocates and some lawmakers want to earmark some tobacco tax revenues to specifically raise payments for doctors and dentists who treat Medi-Cal patients.
The proposal to expand Medi-Cal to young adults living in the country without permission comes as states are warily eyeing federal efforts to repeal and replace Obamacare and dramatically reduce Medicaid spending.
Some states are moving to limit Medicaid benefits, charge small premiums and institute work requirements in an attempt to reshape the federal-state health program for the poor.
The political climate over illegal immigration is similarly fraught, as the Trump administration is broadening efforts to deport people living in the country illegally.
Robin Hvidston, executive director of We The People Rising, a Claremont, Calif.-based anti-illegal immigration organization, said her group opposes California’s expansion proposal.
“It sends the wrong message to the world: come to California illegally and children and young adults will be able to get free health care coverage,” Hvidston said. “Our tax dollars should be spent on citizens.”
The full legislature must pass the Medi-Cal expansion plan and Gov. Brown must approve it for it to take effect. A start date has yet to be proposed.
Beginning last May, California allowed eligible children who were in the U.S. without permission and under 19 to receive full Medi-Cal benefits. An estimated 190,000 such children have signed up for it since then. Previously, they were eligible for emergency services only under Medi-Cal.
The federal government generally pays at least half of Medicaid costs, but California uses its own money to pay for these expanded Medi-Cal benefits. U.S. law largely bars the use of federal money for providing non-emergency Medicaid coverage to immigrants here without permission.
Health Access, a Sacramento-based advocacy group, estimates that anywhere from 50,000 to 80,000 young adults without papers might enroll in Medi-Cal were the expansion to be approved.
Among them is Kevin, a California State University-Los Angeles student who turned 19 a month after the “Medi-Cal for All Children” law was implemented last year, making him ineligible for coverage.
Kevin, who spoke on condition of anonymity for fear of deportation, was born in Guatemala and came to the United States in 2011. That was three years too late to qualify for the immigration relief program known as Deferred Action for Childhood Arrivals or DACA. (Some DACA recipients qualified for Medi-Cal before the current proposal to expand it.)
Kevin, who is uninsured, suffers from the skin condition eczema. It can be treated with a prescription ointment, but a small tube of the cream he needs costs more than $100, which he cannot afford, he said.
“I think many young people, including me, would be very eager to enroll,” Kevin said.
Some parents have been reluctant to renew their children’s newly gained Medi-Cal coverage for fear that personal information in their application could be used by immigration officials to deport them. But Kevin said this may be less of a concern among young adults.
The age limit of 26 in the Medi-Cal expansion proposal meshes with the Affordable Care Act, which allows legal residents to stay on their parents’ private health insurance until they turn 26. It is also consistent with the age at which foster youth who qualify are allowed to sign up for Medi-Cal, said Ronald Coleman, government affairs manager at the California Immigrant Policy Center.
Anthony Wright, executive director of Health Access, said that before the Affordable Care Act, young adults regardless of immigration status were most likely to go without health insurance. Even after the implementation of ACA, young adults living in the country illegally did not have access to Medi-Cal and were unlikely to have families able to afford health insurance, he said.
Wright said the cost of the young-adult expansion proposal is modest compared to overall Medi-Cal spending. If large federal cuts are made to Medicaid, this plan to cover undocumented young adults would be the least of California’s worries, because all Medi-Cal recipients, regardless of immigration status, would be affected, Wright said.
“Those [federal] cuts may or may not happen, and we need to continue to go on about our work of expanding health care for all,” Wright said.