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State’s Medi-Cal Bill For Undocumented Kids Could Rise

The cost of providing full Medi-Cal benefits to immigrant children who are in California unlawfully could be significantly more than the state’s health care agency has projected, according to experts and advocates.

That’s because state officials may have underestimated the number of kids who will be eligible for the program – though it’s hard to know precisely by how much.

The Department of Health Care Services has said about 170,000 such children will be eligible for full Medi-Cal beginning in May, when the expansion takes effect, and that covering them will cost the state $142.8 million in fiscal year 2016-2017.

But some advocates believe the number of eligible kids – and thus the price of covering them – will be much higher.

“Oh, no, it’s going to be a lot more than that,” said Mark Diel, executive director of California Coverage and Health Initiatives, a children’s health advocacy group based in Sacramento. “We think the overall number will be more like 260,000 kids who will be eligible.”

And that, Diel believes, could add roughly $40 million to the health care department’s projection.

Unlike the regular Medi-Cal program, which is a partnership with the federal government, the state of California must foot the bill for coverage of kids who are in the country unlawfully, except when they seek emergency services.

What’s missing from the state’s estimate of that bill, Diel said, are at least 70,000 children without legal immigration papers who are currently receiving benefits through Kaiser Permanente and about 20,000 more who get varying levels of care through county programs.

Because those additional 90,000 children are already receiving care, they will not be as expensive to cover as the ones counted by state health officials, Diel said.

Most of the 170,000 eligible children included in the state’s estimate “don’t have any care at all right now, outside of some of them getting care in the ER,” he explained. “It will be their first year of coverage, and that’s a lot more expensive.”

The 90,000 additional children who are already getting care would cost about half as much as the first-timers, on average, because “it’s easier to care for them,” Diel said.

But the state’s eligibility numbers could be off by even more than 90,000, said Richard Figueroa, program director at the California Endowment, a health care philanthropy.

He said as many as 300,000 children in the country unlawfully might be eligible for full Medi-Cal benefits, though no one really knows exactly how many kids in California are without legal papers.

Diel said his estimate of $40 million in extra state spending is a conservative number “It’s speculation, but it’s speculation based on past experience,” he said.

Ronald Coleman, government affairs manager in the Sacramento office of the Los Angeles-based California Immigrant Policy Center, a think tank and advocacy group, said it is premature to pin down the cost of covering the children who are unlawfully present and have not been counted by the health care department.

However, “it’s safe to say the state will have to put additional funds into this,” Coleman said.

Figures on the those living in the U.S. and California without legal permission are unclear, and the cost of caring for children who already have some kind of coverage is also uncertain, he said.

He noted that not all of the 70,000 or more kids currently getting care through Kaiser Permanente will necessarily go into Medi-Cal. Talks are underway to decide how best to care for them.

In addition, Coleman noted, the equation could change if a federal court injunction is lifted on an executive order by President Barack Obama to give some immigrants residing here unlawfully a three-year “deferred action status.” The Supreme Court in January agreed to hear the case.

If Obama’s order is allowed to proceed, the immigrants who benefit from it would be exempt from deportation for three years and could get temporary work permits during that period. That might save the state money, because those people could get better jobs and earn more money, possibly making their children ineligible for Medi-Cal benefits. Some of them might even get employer-sponsored health coverage instead, Coleman noted.

A conference opening today in Sacramento to address the remaining uninsured in California will include discussion of such children in the state. The annual event is put on by the Insure the Uninsured Project, a nonprofit advocacy and research group based in Santa Monica.

Correction: An earlier version of this story incorrectly stated the effect of President Barack Obama’s executive order on deferred action for immigrants who are residing in the country without lawful documents. The order, if allowed by a court to go forward, would give eligible immigrants temporary work permits and a deferral of possible deportation for three years.

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