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California Set to Expand Health Care to More Undocumented Immigrants After Other States Fail

Gov. Gavin Newsom struck a deal with lawmakers over the weekend.

Supporters of S.B. 10 celebrate the law's passage.
(AP/Rich Pedroncelli)
Last Updated June 10, 2019 at 9:58 a.m. ET



  • Five states let undocumented immigrant children sign up for Medicaid.
  • A bill to make Connecticut the sixth failed.
  • In Washington state, legislation to raise the age of Medicaid eligibility to 25 died.
  • California Gov. Gavin Newsom struck a deal with lawmakers to extend health care to more undocumented immigrants.
As the Trump administration pursues zero-tolerance immigration policies, Democratic politicians are contrasting that message with acceptance and care. 

After several states introduced legislation this year to offer health coverage to more undocumented immigrants, only California came away with a deal, which will expand care to undocumented people between the ages of 19 and 25. (Currently, the cutoff is 18 years old.)

Gov. Gavin Newsom included the proposal to cover more undocumented youth in his budget, but state lawmakers wanted to go further and include undocumented seniors, as well as extend the Earned Income Tax Credit to low-income undocumented immigrants. Newsom resisted, arguing that it would have been too expensive.

“For California’s immigrant communities, today’s budget deal is bittersweet,” said Cynthia Buiza, executive director of the California Immigrant Policy Center, in a statement. “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. And the exclusion of many immigrants from the Earned Income Tax Credit will perpetuate the crisis of economic inequality in our state.”

Five states, and the District of Columbia, let undocumented children 18 years or younger sign up for Medicaid -- California, Illinois, Massachusetts, New York and Washington. Connecticut appeared poised to become the sixth, but the bill that was introduced this year is dead for this legislative session.

The state has struggled with a budget deficit in recent years, and the price tag for Connecticut's proposal would be $53 million for the first two years, reaching up to $64 million. 

“That kind of number, given our current efforts to try to just balance the budget, would be a struggle,” Democrat John Fonfara, the state Senate's deputy president pro tempore, told the Hartford Courant. 

The bill made it out of committee but stalled on the House floor after the cost estimate was released.

In Washington state, lawmakers introduced a bill in both the Senate and the House to raise the age of Medicaid eligibility for undocumented immigrants to 25 years old. Neither bill made it out of committee, and the legislative session ended in April. 


How Newsom Plans to Pay for His Plan

To pay for his plan, Newsom will divert public health funding from 35 mostly rural and small counties. His original budget planned to divert money from 39 counties, but officials from four argued that it would have catastrophic effects on their battles against measles and STDs. Now, Newsom says the remaining funds will come from the state’s general fund.

The policy is expected to cost $98 million a year, but Newsom noted that most of the 35 counties already receive funds from the County Medical Services Program, which currently has a $300 million budget surplus.

The state expects the change to ultimately save money for local governments and hospitals.

“As the state takes on responsibility for providing health care to undocumented adults, counties’ costs and responsibilities on indigent health care are expected to decrease,” said Jenny Nguyen, a budget analyst for California’s finance department.

In 2016, California passed a bill, signed by then-Gov. Jerry Brown, that would have let undocumented immigrants access plans on the state’s health insurance marketplace. But the state needed permission from the federal government. After Donald Trump won the White House, the plan fell apart. 

“In late 2016, California decided to stop pursuing that waiver. It was decided that it would put undocumented immigrants at risk,” says Laurel Lucia, director of the Health Care Program for the Center for Labor Research and Education at University of California, Berkeley. 


Trump's New Immigration Rule

In the backdrop of all this, the Trump administration has proposed a new "public charge" rule, which would penalize legal immigrants for using government benefits, including Medicaid. If enacted, the rule will make it harder for legal immigrants who have used those benefits to obtain green cards or permanent residency status. The proposed rule has yet to be finalized, and there's no word on when that might happen. 

Though the public charge proposal applies only to legal immigrants, there's anecdotal evidence that it has had a chilling effect on the immigrant community overall, making them less likely to use social services for fear of deportation.

Immigrant advocates, however, don’t want that federal proposal to stop state lawmakers from expanding health coverage to the undocumented.

"The thing is, it’s never been easy to be an immigrant in this community. We want people to know that we don’t have a finalized rule, so we don’t know exactly what will be included," says Matthew Lopas, state policy expert for the National Immigration Law Center.

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Mattie covers all things health for Governing.

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