Health Insurance and Demographics of California Immigrants Eligible for Deferred Action
From Daniel J.B. Mitchell (editor), California Policy Options 2016, UCLA Luskin School of Public Affairs
In November 2014, President Obama announced the expansion of the Deferred Action for Childhood Arrivals (DACA) program and the creation of a new program, Deferred Action for Parents of U.S. Citizens and Lawful Permanent Residents (DAPA). More than one million undocumented immigrants in California became potentially eligible for work authorization and relief from deportation under these executive actions. As of this writing,a court decision has blocked implementation of the President’s actions while an appeal to that decision is being considered.
This chapter discusses the health insurance status, Medi-Cal eligibility, and demographics of California immigrants eligible for the original and the expanded DACA programs and for DAPA.1 These immigrants are not eligible for health insurance options under the Affordable Care Act (“Obamacare”). But Californians who are granted DACA or DAPA become eligible for comprehensive Medi-Cal coverage under state policy if otherwise eligible based on income.
California recently approved an expansion of comprehensive Medi-Cal to all undocumented children age 18 and under, to be implemented as soon as May 2016.1Approximately 250,000 undocumented California children are projected to be eligible for Medi-Cal under that expansion, according to previous research.2
Using the latest Current Population Survey (CPS) data,3 we estimate that:
- Up to 54% of Californian adults eligible for DACA or DAPA lacked private health insurance and had income below the Medi-Cal eligibility threshold in 2013.
- We estimate that between 310,000 and 440,000 Californian adults with DACA or DAPA could be eligible for Medi-Cal several years after implementation of both executive actions. This estimate is contingent on sign-up rates for DACA and DAPA, which are highly uncertain.
- Most of these adults (80%) are DAPA-eligible, while the others are already eligible for the original DACA program or would become eligible for expanded DACA after the 2014 executive action is implemented.
- Not all Californians who are granted DACA or DAPA and are eligible for Medi-Cal would be anticipated to enroll in health coverage.
- Approximately two-thirds (66%) of DACA- and DAPA-eligible adults were working in 2013.
- More than nine out of ten (91%) Californian adults eligible for DACA or DAPA were under age 45 in 2013.
Hundreds of thousands of California immigrants could gain health insurance under President’s executive actions
But experts from UCLA, UC Berkeley say many undocumented residents will remain uncovered
March 26, 2015Gwendolyn Driscoll
UCLA Center for Health Policy Research
UC Berkeley Labor Center
Between 360,000 and 500,000 immigrants living in California would become eligible for Medi-Cal if they receive temporary protection from deportation and permission to work as a result of recent executive actions by President Barack Obama. Up to 57 percent of immigrants in California who are eligible under the executive actions are low income and lack private health insurance, according to a study by UC Berkeley’s Center for Labor Research and Education and the UCLA Center for Health Policy Research.
In November, Obama announced the expansion of the Deferred Action for Childhood Arrivals program, or DACA, which was established in 2012, and the creation of Deferred Action for Parents of U.S. Citizens and Lawful Permanent Residents, or DAPA. Applications continue for the original DACA program. Application processes for the new programs have been placed on hold under a court order, but immigration policy experts predict that the new programs will ultimately be implemented.
Although immigrants approved under the DACA and DAPA programs are not eligible for health coverage options under the Affordable Care Act, they are eligible for Medi-Cal under California state policy if they are in families earning less than a certain amount.
“We have left behind millions of undocumented workers and students who are excluded from health coverage options under the Affordable Care Act,” said Laurel Lucia, a policy analyst at the UC Berkeley Labor Center and lead author of the brief. “California is leading among states by providing comprehensive health care services to low-income residents granted DACA and DAPA, which is an important step toward closing the state’s largest eligibility gap.”
The researchers estimated that 66 percent of DACA- and DAPA-eligible adults are working.
“The only way we can improve overall health and efficiencies in expenditures is by providing important preventive and primary care services to everyone, not just those lucky enough to afford coverage,” said Nadereh Pourat, director of research at the UCLA Center for Health Policy Research and co-author of the brief. “Insurance coverage is the essential requirement for getting care when it is needed, and most undocumented working in low-income jobs fall through the cracks.”
New cost per person likely to be low
The researchers found that Californians eligible for DACA and DAPA are relatively young: 92 percent are under the age of 45, which would likely mean that their insurance premiums would be lower than the current statewide average.
Providing comprehensive coverage would also build upon federal and state funds already spent. Previous research by the authors found that 60 percent of the cost per adult of comprehensive Medi-Cal coverage is already paid for by the federal and state government through restricted scope Medi-Cal, which covers emergency and pregnancy-related services.
Many undocumented will remain uncovered
Even after expanded DACA and DAPA are implemented, many undocumented Californians would be expected to remain uninsured because they are not eligible for the programs, face barriers in signing up for deferred action or enrolling in Medi-Cal, or are not income-eligible for Medi-Cal.
This brief comes as the California Legislature considers the Health for All Act, or Senate Bill 4, proposed by state Sen. Ricardo Lara. The bill would expand eligibility for comprehensive Medi-Cal to all low-income Californians, regardless of their immigration status, and broaden undocumented Californians’ options for purchasing private insurance.
The health coverage and demographic estimates use data from the 2013 Current Population Survey, conducted by the U.S. Bureau of Labor Statistics and Census Bureau. The estimates are applied to the Pew Research Center’s estimate that 1.25 million Californians are potentially eligible for DACA and DAPA.
“This report gives us an important new insight on how many people are still locked out of health coverage. Now that we’ve seen these numbers, we can all work together to make sure everyone gets enrolled,” said Daniel Zingale, a Senior Vice President for The California Endowment, which funded the research. “People shouldn’t suffer or die because of their immigration status. The president’s executive action brings us a step closer to securing a healthier future for everyone, but even still, there will be others who are locked out of affordable coverage, and California needs to finish the job.”
Read the policy brief: Health Insurance and Demographics of California Immigrants Eligible for Deferred Action
The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health-related information on Californians.
The UC Berkeley Center for Labor Research and Education was founded in 1964 to conduct research and educate on issues related to labor and employment, such as job quality and workforce development.
The California Endowment, a private, statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of all Californians.
High court ruling could widen healthcare coverage for immigrants
Modern Healthcare | January 19, 2016
Solano Coalition for Better Health: Access to care for all
Vallejo Times-Herald | October 2, 2015
DACA Youth Turned Away for Medi-Cal
New America Media | September 28, 2015
New immigration rules in Calif. could reduce uninsured by up to half a million
Reporting on Health | April 9, 2015
With County Safety Nets Frayed, ‘Remaining Uninsured’ Pin Hopes on Lara’s Bill
New America Media | April 8, 2015
With new immigration proposals, state lawmakers hope to build momentum
Los Angeles Times | April 7, 2015
#Health4All: New Reports On Undocumented Californians’ Access to Health Care
The California Endowment| March 26, 2015
500K Undocumented Immigrants Could Be Added To Medi-Cal Rolls
California Healthline | March 26, 2015
Medi-Cal rolls could swell under Obama’s deportation relief plan
Los Angeles Times | March 25, 2015