February 2014, by Claire D. Brindis, Max W. Hadler, Ken Jacobs, Laurel Lucia, Nadereh Pourat, Marissa Raymond-Flesch, Rachel Siemons and Efrain Talamantes
UC Berkeley Center for Labor Research and Education
UCLA Center for Health Policy Research
UCSF Philip R. Lee Institute for Health Policy Studies
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This is the first report in a two-part series on the profile of the DACA-eligible population in California. This report describes health care coverage of DACA-eligible Californians and presents potential policy solutions to expand their coverage options. A companion report will discuss the health needs, common sources of care, and barriers to care for DACA-eligible Californians and will present potential solutions for health care providers, community-based organizations, and private and public funders to improve health and access to care.
While millions of Californians are expected to gain health insurance under the Affordable Care Act (ACA), between three and four million Californians are predicted to remain uninsured. Of these, approximately one million are undocumented immigrants who are not eligible for federal coverage options under the ACA. Included in this group are teens and young adults who are eligible for or have been granted Deferred Action for Childhood Arrivals (DACA). California policymakers are currently considering state and local options to expand health coverage to all Californians, including those eligible for DACA. This report describes the demographics and current health coverage of this group.
The DACA program provides temporary work authorization and relief from deportation for undocumented immigrants who arrived in the United States before the age of 16 and were under age 31 as of June
2012. They must currently attend school, have a high school diploma or General Equivalency Diploma (GED), or have an honorable discharge from the U.S. military. An estimated 937,000 individuals nationally were eligible for the DACA program when it began in 2012. This report focuses on the 300,000 or more Californians estimated to be currently eligible. California has more individuals eligible for the DACA program than any other state.
Californians who are now eligible for the program were less likely to have private health insurance either through their own or a family member's job or purchased through the individual market (29 percent) than U.S.-born individuals of the same age (61 percent). These data are from prior to the creation of DACA, and therefore may have improved somewhat due to greater employment opportunities for those granted DACA.
In addition to low levels of private health coverage, DACA-eligible individuals are excluded from coverage through federally-subsidized health programs such as Medicaid or the new insurance options created under the ACA. Furthermore, even if comprehensive immigration reform is enacted, proposals currently under discussion at the national level suggest it is not likely to result in access to affordable health coverage options under the ACA for newly legalized immigrants in the near term.
However, in California, unlike most other states, low-income individuals granted deferred action under DACA are eligible for Medi-Cal under state policy. Most individuals who are eligible for DACA were also low-income. Of those teens age 18 and under who are eligible for DACA, the vast majority (93 percent) had household income below the Medi-Cal eligibility standard for children (now approximately $62,900 for a family of four). Nearly two-thirds (62 percent) of DACA-eligible young adults had household income below the Medi-Cal eligibility standard (now approximately $16,000 for a single individual). In addition, DACA-eligible Californians may be eligible for certain other state, county, and private health programs.
Of the 154,000 Californians granted deferred action under DACA as of December 2013, we estimate that up to 125,000 (81 percent) are eligible for Medi-Cal. This is an upper-limit estimate because individuals granted work authorization under DACA may have been able to secure better employment with increased income and/or access to employment-based health coverage, reducing eligibility and demand for Medi-Cal among this group.
The extent to which these approximately 125,000 Californians enroll in Medi-Cal will depend on how many already have private coverage, the effectiveness of outreach efforts, the ease with which immigrants can enroll, and immigrants' level of confidence that enrolling in Medi-Cal will not result in immigration enforcement actions for them or their family members.
Many DACA-eligible Californians are likely to remain uninsured because they do not qualify for or enroll in Medi-Cal and lack access to affordable private coverage.
This report highlights the gap in coverage for a significant number of young Californians despite the implementation of the ACA. Expanding coverage to teens and young adults granted DACA would reduce the state's uninsured population, increase access to needed care, and reduce the burden on the safety net. Removing barriers to timely preventive and primary care would improve population health and potentially reduce avoidable hospitalizations. These two central aims of the ACA are policy priorities that would be bolstered by healthy DACA-eligible Californians, who are and will continue to be important contributors to the state and its economy.
Key informants interviewed as part of this study made a number of recommendations for short and long-term solutions to expand health coverage for DACA-eligible Californians. Some of the top priorities include:
- Maintaining and expanding state and county programs for individuals who do not qualify for federal funding due to their immigration status;
- Ensuring that any staff or contractors who provide information to Californians regarding Medi-Cal eligibility (such as Covered California Service Center staff, Certified Enrollment Counselors, or county eligibility workers) are trained on immigrant eligibility for Medi-Cal to ensure a smooth enrollment process for these young immigrants; and
- Passing comprehensive immigration reform that includes a path to citizenship and would allow newly legalized immigrants to immediately access affordable coverage options under the ACA.
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