Labor Center research was used in a years-long campaign by health and immigrant advocates to bring health coverage to undocumented Californians.
After a doctor’s visit four months ago, Maria was diagnosed with a heart murmur. Luckily, the doctor told her she will live a normal life, but Maria couldn’t help but think of her brother who, after a sudden heart attack two years ago, died from an undiagnosed heart condition.
“He didn’t go to check-ups because it was so expensive,” the 45-year-old Hesperia resident said. For privacy reasons, Maria asked to only use her first name because she is undocumented, as had been her brother.
Seven years earlier, Maria was diagnosed with diabetes but because of expensive medical bills that piled up, she couldn’t afford regular checkups.
“I would pay $100 per check-up that would only last about 10 or 15 minutes,” she said, adding that she could only afford to see the doctor every six months instead of the recommended three for someone with diabetes. She also asked her doctor to prescribe her pills instead of insulin, because they were cheaper.
This past summer, Gov. Gavin Newsom and the Legislature passed a landmark piece of legislation extending Medi-Cal eligibility to low-income, undocumented residents between ages 26 and 49. Now, undocumented immigrants like Maria will finally be able to seek the health care they have long needed. California, home to the largest number of immigrants in the country, including 2.3 million undocumented individuals, is now the first state in the country to fully remove immigration status barriers to healthcare for low-income residents.
“I am very grateful for everything,” said Maria, a mother of three who first moved to the U.S. when she was 21 years old. “I know they fought for us,” she said of advocates for undocumented Californians.
Research out of the UC Berkeley Labor Center has informed this and other health policy debates in California since before passage of the Affordable Care Act. In 2011, the Berkeley Labor Center and the UCLA Center for Health Policy Research developed the California Simulation of Insurance Markets model – CalSIM – a microsimulation model that projects insurance coverage in the state under various policy scenarios. Over the past decade, research conducted using CalSIM has been integral to estimating the impact of policy proposals to increase healthcare access in the state. As debate about expansion of health coverage to all low-income Californians regardless of immigration status intensified, CalSIM estimates and other Labor Center healthcare research were repeatedly cited by policymakers, advocates, and dozens of news articles.
“When we looked at who was still uninsured after the ACA and what they were eligible for, undocumented residents were the biggest group,” said Miranda Dietz, a policy research specialist and one of the research leads for the Labor Center’s CalSIM model. “This really stood out and has been a key focus of the work to expand coverage in California.”
California has been steadily chipping away at the problem of lack of healthcare access among undocumented immigrants. In 2016, then-Gov. Jerry Brown extended Medi-Cal eligibility to undocumented children until age 18. Gov. Gavin Newsom in 2020 expanded this policy under an initiative called Young Adult Expansion, which provided Medi-Cal access to adults under 26 regardless of immigration status. On May 1 of this year, the next phase of the initiative, called Older Adult Expansion, was implemented and has already provided full scope Medi-Cal to 286,000 low-income undocumented residents ages 50 and older.
And now, after years of incremental policy change, the state will close the final gap in Medi-Cal eligibility, providing access to coverage for the remaining previously excluded 700,000 undocumented Californians aged 26 to 49.
The law – which provides full-scope Medi-Cal benefits including the opportunity for routine, preventative, and long-term care and in-home supportive services – will go into full effect on January 1, 2024. The expansion is expected to cost about $613.5 million in the fiscal year ending June 2024 and $2.2 billion each year after that once it’s fully implemented. The state’s total budget for Medi-Cal is an estimated $137.7 billion.
“This is very exciting,” said Dietz. “Californians who only have access to emergency services through Medi-Cal at the moment will be automatically transitioned into full benefits.”
“This is life changing,” said Sarah Dar, the director of health and public benefits at the California Immigrant Policy Center, the organization that co-led the policy campaign along with Health Access California. She and her team have campaigned for Medi-Cal expansion since 2014 using the Labor Center’s projections. “There are people who have gone their whole life without a check-up.”
“From the start, the fight was for everybody,” she continued. “The goal has always been to cover everyone.”
“We are ecstatic over the passage of this policy as it has ensured that everyone regardless of their immigration status can access primary, preventive, and comprehensive care,” said Jose Torres Casillas, policy and legislative advocate at Health Access California, who over the last few years has overseen the policy work to remove immigration status as an eligibility barrier to Medi-Cal. “It truly has been a community effort to ensure this victory for our undocumented neighbors, from partnering with the legislature, community advocates, and policy researchers at UC Berkeley’s Labor Center.”
The California public has grown increasingly supportive of the state including undocumented people in its healthcare system. Back in 2019, about 63% of voters supported Medi-Cal expansion to young adults, according to a statewide survey from the Public Policy Institute of California. That number was up significantly from a 2015 survey which found just 54% support. According to a poll last year, 66% of Californians remain supportive of covering healthcare costs for undocumented residents.
There is still more work ahead to accomplish universal health coverage in California. While the recent Medi-Cal expansion will be life-changing to many, Labor Center projections estimate there will still be approximately 460,000 undocumented people who will remain uninsured in California. Many will be those earning relatively low annual incomes that nonetheless exceed the threshold to qualify for Medi-Cal: $17,609 for single people, $23,792 for a couple, and $36,156 for a family of four.
The Labor Center’s health care program director Laurel Lucia reflects on the challenges met and those still ahead. “While more work remains to get to universal coverage, policymakers’ decision to complete the Medi-Cal expansions is a historic achievement. Immigrant rights and health care advocates and community members around the state campaigned for years to bring health coverage to undocumented Californians. We are proud to contribute research to this effort, and are thrilled that the work so many have put in is reaping policy successes.”
Anabel Sosa is a master’s student at the UCB Graduate School of Journalism and is specializing in narrative writing and investigative reporting. This semester she is working as a GSR with the Labor Center’s communications team.