Introduction

While the number of people without health insurance has declined dramatically since the Affordable Care Act went into effect, undocumented immigrants continue to be excluded from many health coverage options under this law. In California, approximately 1.8 million individuals are projected to remain uninsured due to their immigration status. Without resources to pay for costly health care, undocumented immigrants may delay care and eventually seek treatment in the emergency room or go untreated entirely.

Undocumented adults in California are generally eligible for only emergency and pregnancy-related services through Medi-Cal, the state’s Medicaid program, though undocumented children and those granted deferred action may be eligible for full-scope Medi-Cal. Many of California’s counties provide primary and preventive health care services to low-income undocumented residents through safety-net programs. These programs are of interest to advocates and policymakers in other states who are looking for local solutions to offer non-emergency health services to undocumented immigrants. This report profiles three county programs that offer health care services to undocumented residents and aims to serve as a resource for designing and implementing similar programs elsewhere across the nation. It is based on interviews with county program staff, statewide informants, provider organizations, consumer advocacy groups, and published reports and documents gathered in June and July of 2016.

This report will present a brief history, basic enrollment and eligibility information, and available cost and revenue data for each of the highlighted county health care programs, and then describe lessons learned about building provider networks, engaging in outreach and enrollment, and evaluating the program.

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