For the first time in California’s history, undocumented immigrants ages 26 to 40 will qualify for healthcare. Approved by Gov. Newsom, the new plan further expands California’s healthcare system by allowing this group of undocumented immigrants to gain access to MediCal, the state’s medical insurance program for low-income individuals. The state expanded healthcare to undocumented children in 2015 and later for undocumented adults above age 50 in 2021. Committing approximately $3 billion annually, MediCal is currently the state’s second-largest expense. Gov. Newsom’s healthcare expansion plan is substantial progress in a historically inequitable healthcare system and will undoubtedly better serve vulnerable communities. However, California must continue bridging gaps to serve this vulnerable population effectively.
Residents without legal status experience unique determinants of health compared to other populations. Health studies have found, for example, that they experience “higher rates of chronic conditions,” such as asthma, high blood pressure and heart disease. Undocumented residents are also “more likely to suffer from mental distress” due to employment, living conditions, lack of access to the legal system and traumatic experiences.
Thus, undocumented patients are 20% less likely than MediCal patients to receive much-needed preventative health services, such as vaccinations and annual check-ups. With undetected and untreated health conditions, these patients disproportionately rely on emergency MediCal for care and often visit emergency rooms. Not only is urgent care more expensive than primary care, but many undocumented residents also pay out-of-pocket for their medical bills. Through the MediCal expansion plan, qualifying undocumented adults can receive free or low-cost primary and specialty care. This will significantly reduce high-cost emergency department care and protect undocumented patients’ financial well-being.
Despite these improvements, residents without legal status still face significant barriers to accessing quality healthcare. These challenges are primarily due to a lack of inclusivity in public health institutions and historically anti-immigrant policies such as the “public charge” rule. A federal law, the “public charge” rule, requires non-citizens to prove they will not be “primarily dependent on the government for support” by either receiving “cash assistance for income maintenance” or “for long-term care at government expense” to be considered for permanent residency or citizenship.
Although the law was changed in 2021 when President Biden took office, research suggests the public charge policy had a chilling effect — increasing fears among immigrant families and decreasing participation in social and health services. Fear and confusion about the rule, as well as deep distrust in public institutions, has led to a large cancellation of enrollment of immigrant children and adults from these state programs.
Ultimately, public health institutions must build trust with undocumented residents for the MediCal expansion to be effective. One alternative is the expanded use of telehealth as undocumented patients increasingly choose to utilize telehealth, or long-distance clinical health care through technology, over in-person visits. Extending telehealth technology and patient accessibility is a way to make them feel safer and more comfortable using public programs. Additionally, since California undocumented individuals are 72% more likely to be Latinx than other MediCal members, Spanish is frequently listed as a preferred language. Hiring more bilingual staff will prepare clinics for the expected patient increase and further remove language barriers. These actions are not the only solutions but a starting point for the state to establish a more equitable healthcare system.
The 2020 pandemic left California’s healthcare system and the entire nation without enough medical staff to serve a growing number of patients. While undocumented residents deserve and have a right to healthcare, the addition of this new group will further strain the state’s unbalanced healthcare system. Thus, it is imperative the state invest more funding into growing the public health workforce, including medical workers and mental health clinicians, to meet the growing patient demand.
As previously reported, California can begin by increasing funding for public nursing programs in the state — as data shows more students are turning to private and out-of-state universities — to be educated and for the future of the profession. However, healthcare coverage for all must become a greater funding priority for these additional healthcare programs to exist.
Covering undocumented adults is a significant step in addressing the inequities in the U.S. healthcare system. Still, more can be done to address the ongoing gaps that persist. Regardless of legal status, everyone deserves healthcare without financial worry. Universal healthcare for every Californian should be a priority. The alternative is purely inhumane.
