Introduction to the Issue
For months, Maria, 55, a caregiver to older adults in Orange County, has been trying not to smile. If she opens her mouth too wide, she worries, people will see her chipped, plaque-covered front teeth. An immigrant without legal status, Maria doesn’t have health or dental insurance. When her teeth start to throb, she swallows pain pills. Last summer, a dentist said it would cost $2,400 to fix her teeth. That’s more than she can afford.
The Struggle for Health Coverage
“It’s so expensive,” said Maria, who often works 12-hour days lifting clients in and out of bed and helping them with hygiene, medication management, and housework. “I need money for my kids, for my rent, for transport, for food. Sometimes, there’s nothing left for me.” Maria is among what the federal government estimates are 2.6 million immigrants living in California without legal status. The state had gradually sought to bring these immigrants into its Medicaid program, known as Medi-Cal. But now, facing a state enrollment freeze, low-income California residents in the U.S. without legal permission — along with the providers and community workers that help them — are anxiously weighing the benefits of pushing forward with Medi-Cal applications against the risks of discovery and deportation by the federal government.
Recent Developments and Their Impact
California’s legislature, seeking to close a projected $12 billion budget deficit, has agreed with a proposal by Gov. Gavin Newsom to end Medi-Cal enrollment in January 2026 for those over 19 without legal status. Lawmakers are in the process of hashing out the final contours of the budget deal before the new fiscal year begins July 1. Meanwhile, federal immigration raids — which appear to have targeted at least one health clinic in the state — are already making some people afraid to seek medical care, say immigrant advocates and health providers. And the recent news that Trump administration officials are sharing Medicaid enrollee data, including immigration status, with deportation authorities is expected to further erode trust in the program.
Federal Involvement and Data Sharing
U.S. Department of Health and Human Services spokesperson Andrew Nixon said the agency, which oversees the Centers for Medicare & Medicaid Services, had the legal authority to share the data to address “unprecedented systemic neglect under the Biden-Harris administration that allowed illegal immigrants to exploit Medicaid while millions of Americans struggle to access care, particularly in states like California.” Further complicating matters, the Trump administration has threatened to withhold funds from states that provide health coverage to people without legal status. Currently, about 1.6 million people in the country illegally are enrolled in Medi-Cal.
History of Medi-Cal Expansion
In 2016, California began opening Medi-Cal to low-income people lacking legal status, starting with children, then gradually expanded it to young people, older adults, and — in January of this year — those ages 26 to 49. The state Department of Health Care Services, which oversees Medi-Cal, partnered with community health clinics to help get eligible people enrolled. It’s too early to tell what impact the latest state and federal developments are having on enrollment numbers, since data is available only through March. But many health care providers and advocates said they expect a chilling effect on immigrant enrollment.
Community Response and Concerns
Seciah Aquino is executive director of the Latino Coalition for a Healthy California, which supports community health workers — also called promotores — who help spread awareness about Medi-Cal’s expansion to adults lacking legal status. Just over half of public health insurance recipients in California are Latino, compared with just 30% of Medicaid enrollees nationwide. Aquino said her coalition will tell promotores to disclose data-sharing risks so community members can make informed decisions. “They take it very personally that advice that they provided to a fellow community member could now hurt them,” Aquino said.
Political and Legislative Actions
Newsom condemned the data sharing, calling the move “legally dubious,” while U.S. Sens. Adam Schiff and Alex Padilla, both Democrats, have demanded that the Department of Homeland Security destroy any data shared. California’s Department of Health Care Services announced June 13 that it is seeking more information from the federal government. The agency said it submitted monthly reports to CMS with demographic and eligibility information, including name and address, as required by law. Medicaid enrollee data from Illinois, Washington state, and Washington, D.C., was also reportedly shared with DHS.
Impact on Immigrant Communities
In Sacramento, Democratic lawmakers found themselves in the uncomfortable position of rolling back health benefits for low-income residents with unsatisfactory immigration status, including people without legal status, people who’ve held green cards for under five years, and some others who are in the process of applying for legal status or have statuses meant to protect them from deportation. In addition to supporting the Medi-Cal enrollment freeze for immigrants 19 and older in the country illegally, legislators agreed to charge monthly premiums for all residents with unsatisfactory immigration status between the ages of 19 and 59. Newsom proposed a $100 monthly premium beginning in January 2027; state lawmakers countered with $30 starting in July 2027.
Conclusion
The situation for immigrants like Maria, who are trying to access necessary health care while fearing deportation, is increasingly dire. The recent developments and data sharing between federal agencies and deportation authorities have created a climate of fear, causing many to weigh the risks and benefits of seeking health coverage. As the situation continues to evolve, it remains to be seen how these changes will impact the health and well-being of California’s immigrant communities.
FAQs
- Q: What is the current situation with Medi-Cal enrollment for immigrants without legal status in California?
A: The state has agreed to end Medi-Cal enrollment in January 2026 for those over 19 without legal status, amidst a broader national and state discussion about health care access for immigrants. - Q: Why are immigrants hesitant to enroll in Medi-Cal?
A: The sharing of Medicaid enrollee data, including immigration status, with deportation authorities, and the threat of federal immigration raids have created fear among immigrant communities, making them hesitant to seek health care. - Q: What has been the response from community health workers and advocates?
A: Community health workers and advocates are working to inform potential enrollees about the risks associated with data sharing, so they can make informed decisions about seeking health coverage. - Q: How might these developments affect the health and well-being of immigrant communities?
A: Without access to preventive and primary care through Medi-Cal, many immigrants may be forced to seek emergency care, which is more expensive and can lead to worse health outcomes.
