This summer, California became the first state to approve a Medicaid expansion to undocumented young adults up to age 26. This group can now access health benefits through Medi-Cal, the state’s Medicaid program, as of Jan. 1.
The idea of offering public health insurance to non-citizens initially faced some pushback from Republican lawmakers who oppose using California general fund dollars for this purpose. Health and immigration advocates say the expansion is a crucial step toward “universal health care,” or insurance coverage for all.
"All income-eligible young adults in California, regardless of immigration status, will now be able to enroll in comprehensive health care through Medi-Cal,” said Anthony Wright, director of advocacy group Health Access, in a statement. “Our communities will be healthier and more families will be able to thrive thanks to these expansions of access and affordability in California."
But experts say getting young adults to sign up could be a challenge. A report on the roll-out from a nonprofit organization called the Insure the Uninsured Project predicts some undocumented young adults will be cautious about enrolling.
That’s partly due to fears about the public charge rule — a proposed federal policy that could penalize immigrants for using specified public benefits. That rule doesn’t apply to state-funded Medi-Cal benefits, but providers and community groups say there’s a lot of confusion and fear around the rule.
Young adults are also more likely than other groups to go without insurance, because they’re generally healthy and don’t feel they need it.
Here are the nuts and bolts of the new policy for undocumented young adults in California.
Who is newly eligible for Medi-Cal starting in 2020?
Any California resident under age 26 who meets the Medi-Cal income guidelines — about $17,000 a year for an individual or $35,500 a year for a family of four — can now sign up, regardless of immigration status. Undocumented children up to age 18 became eligible for the program in 2016, but young adults ages 19 through 25 were just added for 2020.
Who is expected to enroll?
The expansion is expected to draw roughly 90,000 undocumented young adults onto standard Medi-Cal. The Insure the Uninsured Project predicts people from three different groups will sign up:
New enrollees: Young adults ages 19-25 who are income-eligible for Medi-Cal but who were previously unable to enroll because of their immigration status.
Transition enrollees: Young adults ages 19-25 currently enrolled in restricted scope Medi-Cal, a limited version of the program that primarily covers emergency services. This transition group makes up 75% of expected enrollees.
Undocumented children who are currently eligible for full-scope Medi-Cal but would have aged out of access after turning 19
What health benefits will undocumented young adults gain through this change?
Full scope Medi-Cal provides medical, dental, mental health, family planning and vision care, as well as treatment for alcohol and drug use, prescriptions and other benefits. Patients get connected to a primary care doctor and can request referrals to specialists as needed.
How is this funded?
The 2019-20 California budget included $98 million to expand full-scope coverage in Medi-Cal. The budget also included $25 million for outreach to encourage people to enroll in Medi-Cal, with a focus on undocumented young adults.
People enrolled in Medi-Cal do not pay co-payments, as the plan covers all medical costs that are medically necessary.
How do I sign up?
People transitioning from restricted-scope Medi-Cal to full-scope Medi-Cal will not have to submit a new application. However, if they receive a renewal packet for restricted scope Medi-Cal eligibility, they must provide the county with any requested information. The Department of Health Care Services began sending notices to the transition population in November.
People who are newly eligible but aren’t already enrolled in restricted-scope Medi-Cal and who don’t receive a notice have a few options to enroll:
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