California immigrants health benefits is making history by becoming the first state to remove immigration status as a barrier to eligibility for Medicaid (Medi-Cal in California). It is a long-sought victory for health care and immigrant activists.
Nationwide, about 22.1 million people lack legal immigration status and are not eligible for most federal public benefit programs. They are often uninsured or under-insured, with poor health outcomes.
1. Medi-Cal
A key part of California’s efforts to achieve universal health coverage is Medi-Cal, which provides comprehensive medical services to low-income adults and children. The program is supported by federal and state funds, including taxes on low-income families and individuals. Depending on the state, a child’s eligibility for Medi-Cal may be determined based on their family income and assets, the number of adults in the household, whether a parent is working, or other factors.
Medi-Cal also offers children’s dental, mental health, and eye care, and can provide coverage for prescription drugs, eyeglasses, and other essential services. It is available to eligible children, regardless of their legal immigration status.
For many unauthorized immigrants, access to medical care is a high-stakes issue. Without insurance, they can’t get the primary and specialty care they need.
To help unauthorized immigrants navigate the health system, advocates are creating community-based outreach teams and enrolling clients in Medi-Cal. One example is the Mixteco Indigena Community Organizing Project (MICOP) in Oxnard, which has trained eight Navigators to assist clients with their applications and enrollment processes.
The MICOP team has helped more than 3,600 people in the area, including Gutierrez’s family, sign up for Medi-Cal since the program began in 2020. The group hopes to continue assisting more unauthorized immigrants in the future.
In addition to helping undocumented immigrants apply for Medi-Cal, the MICOP team also works with them to enroll in private insurance, such as Covered California, which allows them to buy individual and family plans through the state marketplace. They also offer counseling and social services to help their clients find housing, jobs, and other forms of assistance.
A recent study showed that expanding access to health insurance to undocumented Californians could result in a reduction in uninsurance rates, an increase in health care use and improve health outcomes. However, many undocumented immigrants will remain uninsured because of affordability issues.
To address these concerns, a recent report from the University of California Berkley’s Labor Center suggests that the state can reduce uninsurance rates among unauthorized adults by providing them with Medi-Cal coverage. It estimates that, if Medi-Cal is extended to adults 26-49 regardless of immigration status, uninsurance rates would drop by a large margin.
2. Covered California
Covered California is a state-run health insurance marketplace where you can shop for and apply for government subsidies to lower your premium costs. These subsidies are designed to help people with low incomes pay for health care in this state.
All the plans sold through Covered California must include 10 essential health benefits. These are preventive services, prescription drug coverage, maternity and newborn care, dental, and mental health. The plan also must be affordable, have low out-of-pocket costs, and not discriminate against anyone because of pre-existing conditions.
You can find a plan that best fits your needs through the Covered California website or by contacting an agent in your area. There are four groups of plans, including platinum, gold, silver, and bronze, with varying levels of coverage. Each plan must offer minimum benefits and cover at least 60% of the cost of most medical expenses.
The federal government offers subsidies to help you pay for a Covered California plan, but you don’t have to live in California to qualify. You can also get tax credits and cost-sharing reductions to lower your monthly premium payments.
If you don’t qualify for financial help, the health insurance marketplace will check to see if you have other sources of funding to help you with your health care. These may include a child’s health insurance, Medicare, group insurance, a plan through the military or a private health insurance policy.
Special Enrollment: You can sign up for a health plan through Covered California even outside of the open enrollment period. This special enrollment allows people who have a qualifying life event, such as a job loss, to switch or re-enroll in a health plan without waiting until the next open enrollment.
Medi-Cal: This program provides free or low-cost health care to California residents who earn less than 400% of the Federal Poverty Level (FPL). You can apply for this health insurance program at any time.
You can receive assistance for your health insurance through Covered California, Medi-Cal, and other government programs. These include cost sharing reductions that lower out-of-pocket costs like deductibles, copays and coinsurance.
3. Covered California Marketplace
Covered California, also known as the health insurance marketplace, is the state’s health exchange established under the federal Patient Protection and Affordable Care Act (ACA). This website enables eligible individuals and small businesses to purchase private health coverage at subsidized rates. It provides assistance to help people pay for their insurance, including tax credits and cost sharing subsidies from government programs.
The ACA expanded health coverage to more than 20 million Californians who were uninsured in 2016. These include 5.3 million individuals and families who are currently enrolled in coverage through the exchange, 1.7 million adults who would qualify for subsidized individual market plans and 2.4 million children who are eligible for Medi-Cal.
In order to enroll in a plan, individuals must complete an application with basic income and family size information. These data are used to determine eligibility for premium assistance and cost sharing subsides.
Applicants who qualify for a plan through the exchange will typically receive comprehensive, affordable health insurance with no limits on annual or lifetime benefits. In addition, they will not be subject to the deductibles and other copayments of a traditional plan.
However, recent immigrants who do not qualify for a plan through the exchange will need to consider purchasing an individual market policy. These policies are available on a guaranteed-issue basis, regardless of age, and many of them offer subsidies based on income.
Although these policies are much more affordable than ACA-compliant policies, they do not provide the same level of coverage. They do not have the same tenets of protection against pre-existing conditions and may not cover all benefits.
Immigrants who are over 65 years old or have health conditions that make it difficult to get a conventional health plan are able to enroll in an individual market plan through the ACA’s health insurance exchange. In addition, these immigrants are able to receive a premium subsidy, as long as they meet the other requirements for coverage and income levels.
Those who do not qualify for a plan through Covered California will need to consider purchasing a short-term policy to ensure that they have access to healthcare. In fact, short-term health insurance is better than no healthcare at all.
4. Private Insurance
Purchasing private health insurance is an option for many people who aren’t eligible for public health benefits. Most employers offer group health insurance as a part of their benefits package, but individuals and families can also buy individual or family plans from private insurance companies. Depending on the type of plan, costs can vary widely.
In addition to the cost, a number of other factors are considered when determining your private health insurance costs. These include your age, tobacco status and the region in which you live. Some types of coverage also qualify for federal subsidies or cost-sharing reductions, such as the premium tax credit and the advanced premium tax credits available on the Marketplace/exchange.
For example, if you have a high deductible and co-payments, the tax credits could make your premium much more affordable. Similarly, if you are covered by Medicare, the cost-sharing reductions offered in the Marketplace can lower your deductible and co-payments.
However, while some private insurance plans have been regulated by the government to cover minimum essential coverage, others are not. The lack of government regulation may result in inequities. For example, some private insurers have not offered maternity coverage or mental health parity.
Despite these inequities, private insurance is important for some individuals and families. It offers a variety of benefits, including preventive care, maternity coverage and mental health parity.
But for undocumented immigrants, access to these private insurance options has been limited. A large portion of undocumented immigrants are low-income and have limited insurance options due to their immigration status.
As a result, some Californians living without any health insurance have to depend on charity care or cash payments for their healthcare needs. These immigrants often have trouble navigating health systems, and their health care interactions are not recorded in most sources of data.
The good news is that California has made it easier for some undocumented immigrants to obtain health insurance, thanks to policy changes enacted by the state. In fact, this year the state became the first in the nation to remove immigration status as a barrier to Medicaid.
