Claudia Boyd-Barrett
For months, Maria, 55, a caregiver to older adults in California’s Orange County, has been attempting to not smile.
If she opens her mouth too huge, she worries, folks will see her chipped, plaque-covered entrance enamel. An immigrant with out authorized standing, Maria doesn’t have well being or dental insurance coverage. When her enamel begin to throb, she swallows ache drugs. Last summer time, a dentist stated it might price $2,400 to repair her enamel. That’s greater than she will be able to afford.
“It’s so expensive,” stated Maria, who usually works 12-hour days lifting shoppers out and in of mattress and serving to them with hygiene, remedy administration, and house responsibilities. “I need money for my kids, for my rent, for transport, for food. Sometimes, there’s nothing left for me.”
KFF Health News related with Maria via an advocacy group for immigrant staff. Fearing deportation, she requested that solely her first identify be used.
Maria is amongst what the federal authorities estimates are 2.6 million immigrants residing in California with out authorized standing. The state had progressively sought to deliver these immigrants into its Medicaid program, often known as Medi-Cal. But now, dealing with a state enrollment freeze, low-income California residents within the U.S. with out authorized permission — together with the suppliers and neighborhood staff that assist them — are anxiously weighing the advantages of pushing ahead with Medi-Cal purposes in opposition to the dangers of discovery and deportation by the federal authorities.
Seeking to shut a projected $12 billion price range deficit, California Gov. Gavin Newsom, a Democrat, signed a balanced state price range on June 27 that may finish new Medi-Cal enrollment in January 2026 for these over 19 with out authorized standing.
Meanwhile, federal immigration raids — which seem to have focused at least one health clinic within the state — are already making some folks afraid to hunt medical care, say immigrant advocates and well being suppliers. And the current information that Trump administration officers are sharing Medicaid enrollee data, together with immigration standing, with deportation authorities is anticipated to additional erode belief in this system.
U.S. Department of Health and Human Services spokesperson Andrew Nixon stated the company, which oversees the Centers for Medicare & Medicaid Services, had the authorized authority to share the information to handle “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 issues, the Trump administration has threatened to withhold funds from states that present well being protection to folks with out authorized standing. Currently, about 1.6 million folks within the nation with out authorization are enrolled in Medi-Cal.
In 2016, California started opening Medi-Cal to low-income folks missing authorized standing, beginning with kids, then progressively expanded it to younger folks, older adults, and — in January of this yr — these ages 26 to 49. The state Department of Health Care Services, which oversees Medi-Cal, partnered with community health clinics to assist get eligible folks enrolled.
It’s too early to inform what affect the most recent state and federal developments are having on enrollment numbers, since knowledge is out there solely via March. But many well being care suppliers and advocates stated they count on a chilling impact on immigrant enrollment.
Seciah Aquino is government director of the Latino Coalition for a Healthy California, which helps neighborhood well being staff — additionally known as promotores — who assist unfold consciousness about Medi-Cal’s growth to adults missing authorized standing. Just over half of public health insurance recipients in California are Latino, in contrast with simply 30% of Medicaid enrollees nationwide.
Aquino stated her coalition will inform promotores to reveal data-sharing dangers so neighborhood members could make knowledgeable choices.
“They take it very personally that advice that they provided to a fellow community member could now hurt them,” Aquino stated.
Newsom condemned the information sharing, calling the transfer “legally dubious,” whereas U.S. Sens. Adam Schiff and Alex Padilla, each Democrats, have demanded that the Department of Homeland Security destroy any knowledge shared.
California’s Department of Health Care Services introduced June 13 that it’s in search of extra info from the federal authorities. The agency said it submitted month-to-month reviews to CMS with demographic and eligibility info, together with identify and handle, as required by regulation.
Medicaid enrollee knowledge from Illinois, Washington state, and Washington, D.C., was additionally reportedly shared with DHS. Jamie Munks, a spokesperson for the Illinois Department of Healthcare and Family Services, the state’s Medicaid company, stated the division was “deeply concerned” by the information and that the information was repeatedly handed alongside to CMS with the understanding that it was protected.
In Sacramento, Democratic lawmakers discovered themselves within the uncomfortable place of rolling again well being advantages for low-income residents with unsatisfactory immigration standing, together with folks with out authorized standing, individuals who’ve held inexperienced playing cards for below 5 years, and a few others who’re within the means of making use of for authorized standing or have statuses meant to guard them from deportation. In addition to the Medi-Cal enrollment freeze for immigrants 19 and older within the nation with out authorization, all enrolled residents with unsatisfactory immigration standing from 19 to 59 years outdated shall be charged $30 month-to-month premiums beginning in July 2027.
“What I’m hearing on the ground is folks are telling me they’re going to have a really hard time making these premium payments,” stated Carlos Alarcon, well being and public advantages coverage analyst with the California Immigrant Policy Center, an advocacy group. “The reality is most people already have limited budgets.”
The legislature rejected a proposal from the governor to bar immigrants with unsatisfactory immigration standing from receiving long-term nursing residence and in-home care via Medi-Cal however went together with eliminating dental advantages beginning in July 2026.
Health care suppliers stated that with out Medi-Cal protection, many immigrants shall be pressured to hunt emergency care, which is dearer for taxpayers than preventive and primary-level care. Sepideh Taghvaei, chief dental officer at Santa Cruz County’s Dientes Community Dental Care, noticed this play out in 2009 when the state cut adult Medi-Cal dental advantages. Patients got here in with swollen faces and excruciating ache, with circumstances so superior that they required hospital therapy. “It’s not cost-effective,” she stated.
State Sen. Roger Niello, a Republican who serves as vice chair of the Senate price range committee, stated he believes California shouldn’t be funding Medi-Cal for individuals who lack authorized standing, significantly given the state’s fiscal challenges. He additionally stated he worries that protection of individuals within the nation with out authorization may encourage others to maneuver to California.
“If we maintain that expense to the noncitizen,” he stated, “we’re going to have to cut someplace else, and that’s undoubtedly going to affect citizens.”
Californians, too, are going via a change of coronary heart. In a May ballot performed by the Public Policy Institute of California, 58% of adults opposed the profit.
For Maria, shifting well being care insurance policies have left her feeling paralyzed. Since she arrived right here 5 years in the past, the caregiver’s focus has been on incomes cash to help her three kids, whom she left along with her mother and father in her residence nation, she stated.
Maria didn’t study she may be eligible for Medi-Cal till earlier this yr and hadn’t but discovered time to finish the paperwork. After a good friend informed her that the state may freeze enrollment in January, she started dashing to complete the sign-up course of. But then she discovered that Medi-Cal knowledge had been shared with immigration authorities.
“Disappointed and scared” was how she described her response.
Suddenly, she stated, enrolling in Medi-Cal doesn’t appear to be a good suggestion.
Phil Galewitz and Bram Sable-Smith contributed to this report.
This article was produced by KFF Health News, which publishes California Healthline, an editorially unbiased service of the California Health Care Foundation.
