California Sets its Sight on Universal Health Care Through Medi-Cal Expansion to Undocumented Young Adults

Health care dominated the California Governor’s race last year and is once again a top issue in the 2020 Presidential race. The initial support by the democratic Presidential candidates for single-payer health care has transformed into support for universal health care. Rather than call for the elimination of all private health insurance, the candidates’ focus is to ensure health care for all. California is taking steps towards that goal through the expansion of Medi-Cal. The proposed expansion, which was announced on Governor Newsom’s first day in office, would cover any undocumented young adult who is otherwise eligible for Medi-Cal.

At an Informational Hearing on February 14, 2019 the bipartisan Legislative Analyst’s Office reported that their fiscal projections of the cost of Medi-Cal expansion to young adults revealed that it would “grow to potentially about a little less than $300 million net general fund” annually in the future years of the program. This is significant, because the Governor’s budget proposal to provide full-scope Medi-Cal coverage to undocumented immigrants ages 19 -25 put program costs at $194 million net general fund expenditure for 2019-2020. Interestingly, the LAO estimate of costs for 2019-2020 was $60 million lower due to a redirection of current funding for county health activities which would offset the cost of this program.  According to the proposed Budget, expansion is expected to provide health coverage to approximately 138,000 undocumented adults in its first year.

Currently, undocumented immigrant adults receive limited scope coverage under Medi-Cal including emergency and pregnancy related care.  Since the ACA, California has reduced its uninsured rate from 19% to approximately 7% or 2,700,000 individuals. The majority of the uninsured individuals, approximately 58% of that 2,700,000, are undocumented immigrants. Which is why the Governor proposed chipping away at the uninsured rate by expanding Medi-Cal coverage, thereby getting closer to fulfilling his goal of achieving Universal Healthcare in California. In 2015, the state expanded full-scope Medi-Cal coverage to undocumented children ages 0 – 18. That expansion provided Medi-Cal coverage to 200,000 undocumented children at an annual General Fund cost of $300 million. According to the LAO’s Medi-Cal Budget Analysis, this year’s proposed expansion would build among the previous expansion and additionally reduce the number of uninsured undocumented Californians by more than 10 percent.

In addition to the fiscal analysis on the cost of expansion, the Senior Fiscal and Policy Analyst from the LAO stated that they “grapple(d) with the same issues (in their report) as Senator Roth” who asked during the hearing, what led to the public policy decision to expand Medi-Cal coverage to young adults versus undocumented seniors. The analyst noted that the legislature is now “presented with an opportunity to decide amongst its priorities. In terms of do we expand coverage to the 19 to 25-year-old population thereby extending continuous coverage all the way from zero to 25 and make it consistent with the ACA. Versus other considerations, such as the elderly population having higher health needs and having health needs that might not as often be covered by emergency and pregnancy related services such as for the young adult population.” He concluded that the LAO has no recommendation but has raised those issues for the legislatures consideration.

The next action item for this budget proposal is to be heard in a budget committee.

Karen Sarkissian, Policy Advocate