In a sharp rebuke to the Trump administration, California is expanding access to health care for its largest uninsured group: the undocumented.

Activists have been trying to get the state to cover undocumented residents for some time, as about 1.4 million lack insurance. On Sunday, they made progress when state lawmakers reached a budget agreement that would make California the first-ever state to offer health coverage to certain undocumented residents.

Specifically, undocumented residents between the ages of 19 and 25 would be eligible for the state’s Medicaid program if they already meet the income requirement; meaning, an individual who earns no more than $16,395 annually. The state estimates about 90,000 residents will gain coverage, costing about $98 million in the upcoming fiscal year. The state will partially pay for the Medicaid expansion by fining people who don’t have health insurance, which is what the Affordable Care Act did before Republicans voted to roll back the individual mandate in 2017.

The legislature is expected to approve the plan as part of a larger budget deal this week, according to the Associated Press. Once approved, the expansion will take effect on January 1, 2020.


For many activists, the budget deal is “bittersweet.” The California Immigrant Policy Center (CIPC) praised the deal for covering young adults, but faulted it for excluding “critical opportunities.” Ultimately, the legislature didn’t extend Medicaid eligibility to undocumented seniors, as state senators proposed. Nor did it extend subsidies to undocumented immigrants looking to purchase care on the Obamacare marketplace.

“Our leaders must treat all Californians with the same compassion we would hope for when we need it,” said CIPC Executive Director Cynthia Buiza, in a statement.

Activists have been trying to get lawmakers to expand access to all undocumented residents. For years, bills have been introduced to extend full Medicaid benefits to all residents, regardless of citizenship status. California’s single-payer bill, which would move everyone into one government-run plan, would also extend coverage to undocumented residents.

“Unfortunately, California doesn’t have jurisdiction over immigration. If that was the case, we would have — California would have been far ahead in this immigration issue,” California Insurance Commissioner Ricardo Lara told ThinkProgress last year when he was state senator. During his time in office, Lara pushed bills to expand health coverage to all residents.

“But what we can do is ensure that everyone has access to health care,” he added.

In 2016, the legislature expanded Medicaid to undocumented children. State officials say the vast majority of undocumented children are now enrolled in the program. Indeed, more than 250,000 children gained health care. However, a recent state audit found children enrolled in Medicaid aren’t always getting the preventive care to which they are entitled. The audit says it’s because many pediatricians don’t accept Medicaid due to its relatively low payment rate to providers.

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