Funding health care for illegal migrants in California poses risks

California is now providing full health insurance, free, to all low-income undocumented immigrants.

Full scope Medi-Cal, called Medicaid in other states, covers primary and preventive care, specialists, prescription drugs and other services.

Previously, immigrants without legal status were eligible only for restricted scope Medi-Cal, which provided benefits for such things as emergency room visits and pregnancy-related care.

But effective January 1, 2024, all low-income California residents, regardless of immigration status, are eligible for the same taxpayer-funded, safety-net health insurance program on which 14 million Californians already rely.

Yes, you read that right.

One-third of the population of California lives in poverty, or close to it.

State lawmakers extended full health insurance to undocumented immigrants incrementally.

Beginning in 2016, full scope Medi-Cal benefits were granted to children up to age 19, regardless of immigration status, as long as they met the other eligibility criteria.

That was expanded to young adults through age 25 in 2020. Two years later, the policy was expanded again to include anyone age 50 or older.

And on January 1 of this year, the missing group, adults age 26 through 49, became entitled to exactly the same all-inclusive Medi-Cal benefits available to low-income citizens and legal residents of California.

State officials said the latest addition will add an estimated 700,000 people to the rolls and will cost an extra $3.1 billion per year.

In truth, no one has any idea how many people will be added to the rolls, or what it will cost.

Medi-Cal is an entitlement program. Everyone who meets the eligibility requirements is entitled to enroll in it, and then they’re entitled to have Medi-Cal cover the cost of whatever healthcare services they need.

The latest expansion of benefits was approved by the legislature in 2022 in Senate Bill 184, an omnibus budget “trailer” bill rushed through the legislature in a matter of days.

Trailer bills are a California budget gimmick that evades the usual committee process where policies can be more thoughtfully considered.

If lawmakers had taken the time to read the bill, this sentence might have jumped out at them: “The federal Medicaid program prohibits payment to a state for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law.”

That means California will not receive federal matching funds to help pay for the extension of full scope Medi-Cal benefits to undocumented immigrants.

The cost of this new entitlement is on California taxpayers.

Now, however, the state’s finances are deep in the red. Gov. Gavin Newsom insisted at his recent budget presentation that the projected shortfall is “only” $38 billion, not the $68 billion estimated by the nonpartisan Legislative Analyst’s Office.

The LAO stood by its numbers, tactfully responding that the governor was being “optimistic.”

Newsom told reporters that he would not consider pulling back the expansion of Medi-Cal to undocumented immigrants, declaring, “It’s a fundamental right.”

It’s not, of course.

Health care is a service.

There can’t be a right to anything that’s provided by other people.

The 14 million Californians already on Medi-Cal face long waits, and often long travel times, for medical appointments.

One reason is that Medi-Cal reimbursements to providers are notoriously low, around 70% of what Medicare pays for the same service.

As a result, doctors limit the number of Medi-Cal patients they will accept, if they accept them at all.

Reimbursements are below the cost of providing the care.

In 2015, groups representing California Latinos filed a civil rights complaint with the U.S. Department of Health and Human Services alleging that long wait times for care had resulted in lower survival rates for cancer patients on Medi-Cal.

Then in 2017, the Mexican American Legal Defense and Educational Fund (MALDEF) sued the California Department of Health Care Services, charging that low reimbursements were causing Medi-Cal patients to have substantially worse access to health care than Californians who had different insurance, which violates the law.

MALDEF’s lawsuit pointed out that the federal Medicaid act requires that reimbursement rates to health care providers must be “adequate to enlist providers for the level of care and services…available to the general population” and that medical care must “be provided with reasonable promptness to all eligible individuals.”

The situation will only get worse now that Medi-Cal enrollment is open to the whole world.

New York may be on the same path. As of January 1, 2024, all low-income undocumented immigrants in the state are eligible for full Medicaid if they are at least 65 years old.

Given what Americans are paying for health insurance, maybe we should go out and come in again.

Susan Shelley is a columnist and editorial writer for the Southern California News Group and VP of Communications for the Howard Jarvis Taxpayers Association. On X at @Susan_Shelley.