全面健康福利对所有低收入加州人的重要性

UC Berkeley Center for Labor Research and EducationMay 2025 The Importance of ComprehensiveHealth Benefits for All Low-IncomeCalifornians By Laurel Lucia, Miranda Dietz, and Alexis Manzanilla Over the last decade, California has expanded access to Medi-Cal to alllow-income Californians, beginning by removing immigration-based exclusionsfor children in 2016 and then by gradually expanding coverage to adults ofall ages by 2024. As a result, immigrants who were previously eligible onlyfor costly emergency care are now eligible for comprehensive health benefitsincluding primary and preventive care, and care for chronic conditions. Today,1.6 million undocumented Californians, including many low-wage workers whoare not offered affordable coverage by their employers, are enrolled in fullMedi-Cal benefits using state funds. This inclusive policy recognizes that undocumented Californians are integralto our communities, families, and the health of our state’s economy.Undocumented immigrants in California contribute approximately$8.5 billionin state and local taxeseach year, and are commonly long-term members ofour communities with nearlytwo-thirds having lived in the U.S.for at least adecade. Undocumented workers make up7% of the state’s workforce, withapproximatelyhalf working in retail, agriculture, or constructionindustries.Additionally,one in ten childrenin the state has an undocumented parent. California’shistoric expansion of coverageto undocumented individualshas not only brought the statecloser to universal coverage, but has alsoreduced racial disparitiesin health coverage. However, this progress is at riskdue to a new state budget proposal that would curtail Medi-Cal benefits forcertain immigrants, ahead of additional severefederal cuts to Medicaidbeingconsidered. Over time, premiums and an enrollment freeze could resultin more than 1 million fewer immigrants with Medi-Cal Despite current Medi-Cal enrollees generallypaying no premiums, state policymakers areconsidering aMay Revise budgetproposal that would impose new $100 monthly premiums(beginning in 2027) on adults ages 19+ with “unsatisfactory immigration status” (UIS). UISis a federal term referring to immigrants with specific statuses that make them ineligible forfederally-funded Medicaid benefits. In California, approximately 2 million immigrants whoreceive Medi-Cal coverage using state funds have UIS and thus would be subject to the newpremiums. While undocumented enrollees make up the majority of this group, there are alsolawfully present immigrants who are included. For example, lawful permanent resident adultswho have held “green cards” for less than five years areineligible for federal Medicaid benefitsunless they are pregnant, but they have been eligible for state-funded Medi-Cal benefitsfordecades.1 The income limit for Medi-Cal eligibility for single adults is less than $1,800 per month; manypeople at this income level in this high-cost state would not be able to pay $100 monthlypremiums. A two-parent family of four with income at the poverty level (less than $2,700per month) would pay $200 a month in combined premiums for both parents, which is 7.5%of their income. For families living on very tight budgets, these premium costs could meanforgoing the equivalent of almost an entireweek’s worth of minimal groceries every month. Federal Medicaid policy generally prohibits premiumsfor enrollees earning less than 1.5 timesthe federal poverty level. In Covered California, enrollees in the lowest income range currentlypay no premiums for a benchmark plan. While federal Medicaid and Marketplace policies donot apply to this state-funded program, they are helpful indicators of minimum standardsfor premium affordability for low-income populations. In states that have received federalwaivers to charge Medicaid enrollees premiums, research has found that thesepremiums areassociated with coverage loss, reduced access to care, and negative health outcomes. In addition to introducing premiums, the budget proposal also seeks to freeze new Medi-Calenrollment for undocumented adults ages 19 and up, beginning in 2026. The combinationof these two policies means that if enrollees cannot afford to pay their premiums, they willlose their Medi-Cal coverage and be unable to re-enroll. These provisions would spur a majorerosion of the program that would leave hundreds of thousands of Californians, and potentiallyover 1 million over the longer-term, without access to health care. Projected Enrollment Impacts a 20% reduction in enrollment due to thepremiums imposed, though other statesthat have implemented or increasedpremiums for Medicaid enrollees haveseen evengreater disenrollment rates.Over the long term, these two policies incombination could result in over 1 millionfewer immigrants, including some lawfullypresent immigrants, enrolled in Medi-Cal. According toDepartment of Health CareServices testimony, the enrollment freezealone is projected to result in