Health Coverage for California’s Immigrant Communities

Health Coverage for California’s Immigrant Communities


California has become an extraordinarily diverse state attracting immigrants from around the world working in and contributing to the success of the state’s technology, agricultural, entertainment, international trade and tourist industries.[1] Immigration in all forms is critical to many aspects of the California economy from high tech to agriculture. At the federal level, immigration is a political hot potato with enhanced efforts to deport immigrants, restrict entry of new immigrants and curtail use of existing immigration categories.[2] Undocumented workers are 6% of California residents working in low wage jobs and living in the shadows; their numbers have been in steady decline since the Great Recession of 2008.[3] Prior to the ACA, undocumented workers were about 20% of California’s uninsured. Due to successful enrollment of California citizens and legal permanent residents in the ACA’s coverage expansions, they comprise well over 50% of the remaining uninsured in our state.[4]

California covers citizens, legal permanent residents and others with legal residency status for full scope services in both Medi-Cal and Covered California.[5] Pursuant to a provision in the 1986 Omnibus Budget Reconciliation Act signed by then President Ronald Reagan, California covers the undocumented workers and their children for emergencies, prenatal care and deliveries.[6] The undocumented are excluded from purchasing Covered California coverage even with no subsidy or premium assistance. California would like to change that, going so far as submitting then withdrawing a §1332 waiver request to allow a parallel purchasing pool with no premium assistance for the undocumented.[7]

Little progress in extending coverage for low-income undocumented working families can be made without substantial premium assistance.[8] Most counties with public facilities include the undocumented workers in local programs like Healthy San Francisco or My Health LA (Healthy Way LA).[9] In large counties without public facilities undocumented workers are excluded from the county system. Limited access to care is available through local non-profit community clinics and local hospital’s charity care pools and obligations.[10]

For many years, local managed care organizations and local philanthropies led by The California Endowment supported county-based Healthy Kids programs that provided coverage for all children, regardless of immigration status.[11] After 15 years of unrelenting advocacy, the state of California now provides full scope MediCal coverage for an estimated 180,000 low income, undocumented, uninsured children.[12]

A promising approach for coverage of undocumented working adults may be through employment-based coverage since there are no public funds involved and no public exposure to the potential of deportation. As most undocumented live in the shadows and many work in agriculture, restaurants, janitorial and residential building; industry-wide efforts to provide coverage may have some potential.[13]

 Prepared by: Lucien Wulsin

Dated: April 24, 2018



[1] California Governor’s Budget Summary 2018-19

[2] Wulsin, Immigration Issues and the Alignments (Feb. 2018) at Wulsin, Immigration Issues, All the Moving Parts (Feb. 2018) at California has its own inglorious past of immigration restriction on Asian and Mexican-American communities. For example, Proposition 187 at of 1994 and Asian exclusion policies

[3] Public Policy Institute of California, Undocumented Immigrants in California (March 2017) at

[4] Lucia, California’s Remaining Uninsured, Preliminary CalSim v 2.0 Regional Remaining Uninsured (2016) at  

[5] Covered California Eligibility and Immigration at California Department of Health Care Services, Medi-Cal Eligibility, Frequently Asked Questions at  

[6] Ibid. PPIC, Undocumented Immigrants in California

[7] Covered California, §1332 Waiver at  

[8] As a predominantly low wage workforce, they cannot afford to purchase their own individual coverage. PPIC, Undocumented Immigrants in California

[9] Ibid. Rojas and Dietz, Providing Health Care to Undocumented Immigrants: a Three County Study (UC Berkeley Labor Center, 2016) at

[10] Health Access, County and Community Safety Nets at

[11] California Budget Project, Lasting Returns: Investing in Health Coverage for California’s Children (2005) at  

[12] SB 75 (Lara) at  

[13] Wulsin, Thoughts on Financing Care for the Undocumented (3/16/16) at

 Wulsin, Financing Care for Undocumented Adults (luciensblog, April 22, 2016) at Mason, California Health Care Proposal Unveiled at The Capitol Seeks to Build on Obamacare Gains (Los Angeles Times, Mar. 15, 2018)

County Health and the Vital Role of Federal Waivers in California

Financing Health Care Reform in California