- California is considering a proposal to allow anyone in the state to sign up for Medicaid, including undocumented adults.
- The plan would be the first of its kind in the country and would provide Medi-Cal coverage to undocumented adults over the age of 19. It is expected to cost about $3 billion in 2018-2019. The state would have to pick up all of the costs.
- The proposal is in the state Senate, which was introduced in February, and Democratic Gov. Jerry Brown hasn’t said whether he would support it. Brown did offer a plan to provide health coverage for all children regardless of immigration status in 2015.
California’s plan would reshape who is eligible for Medicaid. Currently, undocumented adults in the Golden State have restricted-scope Medi-Cal coverage. They are covered mostly for emergency and pregnancy-related treatment, but not other services.
The restricted-scope coverage reimburses hospitals for emergency room costs that may otherwise be uncompensated and provides prenatal care, which can reduce complications and costs later in the pregnancy or after the birth. The new plan would expand to offer complete Medi-Cal coverage to all adults. This move would further reduce uncompensated care for hospitals and providers, but it would also come with a hefty price tag.
California’s plan runs counter to other recent moves concerning Medicaid. States, especially the three dozen that expanded Medicaid under the Affordable Care Act, are struggling with costs and looking for ways to slow growth. Four states have received Medicaid waivers for work requirementsto nudge people off the program and back into the workforce. These moves are also seen as a catalyst to save millions from Medicaid, but can threaten access to care.
California’s plan, on the other hand, would add billions of costs annually and may even exacerbate expected provider shortages. A recent report from the Healthforce Center at University of California, San Franciscopredicted that California won’t have enough primary care physicians by 2030.
This isn’t the only high-cost healthcare plan being discussed in California. The California Senate Committee on Appropriations said SB 562, The Healthy California Act, which would create a single-payer healthcare system in the state, would cost $400 billion. The state would need to raise half that amount via tax increases.
These proposals will test how far a blue state like California is willing to go to expand coverage while also pushing back against the White House. The Trump administration opposes expanding public health insurance options and is also outspoken against pro-immigration policies, such as sanctuary cities.
