‘Coverage and access’: Medi-Cal expansion to undocumented immigrants draws cautious praise

Access to basic healthcare is a fundamental right to Lisa Chamberlain, a pediatrics professor who directs Stanford Medicine’s Office for Child Health Equity, but one that many Californians struggle to realize. A new California initiative hopes to address this by expanding a state insurance program to include over 700,000 undocumented immigrants.

The state expanded Medi-Cal on Jan. 1 to offer comprehensive insurance coverage to undocumented immigrants who are 26 to 49 years of age. 

This expansion makes California, which has the largest population of undocumented immigrants in the country, the first state to offer health insurance to undocumented immigrants of all ages. Several hundred thousand undocumented adults are now eligible for full coverage, according to a press release from the office of State Senator María Elena Durazo

Stanford Medicine physicians and health policy experts delved into challenges tied to the new expansion, but celebrated its potential to improve healthcare access for vulnerable immigrant populations statewide. 

Medi-Cal, California’s federal Medicaid insurance program, provides healthcare service coverage to low-income children and adults. In 2016, California extended full-scope Medi-Cal eligibility to undocumented children younger than age 19, then included young adults ages 19-25 in 2020 and adults over age 50 in 2022. 

Chamberlain stressed that the most recent expansion was integral, especially since it provides insurance to young working parents in the 25 to 49-year old age group among undocumented immigrants. Beyond healthcare for the parents, she said it carried positive effects to children: Care for undocumented parents is an “investment” impacting “two generations.”

“If you have a parent with mental health challenges or a kidney problem, for example, that can certainly impact their child,” Chamberlain said.

Echoing Chamberlain, economist and assistant professor in health policy Adrienne Sabety said the expansion is in line with state- and nationwide movements toward covering more undocumented immigrants with health insurance. Studies have projected that Medi-Cal’s expansion will decrease California’s uninsured population to a record low of 2.57 million people under age 65. 

However, Sabety said that there is a chance that the new Medi-Cal expansion might not change much — Medi-Cal already covers most eligible undocumented immigrants, including emergency and pregnancy-related services for everyone.

Furthermore, coverage is only one element to care. Language barriers and a lack of knowledge of the American healthcare system continue to prevent undocumented immigrants from accessing health services, according to a policy brief from the U.S. Department of Health and Human Services. 

Additionally, undocumented individuals may worry that seeking healthcare would lead to immigration issues.

Foreign-born individuals, including undocumented immigrants, accounted for more than 60% of the United State’s labor force growth in 2023, according to the Bureau of Labor Statistics. However, lingering anti-immigration sentiments and fears of deportation further discourage individuals from accessing covered healthcare. 

Fernando Mendoza, pediatrics professor and associate dean of minority advising at Stanford Medicine, said that despite now being eligible for Medi-Cal coverage, undocumented parents continue to experience challenges related to their immigration statuses. 

“While health policies involving Medicaid expansion have been helpful, they still do not address the immigration status issue that causes chronic family stress and can lead to less than helpful health access behaviors among family members,” Mendoza wrote.

Previous studies conducted at Stanford Medicine have suggested that some healthcare access behaviors exhibited by undocumented parents, such as avoiding preventive care or only utilizing healthcare in extreme emergency situations, can persist intergenerationally, even in children eligible for public health insurance benefits. 

In light of the new Medi-Cal expansion, both Chamberlain and Sabety emphasized the importance of distinguishing between healthcare coverage and access. 

“Ultimately, we want 100% coverage and access,” Chamberlain said. She proposed a few solutions to enhance access, like providers speaking different languages to translate for patients, as well as providing transportation services to help patients arrive at their clinics.

Sabety’s recent research at Stanford focuses on improving vulnerable populations’ access to healthcare services. In a recent study, Sabety and her team randomly made initial primary care appointments for almost 2500 low-income undocumented immigrants in New York City at safety-net clinics.

The intervention increased patients’ continuous access to primary care and reduced emergency department visits compared to individuals who also qualified to see a physician but did not recieve pre-scheduled appointments. 

Chamberlain’s work at Stanford focuses on enhancing healthcare access for refugees crossing the U.S.-Mexico border. The vast majority of California’s immigrants are of Latin American descent, according to a report by the Center for Immigrant Studies. 

She directs Families at the Border, an organization of Stanford Medicine physicians and affiliates working in partnership with community-based health service clinics in Tijuana. The group provides on-the-ground medical training and education, including emergency birth midwife training. Chamberlain also helps coordinate the Specialty Care Access Network (SCAN), a program that connects newly-arrived refugee children with complex medical problems such as cancer and heart disease to a network of pediatricians across the country. 

Speaking from personal experience, Chamberlain shared how healthcare materially impacted patients lives. For instance, she said she previously worked with some high-achieving high school patients who were undocumented. She struggled to provide them with eyeglasses, before they became eligible for Medi-Cal coverage. 

“These patients are a fabulous hope for our future,” Chamberlain said. “They could be bilingual and bicultural doctors standing next to me that would be fluent in Spanish, [and] would be generating more access for my patients than I [could] alone.”

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