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By IHPL - September 15, 2025

During the past decade, lawmakers in California had made a series of step-wise changes to expand undocumented immigrants’ eligibility for Medi-Cal, the state’s health insurance program for the low-income population, in order to improve healthcare access for this vulnerable population and to narrow the gap in the number of uninsured in the state. First, they expanded eligibility for full scope Medi-Cal to all low-income children regardless of immigration status starting in 2016.1 Then in 2020, the eligibility was further expanded to include undocumented low-income young adults ages 19-25. Beginning in May 2022, all income-eligible adults over the age of 50 became eligible to apply for Medi-Cal regardless of immigration status.1,2 Finally, the last phase of the expansion took effect on January 1, 2024, with income-eligible adults ages 26-49 becoming eligible regardless of immigration status.2

As a result of these expansions, nearly 1.7 million undocumented immigrants are currently enrolled in Medi-Cal, an important source of healthcare coverage for individuals who have historically lacked health insurance access.3-5 Nationwide, California is one of six states that provide healthcare coverage to immigrant adults regardless of legal status.3

Faced with a $12 billion budget deficit, however, Governor Newsom and California lawmakers decided to roll back some of the Medi-Cal coverage offered to undocumented immigrants through the Budget Act of 2025 (S.B. 101 and A.B. 102) and the Health Omnibus Trailer Bill (AB 116) which were chaptered on June 27, 2025 and June 30, 2025, respectively.4-8 New policy under these budget bills for fiscal year 2025-26 freezes full-scope Medi-Cal enrollment for new undocumented applicants aged 19 and older starting in January 2026.5-8 Existing enrollees as well as those in limited-scope plans can retain their coverage, and any new undocumented children ages 18 and under may still continue to enroll in Medi-Cal.5-8

In addition, the budget bills set several new policies for those with “unsatisfactory immigration status” (UIS), a population category that includes both undocumented individuals and certain lawfully present immigrants who are ineligible for federally funded Medicaid such as those with asylum status.5 For example, all UIS adults ages 19 to 59 that are enrolled in Medi-Cal will have to pay a $30 monthly premium starting in July 2027.5-8 The new policy also removes coverage for certain benefits, such as dental benefits, for UIS adults on Medi-Cal starting in July 2026.5-8 Furthermore, it eliminates payments to Federally Qualified Health Centers and Rural Health Clinics for services to the UIS population, leaving these entities to either stop caring for these patients or fully shoulder the cost of their care.5-8

The fear of Immigration and Customs Enforcement (ICE) raids and deportations coupled with these new policies that limit Medi-Cal coverage will impose significant barriers to care for these patients. With California, which usually stands at the forefront of progressive policies, rolling back coverage for these patients, it remains to be seen what other states that currently provide healthcare coverage to immigrant adults regardless of legal status will do moving forward. As these immigrants are part of our society and our wellbeing is interconnected in this global era, it behooves the healthcare community to find ways to continue to care for these patients with empathy and compassion despite these obstacles so that we can improve health for all.

Author Bio: 

Wonha Kim, MD, MPH, CPH, FAAP

Dr. Kim is the Director of the Institute for Health Policy and Leadership. She is also an Assistant Professor of Pediatrics and of Preventive Medicine at the School of Medicine and an Assistant Professor for the School of Public Health. Her research interests include pediatric obesity, social determinants of health, global health and policy approaches to addressing health issues faced by vulnerable populations.

Reference:

  1. 1. Dietz, M., Lucia, L., Kadiyala, S., Challenor, T., Rak, A., Roby, D., and Kominski, G. (2022). California’s biggest coverage expansion since the ACA: Extending Medi-Cal to all low-income adults. https://escholarship.org/uc/item/0897m53s
  2. https://calmatters.org/health/2025/03/medi-cal-budget-shortfall/
  3. https://calmatters.org/health/2023/12/undocumented-health-insurance-new-california-laws-2024/
  4. https://calmatters.org/politics/2025/05/california-budget-revision-may-2025/
  5. https://src.senate.ca.gov/sites/src.senate.ca.gov/files/2025-26%20Budget%20Act%20Highlights%20and%20Analysis.pdf
  6. https://legiscan.com/CA/bill/SB101/2025
  7. https://legiscan.com/CA/text/AB102/id/3043983
  8. https://legiscan.com/CA/bill/AB116/2025