By Richard Hernandez
Even as millions of California residents with full U.S. citizenship are unable to access healthcare, the State of California next spring will extend Medi-Cal health coverage to some 235,000 low-income undocumented immigrants over the age of 50 – offering the most expansive health coverage in the nation to people without legal residency.
Medi-Cal is California’s medical assistance program serving the handicapped, low-income woman, children as well as state residents 65 years of age or older. It is generally not available for able-bodied men under the age of 65.
The State of California already offered Medi-Cal healthcare to immigrant children and young adults under the age of 26. This latest expansion, once it receives final approval, will mean undocumented immigrants other than those between the ages of 26 to 50 will be eligible to receive healthcare, the expense of which is to be defrayed by California’s taxpayers.
On June 25, 2021, California Governor Gavin Newsom, as part of the state’s $262.6 billion 2021-2022 budget, finalized a pact with leaders of both the California Assembly and State Senate which is to extend Medi-Cal coverage to undocumented immigrants who have eclipsed the age of 50. On Monday, June 28, both houses of California’s legislature approved the budget. The Medi-Cal expansion was included in the health care omnibus bill tacked onto the budget and approved yesterday.
In practical terms, legislative analysts predict the change will provide Medi-Cal health care coverage to an estimated 230,000 to 240,000 low-income undocumented immigrants over the age of 50 at a cost of $1.3 billion. It was not spelled out how legislative staff was able to make an estimate of the number of the undocumented population in California over the age of 50. California law prevents the tabulation of statistics on undocumented aliens, which includes their point of origin, age and gender. Federal immigration authorities are subject to no such restriction, but those statistics are not systematically or methodically compiled in any meaningfully comprehensive way in California because state law does not allow state or local authorities to cooperate with federal immigration officials. Nor is it clear how claimants of the benefits will establish their age to be eligible for the benefits, and what protocol Medi-Cal will use in ascertaining the actual eligibility of those applying under the new regulations.
A move has been afoot at least since 2014 to extend Medi-Cal benefits to illegal aliens, championed by then-Assemblyman Ricardo Lara. Lara’s original proposed legislation failed to gain passage, but in 2016 legislation was passed and signed into law that extended Medi-Cal coverage to children without legal residency status. Last year, on January 1, 2020, based on Senate Bill 104 passed into law in 2019, Medi-Cal was extended to cover low-income illegal aliens aged 19 to 25.
Governor Gavin Newsom has justified the extension of health care to non-citizens as part of a larger effort to integrate the estimated 2.3 million illegal aliens residing in California into society.
The 2.3 million number roughly reflects the estimated 2.5 million U.S.-born Californians who also are not fully integrated into society, whose inability to pay for health care leaves them without doctors, dentists and access to medicine, therapy and treatment. Under both U.S. law and California law, their inability to afford health insurance renders them non-compliant with statutes mandating that they secure, at their own expense and without assistance from the government, medical coverage. Failure to secure medical coverage for oneself or any minor children under one’s care or guardianship, under California law and U.S. law is a crime.
The federal law relating to failure to maintain health insurance falls under the U.S. Tax Code. The federal tax penalty for not being enrolled in health insurance is $695 for adults and $347.50 for children or 2 percent of the individual taxpayer’s or breadwinner’s yearly income, whichever amount is more. Under California state law, the failure to secure minimal coverage entails penalties of $695 for each adult in a household and $347.50 per child or 2.5 percent of the household’s annual income, whichever is the higher amount of the two.
Both federal law and state law have driven hundreds of thousands of Californians underground. In some cases, California residents who are U.S. citizens have gone to extraordinary means to make fraudulent representation of having medical coverage for themselves or their families that they do not possess. This, in most cases, entails the commission of several felonies.
The adjustments to California’s 2021-2022 budget to provide the $1.3 billion in funding that will be applied beginning in May 2022 to provide Medi-Cal overage to illegal aliens over the age of 50 were championed by California Senator Maria Elena Durazo, D-Los Angeles, and Assemblyman Joaquin Arambula, D-Fresno.
“Health care is a human right. All Californians should have the right to healthcare, regardless of immigration status,” Arambula, a former emergency room doctor said. “I am proud that in California we are tearing down barriers for our immigrant families, not building them.”
The expansion of Medi-Cal coverage to illegal aliens over the age of 50 comes while Lara is now serving as California’s health insurance commissioner.
An effort was made, in light of the anticipated provision of Medi-Cal to illegal aliens over the age of 50, to see if Lara believes that California residents who are taxpaying American citizens who cannot afford health insurance should still be subject to the $695 per adult or $357.50 per child state penalties. Lara was also asked if he at this point supports making Medi-Cal available to U.S. citizens who are residents of California between the ages of 19 and 25 and the ages of 50 and 64 who cannot afford to purchase medical insurance. Lara was asked if he considered fining or financially penalizing those who cannot afford medical insurance to be a sound social policy. Lara was asked if he in fact was opposed to making Medi-Cal available to U.S. citizens who are residents of California between the ages of 19 and 25 and the ages of 50 and 64 who cannot afford to purchase medical insurance, would he support converting the fines or financial penalties levied upon the households where medical insurance has not been secured into credit toward those households purchasing medical insurance.
Lara did not respond.
By Richard Hernandez