By Richard Hernandez
Less than a year after Governor Gavin Newsom and the two-thirds Democrat California Legislature provided free health care to low-income immigrants including those in the United States illegally, California is now confronted with a $6.2 billion shortfall in the fund for Medi-Cal services.
Medi-Cal is California’s Medicaid health care program, which pays for a variety of medical services for children and adults with limited income and resources. A joint federal and state program, Medicaid provides health insurance for adults and children with limited income and resources. Each state runs its own version of Medicaid as a program available to citizens of that particular state eligible for the service. While originally intended for and administered to provide health care insurance to California’s lowest income individuals and families, Medi-Cal’s eligibility requirements and benefits have been modified and liberalized over the years to become more and more inclusive. At present, approaching 15 million of the state’s nearly 40 million residents are recipients of some form of Medi-Cal assistance, including roughly 2.4 million noncitizens, the vast majority of whom are illegal aliens from Mexico.
As a consequence, Governor Newsom, whose final term as governor is to conclude in January 2027, and the members of his party who dominate both California’s lower legislative house, the Assembly, and the California Senate are scrambling to find some graceful and face-saving way to acknowledge that the state’s minority Republicans were correct last year when they argued that allowing able-bodied undocumented foreigners residing in California between the ages of 27 and 64 inclusive to participate in the Medi-Cal System would stretch it unto breaking. Now, those same Democrat politicians are trying to find a way to perhaps remove those most recently welcomed into the program – those being low-income adults living in California regardless of their immigration status – in the aftermath of that portion of the state’s population growing accustomed to receiving a heretofore unavailable benefit that is now perceived by those recipients as an entitlement.
Exacerbating the situation for California’s Democrats is a current reality that was not anticipated by Newsom and the lawmakers in Sacramento when they took action to expand Medi-Cal coverage last year: Donald Trump’s reclaiming of the White House and the Republican majorities in the U.S. House of Representatives and the U.S. Senate. The Republican-led Congress appears poised to adopt a plan to slash the allotment of money to the Medicaid program by billions of dollars, action President Trump is advocating in his quest to efficientize governmental operations and draw down the federal budget and national debt.
Republicans in Congress are in the midst of preparation to reduce by a substantial percentage the $880 billion in federal money going into the Medicaid program. While that reduction is not intentionally vectored toward California, the reality is that Medicaid covers roughly 80 percent of the individual states’ medical programs. Gone, most likely, will be the open-ended funding for state programs such as Medi-Cal that the Democrats indulged in. What is just around the corner, legislative prognosticators say, are sharply reduced and fixed medical aid subsidizations from Washington, D.C. to the state capitals, including Sacramento, which sucks in more Medicaid dollars than any other state in the union. Thus, in California, where as many as one third of the state’s $39 million residents receive Medical funding of some sort, a reckoning is coming.
To be absolutely fair and accurate, it is not California providing medical coverage to non-residents alone that is going to break the bank. Still, it is a major factor.
The declension was a long time in coming.
For decades, California has provided medical care to pregnant women, including those who were in the country illegally.
In 2015, California extended health care benefits to low-income children without legal status.
In 2019, illegal immigrants over the age of 65 became eligible for Medi-Cal coverage.
In 2022, California extended health care benefits to low-income adults over the age of 50 without regard to their legal status as registered residents, citizens or non-citizens.
In 2024, California extended health care benefits to low-income adults between the ages of 18 and 26, with or without legal residency status.
A problematic consideration is that throughout the United States there is not a fix on exactly how many undocumented foreigners there are. In California, that inexactitude is every bit as, if not more, pronounced than elsewhere. In 2023, the number of unauthorized immigrants in California was estimated at 2.3 million. There are reports that at present that number could be as high as 3.1 million.
Upon simply showing up at a facility providing medical care to the indigent, anyone claiming to not have sufficient funds to pay for medical coverage can tap into the Medi-Cal wellspring.
It turns out now that the cost of last year’s expansion of Medi-Cal eligibility to cover all low-income adults is at least $2.7 billion more than the state budgeted as a consequence of the underestimation of the number of people who would sign up for services. When projecting that monetary allowance, California officials used a one-month survey to arrive at that number.
State bureaucrats, under pressure by embarrassed Democrat officeholders, have refused to disclose how many people have enrolled through the expansion. Last year, the state projected something on the order of 700,000 state residents who are living in the U.S. illegally would gain full health/preventative care treatment coverage which they were not previously eligible for.
There have been other unanticipated escalations in the cost of providing medical care since last year, including inflation in the price of pharmaceuticals.
There has been some loose talk around Sacramento with regard to rescinding some of the benefits most recently extended to illegal immigrants. That has not yet been done, and Democrats do not want to contemplate doing that any time prior to the November 2026 election, when California is to select a new governor.
Indeed, Governor Gavin Newsom has given indication that his administration and therefore all Democratic members of the legislature and state residents should consider medical coverage for illegal immigrants to be an entitlement in California. Instead of rescinding the benefits, Newsom last week informed the legislature that he had used his gubernatorial spending authority to borrow $3.44 billion from the state’s general fund, the maximum intragovernmental loan allowed under California law, in order to shore up the Medi-Cal fund.
Earlier this month, the Department of Health Care Services requested another $2.8 billion to cover Medi-Cal operations until the end of the 2024-25 fiscal year on June 30. The Department of Health Care Services is responsible for managing Medi-Cal.
A joint committee of the California Senate and Assembly must sign off on Medi-Cal budget numbers beyond that date in April, prior to the setting of California’s @025-26 budget.
California made major commitment to provide COVID-related medical care during the pandemic. Newsom’s administration wants to end those programs but has not done so. There is no data available as to how much savings the state would reap from such an economy.
Newsom finds himself in the very uncomfortable position after having emerged as one of Donald Trump’s most vocal critics by now needing to go hat-in-hand to the Trump Administration to ask it to extend the Golden State special budget subsidization so it can continue to offer individuals in California who are defying federal immigration law by not complying with federal documentation requirements after encouraging the state’s more than 400 cities to sanctuaries refuse to cooperate with the efforts by the federal government to crack down on illegal immigration.
Newsom publicly stated this week, and was backed by Assembly Speaker Robert Rivas and Senate President Pro Tempore Mike McGuire, that the state government is not contemplating making any reductions to Medi-Cal coverage and they were committed to safeguarding medical benefits for illegal immigrsnts.
That attitude did not sit well with the state’s leading Republican officeholders
“Californians should not be forced to shoulder the burden of radical Democrats’ reckless financial mismanagement,” State Senator Brian Jones posted on Tuesday.
Newsom countered that denying illegal immigrants medical care is pennywise but pound foolish, in that diseases unchecked in any portion of the state population is a threat to all.
Newsom indicated he is confident the state’s taxpayers will come through with the $6.2 billion needed to plug the state’s budget gap. California has a projected upcoming budget of $322 billion.
Republicans said the Democrats are being far to blasé about Calfornia’s eroding financial position and that the Republican Congress and Senate in Washington, D.C. will not bail California out after it squanders its own money on providing medical care for individuals who are not American citizens.
They say that Governor Newsom and the state’s Democratic lawmakers need to reassess whether they should be extending coverage to immigrants who are not paying taxes if that generosity is going to result in state residents who are native born or naturalized citizens who play by the rules seeing their medical benefits being severely reduced or eliminated altogether.