It’s that time of year where families, educators, and school administrators get back to familiar routines. Families are preparing their children for the first day of school with the right tools, like pencils, notebooks, and even health insurance coverage. Yet there is one thing about this school year that is different from years past—for the very first time, many families have access to quality, affordable health coverage for their children. That’s right! All low-income children in California, regardless of their immigration status, can apply for full-scope Medi-Cal and get needed care—giving them one more tool to stay healthy and be better prepared to learn. Those who qualify will get coverage for free or at very low cost, and they can stay covered up to the age of 19, giving them the opportunity to access comprehensive health services at no cost. Learn more about Health4All Kids.
This back-to-school season provides a great opportunity to make sure families enroll their kids in coverage since parents and guardians are most engaged this time of year. With just over 6.2 million students in public schools, educators and leaders will be interacting with many parents and guardians in the coming weeks. Parents will visit new classrooms and introduce themselves to new teachers. When they walk through the door this year, let’s make sure to tell them about Health4All Kids.
With the Health4All Kids expansion of Medi-Cal, up to 225,000 children will be newly eligible for comprehensive health coverage, including access to preventive care and other critical health services. Students will be able to see a doctor regularly, get routine checkups at the dentist, and get the care they need when they start to feel under the weather. Healthy students make better learners and, with this new opportunity for coverage, more students have the chance to lead healthier lives.
Educators know that healthy students make better learners. Help us publicize this new opportunity by distributing health coverage materials from the ALL IN For Health Back to School Toolkit. It includes easy-to-use materials to share with families, as well as tools to help spread the word, like robocall scripts and sample text for parent newsletters. Together, we can make sure ALL KIDS are ALL IN for health coverage!
Despite this June’s disappointing inaction by the Supreme Court on the Obama Administration’s executive actions on immigration, California continues its leadership as a welcoming environment for immigrant families, especially immigrant children. The Supreme Court’s split ruling has no impact on the historic Health4All Kids Medi-Cal expansion that went into effect this May, meaning that all low-income children can apply for Medi-Cal, regardless of where they were born. Californians who qualify for the original Deferred Action for Childhood Arrivals (DACA) program are also still able to enroll in Medi-Cal.
Thus far, there is cause for celebration. Since earlier this summer, over 135,000 immigrant children have enrolled in full-scope, comprehensive Medi-Cal benefits, giving peace of mind to thousands of families that their children are protected.
However, while we have made important progress, there is more work to do. A recent report from the UC Berkeley Labor Center estimates that there are 225,000 undocumented immigrant children eligible for Medi-Cal, meaning 90,000 eligible undocumented children have yet to be enrolled in coverage in addition to the hundreds of thousands of other eligible but unenrolled children. Though we continue to wait on federal action on immigration, our work in California does not. We are proud to join partners from across the state in reaching out and helping every eligible child to enroll in affordable health coverage. Read our recent blog posted on the California Health Care Foundation website, written in partnership with Clinica Romero, to learn more.
We Can’t Let the Supreme Court’s Latest Ruling on Immigration Hurt Medi-Cal Expansion
Mayra E. Alvarez, President, The Children’s Partnership,
Sandra B. Rossato, Executive Director, Clínica Monseñor Oscar A. Romero
The movement to improve the lives of immigrant families hit a roadblock in June when a deadlocked US Supreme Court prevented, for now, expansion of the Deferred Action for Childhood Arrivals (DACA) program and implementation of the new Deferred Action for Parents of Americans and Legal Permanent Residents (DAPA) program. These programs were designed to protect millions of undocumented children and parents across the country from deportation. This disappointing decision leaves families in fear, with uncertain futures, and further from fulfilling the American promise of life, liberty, and the pursuit of happiness.
California continues to pursue state-level efforts to create an inclusive environment for all aspiring Americans. The expansion of full-scope Medi-Cal to all low-income, undocumented children that took effect in May is another example of California’s clear commitment to inclusivity, which is even more important in the face of this ruling and the lack of movement in Congress on immigration reform.
As we seek to ensure every California child has coverage, it is imperative that the high court’s ruling does not adversely impact enrollment made possible by the state’s historic policy. The Medi-Cal expansion has the potential to help more than 185,000 children statewide, yet there remain multiple barriers to enrollment. Now more than ever, undocumented families may fear providing information to government officials and, as a result, refrain from seeking critical health coverage for their children. More information is needed at the community level to assuage families’ fears and drive home the importance of enrolling their kids.
Advocacy organizations like The Children’s Partnership, community health centers like Clínica Monseñor Oscar A. Romero in Los Angeles, the California Department of Health Care Services (DHCS), county eligibility workers, and a variety of state and local partners are working tirelessly to ensure newly eligible children are signed up. In the coming months, it’s essential that that we clearly explain to immigrant families that:
- The Supreme Court ruling has no impact on the Medi-Cal expansion. All income-eligible children, regardless of immigration status, now have access to full-scope Medi-Cal. Health application information is used only to verify eligibility for health programs and not for immigration enforcement.
- The ruling has no impact on people deemed eligible for the original DACA program, which is still accepting applications and renewals. This has important implications for health coverage of undocumented families. All those accepted into the original DACA program are also eligible for Medi-Cal. An estimated 11,000 Californians (PDF) who qualified for the original DACA program are now covered by full-scope Medi-Cal.
The good news is that the Medi-Cal expansion is off to a strong start. DHCS reports that so far more than 125,000 kids have successfully enrolled in full-scope Medi-Cal since the expansion went into effect in May 2016. Community health centers continue to play a vital role in helping children enroll and providing them with the care they need. Clínica Romero has already seen a huge difference, with newly enrolled kids coming in for long-delayed care, including dental, vision, and mental health services.
Much work remains, as thousands of eligible kids are still not enrolled. For organizations on the front lines of outreach and enrollment, tools and resources related to the expansion of Medi-Cal are available at the Health4AllKids website. For example, the California Welfare Directors Association recently released a list of designated county staff (PDF) with whom partners can work to assist immigrants and mixed-status families (those in which some members are legally present and others are undocumented) having trouble with the Medi-Cal application.
The fight also continues to build a more just and inclusive, and therefore healthier, society. An estimated 1.1 million Californians (PDF) could have gained health coverage through Medi-Cal and Covered California with the expanded DACA and DAPA programs. Parents living under the threat of deportation are less likely to get the health services they need and frequently are too scared to enroll their children in vital public programs. Children in constant fear that a parent or loved one will be deported are more likely to suffer depression and anxiety (PDF), which can have a tangible effect on brain development, performance in school, and long-term life outcomes. As advocates and health care providers in the community, we see this reality every day.
California has led the way with policies for expanding Medi-Cal, providing in-state tuition and state educational grants to undocumented students, and allowing undocumented immigrants to apply for driver licenses. Immigrants are part of the fabric of society, and we must keep pushing the envelope. The immigrant community’s health, well-being, and ability to realize its full potential are directly linked to the future success of our state and nation.
The American story is inherently one of immigrants. Like so many in our country, my parents came to the United States from Mexico some 40 years ago in search of a better future for their children. Today, my three sisters and I are leading lives our parents once dreamed of—with a career dedicated to making a difference, in a home that is your own, or a schedule that you are able to set for yourself. For many, these are simple things, but to many immigrants, they are what make America special.
Whether your family came to America decades ago or months ago, faith in the American Dream remains the same, and immigrants continue to come to this country to find a better life for their family and make the country a stronger place. This is particularly true in California, home to more than 10 million immigrants and where half of children have at least one immigrant parent. During this past month, The Children’s Partnership proudly joined the #IAmAnImmigrant movement sweeping the nation for Immigrant Heritage Month, reminding us that America’s strength is reflected in our diversity built over generations.
Immigrants are part of the fabric of our society and their well-being is directly linked to our country’s well-being today and in the future. While many policies increasingly reflect that value, others continue to not. We were deeply disappointed by the recent Supreme Court deadlock that effectively blocked the Obama Administration’s executive actions to expand the Deferred Action for Childhood Arrivals (DACA) program to more DREAMers and implement the Deferred Action for Parents of Americans and Legal Permanent Residents (DAPA) program. The impasse continues a broken immigration system that harms the healthy development of immigrant and citizen children alike. In California, thousands were denied the peace of mind such policies offered and the security of health coverage that could have followed.
While we continue to fight for all families that call this country home, in California, we continue our path of immigrant integration by making important strides for the health and well-being of immigrant families. As of May 16, 2016, low-income undocumented children can enroll in full-scope Medi-Cal (California’s Medicaid program), opening the door to free preventive services and other critical services. With access to the care they need to be healthy, children are on a trajectory to be better prepared for school and life. More recently, Governor Jerry Brown signed legislation authorizing the State to request a waiver from the federal government to allow undocumented immigrants to purchase unsubsidized insurance through Covered California, the state’s health insurance marketplace. While the decision will ultimately rest with the federal government, the “Health4All” movement in California continues on to ensure all members of the family have affordable, comprehensive health coverage.
Creating an equitable health care system that works for everyone, no matter where they were born, will require more than just securing coverage. Helping newly insured families navigate a health care system that may be new to them and creating a culturally appropriate system of care that meets the needs of California’s uniquely diverse residents will help ensure the health of not just immigrant families but all families as well. Here are some ways that can be accomplished:
- Tailor outreach materials to better meet the needs of California’s diverse families.As we help families understand their coverage and care, we need to make sure they understand the information shared and that resources created and disseminated by the State, health care entities, and community organizations are personalized to different cultures and are in appropriate languages. Time-intensive, targeted, culturally competent, innovative outreach strategies have proven effective in enrollment assistance. Similarly, we can apply these strategies to help families understand the health care system and get the care they need. Linguistically and culturally targeted materials can supplement work to reach families through trusted messengers, including schools, small businesses, religious organizations, and other non-health channels.
- Create a system of care that works for families’ needs. While the traditional medical office works for many, there are other ways communities can work to better meet the needs of families. Families often face financial, transportation, and language barriers when seeking traditional, office-based care. Local health centers, schools, and community centers may be more appropriate for some. By supporting efforts to bring health care to the community, we can create mechanisms to better deliver health care to all families. For example, school-based health centers have proven successful in providing critical health care services to children and making sure students who are unable to get health care elsewhere can receive it at school.
- Develop a workforce that families trust. In traditional medical settings, it is often a team of providers that offer community members a health home they trust. In addition to the doctor or dentist, there are others on the team that deliver health information and care and serve as trusted sources for such information and care. Given the number of newly insured, we have an opportunity to look at trained members of the community, such as community health workers and promotores, as well as public health nurses, home visitors, and appropriate school personnel that are responsive to families’ unique needs. Not only is it more effective in reaching the millions of newly insured families, but it is also a smart use of the tremendous resources we have to make up our health care workforce. The State should support community-based education, care coordination, and support models, not only because such models improve families’ health literacy and overall health outcomes, but also because such an investment is also an investment in preventive care, which leads to both healthier children and adults and is cost effective in the long run.
Good health is critical to a successful future for everyone. When immigrants come to this country, they come with the highest expectations of what America can do for their families and what they, in return, can do for America. For the millions of immigrants in California, the ability to contribute to this nation goes hand in hand with their health status. This Immigrant Heritage Month, we celebrate our diversity and renew our commitment to doing more to support the health and well-being of every member of our immigrant communities, for their sake and our own.
Co-authored by Sonya Schwartz, Georgetown CCF
The Supreme Court’s 4-4 vote in United States v. Texas leaves immigrant families and those who care about their future deeply saddened but ready to fight again for inclusion and fairness. With this split decision, our country is still prevented from moving forward with the Obama Administration’s 2014 actions to expand the Deferred Action for Childhood Arrivals (DACA) program to more DREAMers, and implement the new Deferred Action for Parents of Americans and Legal Permanent Residents (DAPA) program for the many parents that have long called this country home. Moreover, it is a major missed opportunity to improve the lives of families in communities across the country. From coast to coast, our family, friends, and neighbors will have to continue to wait for immigration relief, and, with it, the potential gains in health and well-being that would follow.
Technically, this split decision means that the Fifth Circuit’s decision upholding the preliminary injunction against the DAPA and expanded DACA initiative still stands. United States v. Texas will be sent back to the lower courts for consideration. There are still additional legal avenues potentially available to move forward action for our families. It is important to note that this case has no impact on the DACA program launched in 2012, which is still in effect and open for applications and renewals.
Children’s advocates nationally know the promise that immigration relief has in improving the health of children. Nationally, it is estimated that more than 3.7 million additional undocumented immigrants would have qualified for expanded DACA and DAPA. What’s more, 4.3 million children under age 18 live in a household with at least one potentially DAPA-eligible adult. Providing immigrant parents with relief from deportation holds huge potential for improving children’s health. By allowing more parents and family members to come out of the shadows, children in immigrant families, including mixed-status families—or those where some family members are legally present and others are undocumented—would be willing to enroll in public coverage options like Medicaid or CHIP. Though many of these children were already eligible for these coverage options, fears of deportation and immigration enforcement continue to prevent many parents from getting their children covered, particularly in this climate of continuing immigration enforcement actions.
In preventing implementation of expanded DACA and DAPA, the decision also stunted the potential for further health coverage gains, and these gains would have been greatest in California. California provides state-funded, full-scope Medi-Cal benefits to anyone with an eligibility determination known as Permanently Residing in the US Under Color of Law (PRUCOL), including DACA and would-be DAPA recipients. In California, approximately 1.5 million children live in families where a parent would have been eligible for DAPA, of whom 223,000 are eligible for Medi-Cal but uninsured. Already, an estimated 11,000 Californians who qualified for the original 2012 DACA program have enrolled in Medi-Cal (Note again that the 2012 DACA program is still in effect and open for applications and renewals). In total, as many as 1.1 million Californians could have gained coverage had there been access to the expanded DACA and DAPA programs. Without access to comprehensive health insurance for both parents and children alike, many of these children will remain uninsured as their families continue to live in the shadows.
Without this step forward in immigration reform, our national immigration policies continue to harm the healthy development of immigrant and citizen children alike. A growing body of evidence in recent years has shown that children in mixed-status families face unique health issues not faced by children in other families. For these children, adverse childhood experiences such as the constant threat of a parent or loved one being deported can have immense impacts on their development, including increased occurrences of depression and anxiety. As a result, there is a real and tangible impact on brain development, performance in school, and long-term life outcomes. Providing immigrant family members a path to legal status will have a major impact on many kids in immigrant communities.
In the absence of national action on immigration, states are moving forward to better serve their residents. In California, the state has expanded Medi-Cal coverage to undocumented immigrant children, with the potential to open doors to the security coverage provides to 185,000 kids in the state. Efforts are continuing to identify ways to secure health coverage for every member of the family. Additionally, those who are granted deferred action under the original DACA program will continue to benefit from state-funded Medi-Cal for PRUCOL. While we applaud the efforts of the handful of states around the country that have taken similar actions, the overwhelming majority of undocumented children and families in the nation will remain locked out of critical health coverage.
Along with the disappointment in today’s decision comes a renewed commitment to the fight for comprehensive immigration reform. Georgetown CCF and The Children’s Partnership, along with other partner organizations, continue to work alongside families to make sure everyone in this country, no matter where they were born, feel welcomed and supported as members of our shared community. Providing undocumented immigrant families in this country a path to citizenship is about even more than work authorizations or green cards. It is about creating peace of mind, building healthier communities, and investing in the future—for the sake of all our children and families.
Last week, California demonstrated how it continues to raise the bar for states’ efforts to support new Americans. On May 16, all income-eligible children, regardless of immigration status, were given the opportunity to enroll in full-scope Medi-Cal. In doing so, hundreds of thousands of children were provided new access to important health care services that they need to be healthy. With this coverage, parents have the peace of mind that their children are protected. Families know they can take their children to the doctor, dentist, or any other health care provider they may need to help ensure their well-being. There is hope that all children, no matter where they were born, can lead the healthiest lives possible and reach their full potential.
We at TCP are proud to have been a part of a diverse coalition of advocacy groups, community organizations, foundations, policymakers, providers, and families that banded together and never lost sight of the goal of coverage for all children. Our work together continues as we shift to spreading the word about Health4All Kids and doing all we can to make sure those who are eligible know how and where to enroll and what services are available to assist them. Here are some ways that’s already happening:
Last week, we celebrated the launch of Health4All Kids with the Health4All coalition at a press conference headlined by legislators, including Speaker Pro Tem Kevin de Leon, Senator Ricardo Lara, Senator Ed Hernandez, Assemblymember Jim Wood, and Assemblymember Tony Thurmond. Together, we celebrated the accomplishment of extending coverage to all children and renewed our commitment to making sure all members of every family can enroll by advocating the passage of SB 10 and SB 1418.Watch the speech and see photos here.
To commemorate the day, our leading ALL IN For Health partner, State Superintendent Tom Torlakson, sent a letter to all 2,000county and district superintendents in the state to encourage schools across California to spread the word about the new opportunity. Schools are trusted messengers for many communities and play a critical role in helping reach families with news about the Medi-Cal expansion. Schools can make calls to families using a script or send home a flyer, available in the ALL IN For Health toolkit.
The California Endowment partnered with Telemundo 52 for a special segment to educate Spanish-speaking communities about what the Medi-Cal expansion means for immigrant families. We were proud to be a part of the segment and invite you to share it with families you think would be interested in learning more. Watch the clip.
If you or someone you know needs more information about the Medi-Cal expansion, we encourage you to visit the Health4All Kids website (http://health4allkids.org/). The website serves as a central resource for information for families and community organizations looking to learn more about the new benefits. The site will continue to serve as a resource with recordings of informational webinars and a toolkit, as well as new tools and updates as they become available.
While we celebrate this important victory, we know our work is not over. In the next year, we will be partnering with community groups across the state to make sure implementation runs smoothly and all families know how to enroll. Once enrolled, it is our collective responsibility to make sure families can navigate the health care system that is newly available to their children. And while we make sure kids can get and use their new health care, we will continue to work to ensure that every Californian, including the parents of these newly eligible children, has access to coverage.
I am so proud to be in a state that takes care of all its children and is leading the way on welcoming our immigrant communities. Let’s continue on this path and make sure the opportunity for quality, affordable coverage is realized for all of our families.
Next month, California will take a critical step toward securing the health of the state’s children. On May 16, 2016, full-scope Medi-Cal will officially expand to all low-income children, regardless of immigration status. The countdown to coverage for undocumented children across California has begun!
Last year, California Governor Jerry Brown signed the state budget, which included new funding for Medi-Cal (SB 75), and expanded access to affordable, quality health care—including preventive care—for all lower-income children younger than 19 years old, regardless of immigration status. At the end of 2015, legislation was enacted (SB 4) to ensure that children already enrolled in restricted-scope Medi-Cal coverage would be transitioned to full-scope Medi-Cal without having to fill out an additional application. Under the expansion, at least 170,000 undocumented immigrant children will have the security health insurance provides.
Now, it’s time to make this expansion a reality and make sure families know about this opportunity. Here are a few resources and upcoming events that we hope you will share with your community.
1. Health4All Kids Website
A group of children, immigrant, and health advocates launched www.health4allkids.org, a brand new website that provides resources for families impacted by the upcoming Medi-Cal expansion to all low-income children, regardless of immigration status.Please share with your community and be sure to check back regularly for updates! An expanded toolkit for organizations will be coming soon.
2. Telemundo Health4All Kids Segment
Tune in to Telemundo to learn about the Medi-Cal expansion for undocumented children. Hosted by Edgardo Gazcón, this special segment will cover the basics of the Medi-Cal expansion and how to enroll. The program is sponsored by The California Endowment and will include interviews with The Children’s Partnership, National Immigration Law Center, and Eisner Pediatric & Family Medical Center. Check out the listings below to see when these shows are airing near you. If you miss one of the segments, you will be able to watch it after the airdate on the Telemundo Asegúrate site.
Acceso Total Special
- Telemundo 52 Los Angeles, Thursday, April 7, 10:00 a.m. and Thursday, April 21, 10:00 a.m.
- Telemundo 33 San Diego, Saturday, April 9, 5:30 p.m.
- Telemundo 51 Fresno, Saturday, April 9, 11:30 a.m.
Want to learn more? Join the Linea de Ayuda. Telemundo 52 viewers will be able to learn more about the Medi-Cal expansion for undocumented children. Edgardo Gazcón will share more on eligibility and urge viewers to call the California Health Plus Local Clinic Finder hotline (855-899-7587) for more information.
o Telemundo 52 Los Angeles, Thursday, April 14, 4:00 to 8:00 p.m.
3) Health4All Kids Webinar
On Wednesday, April 20, policy experts and fellow community organizations will host a webinar to help California community-based organizations, clinics, enrollment entities, and interested local leaders prepare for this historic expansion of Medi-Cal to undocumented children in California! This webinar will discuss the upcoming changes to children’s health coverage, delve into implementation challenges, and share strategies for community groups to better reach eligible families and their children so they are enrolled in full-scope Medi-Cal as soon as possible. California policy, legal, and health enrollment experts will be on hand to answer questions and describe the information and resources available in the soon-to-be-launched Health4All Kids online toolkit on www.health4allkids.org.
Be sure to stay tuned for more activities and resources leading up to the full-scope Medi-Cal expansion for children. As always, please reach out if you are interested in partnering with us on activities to help make sure all children can get affordable, quality coverage and care. Thank you for your partnership!
For decades, community organizations, policymakers, and advocates have worked together to make sure every member of the family could experience the benefits and security that health coverage provides. Families have bravely made their voices heard to make sure their kids could lead healthy and happy lives and the state of California is listening. Last year, the first victory in the journey toward health for all was achieved—all children, regardless of immigration status, will soon get free or low-cost health coverage through Medi-Cal. If a child under the age of 19 meets income guidelines, he or she will qualify for Medi-Cal. As we celebrate this milestone, we must continue our work to educate families, build awareness, and make sure every family takes advantage of this important opportunity.
Although the expansion of benefits to all children is expected later this year, families can act now to make sure that their kids get the comprehensive health coverage they need as soon as possible! Families can begin enrolling their children in restricted Medi-Cal (also known as emergency Medi-Cal) TODAY. Then, once the expansion is in place, those children enrolled in restricted Medi-Cal will be automatically enrolled into full-scope Medi-Cal. Families can apply without fear and know that their immigration status information is kept private. To enroll, immigrant families should visit www.localclinic.netto identify a local clinic to apply at or visit their local county human services office.
The expansion of Medi-Cal will help thousands of California children, but many families have questions and concerns about applying. The ALL IN For Health Campaign—the TCP-led effort to equip the education community with tools to help families connect to health coverage and care—has created a new flyer for schools to distribute to families. The flyer includes the most important facts about the expansion of Medi-Cal to undocumented children and how to get enrolled today. With our school and early learning partners, we can reach many of California’s more than 9 million children, including this newly eligible population, encourage families to enroll in restricted Medi-Cal now, and connect them to enrollment assistance. We also plan to continue learning about how we can better reach families with this information. We want to do all we can to work with trusted community centers, such as churches, clinics, small businesses, and more to help get the word out that it’s safe to apply.
Getting more kids enrolled in health coverage is key to children getting the care they need to grow up healthy. When children have health coverage, they can get preventive care that catches potential health issues before they become a problem. It also enables families to build a relationship with a doctor, dental provider, or other health care provider so that they have someone to call on when health issues do come up. Finally, children with health coverage are much less likely to miss school and are better prepared to learn and succeed in the classroom!
We hope you will join us in making sure all families have this important information and take the next step to enroll their kids in coverage. And, together, we will work toward a statewide solution so that all Californians, both children and adults, have access to quality, affordable coverage. Help spread the word by sharing “The ABCs of Health Coverage for ALL Kids” with your community.
By Sonya Schwartz
Now Playing: Coverage for more than 400,000 children and youth
Coming Soon: Coverage for more than 800,000 additional immigrant children, youth and parents
This week, Georgetown University’s Center for Children and Families and The Children’s Partnership released a new paper outlining how to get ready for big coverage opportunities in California. It highlights opportunities that will provide coverage to more than a million people in California’s immigrant families when immigration relief takes affect.
But as spelled out in the paper, Immigration Relief for Parents and Youth = Whole Family Health Coverage in California, while we wait for some of the immigration relief-related coverage options in California to become available, there is a lot that advocates and community organizations in California can do right now to cover eligible children and youth in immigrant families. Here is the run down of coverage opportunities “now playing” in California and also “coming soon” that could get many more children, youth and parents in immigrant families covered.
Now Playing: More than 400,000 children in immigrant families are already eligible for full scope or state-funded Medi-Cal but are not yet enrolled. It is not too soon to roll up our sleeves and get to work on covering them. Here’s the breakdown:
- More than 200,000 youth who qualify for the 2012 DACA program are estimated eligible for Medi-Cal but not yet enrolled. The initial DACA program announced in 2012 is for youth who came to the US before their 16th birthday; have continuously lived in the US since January 15, 2008; are at least 15 years old; are currently enrolled in school or qualifying adult education; or have graduated or obtained a certificate of completion of high school. Our estimates show that of the 343,000 youth qualified for the 2012 DACA program in California, 60 percent or 206,000 are uninsured and eligible for state-funded Medi-Cal. Not all of these 343,000 youth have applied for or been granted DACA status, but if they do receive DACA status and meet the income requirements, they are eligible for a state-funded version of Medi-Cal.
- More than 200,000 citizen or lawfully residing children in immigrant families are eligible for Medi-Cal but not yet enrolled. Our estimates show that 1.6 million children are living with immigrant parents who will be eligible for the new DAPA program in California. DAPA was announced on November 20, 2014, and, when implemented, will allow undocumented immigrant parents who have U.S. citizen or lawful permanent resident children, to apply for work authorization and protection from deportation, if the parent has been in the U.S. since January 1, 2010. Of those 1.6 million California children in DAPA families, 14 percent or 223,000 children are currently eligible for full scope Medi-Cal but remain uninsured. Reaching and enrolling these 223,000 children living in DAPA families would make a huge dent in the number of California’s uninsured children. This map shows that most of these DAPA families live in Southern California with the greatest concentration in Los Angeles County, followed by Orange County, San Diego County, Riverside County, and San Bernardino County.
Coming Soon: There are also opportunities to provide health coverage to more than 800,000 additional immigrant children, youth, and parents and the time to prepare is now. California just passed a law that will provide coverage to all children regardless of immigration status. And, when Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) the 2014 expanded Deferred Action for Childhood Arrivals (DACA) program take effect, hundreds of thousands of children, youth, and parents will be eligible for state-funded Medi-Cal. People granted DAPA or DACA statuses are not eligible for federal matching funds for Medicaid or CHIP or for federal premium tax credits in the health insurance marketplace. However, California provides state-funded Medi-Cal coverage for persons residing under color of law (or PRUCOLs), and DACA grantees.
- 170,000 children in California will be eligible for state-funded Medi-Cal for children regardless of immigration status. California recently passed a budget bill (SB 75) that includes health coverage for all children up to 266 percent of the federal poverty level, regardless of immigration status. Children will enroll in a state-funded version of Medi-Cal and coverage will begin no sooner than May 2016. The expansion is estimated to cover 170,000 children.
- More than 600,000 parents in California will qualify for DAPA and likely to be eligible for state-funded Medi-Cal if granted DAPA status. More than 1 million parents in California are estimated to qualify for DAPA and 56 percent are low income by Medi-Cal standards and lack health insurance.
- More than 50,000 youth in California will qualify for the 2014 expanded DACA program and are likely to be eligible for state-funded Medi-Cal if granted DACA status. The expanded DACA program, announced on November 20, 2014, but on hold because of litigation, is also for youth who came to the US before their 16th birthday but who have continuously lived in the US since January 1, 2010 and meet other requirements. Estimates show that of 92,000 youth qualified for expanded DACA, 60 percent or 55,200 are uninsured and likely eligible for state-funded Medi-Cal.
If you are a children’s or immigration advocate or social service provider in California, our paper also provides specific suggestions about what you or your organization can do to help get children, youth, and parents in immigrant families covered. If advocates, service providers, and others working on health care, immigration, and child and family well-being work together to educate and enroll children and families in health insurance, it could lead to a significant reduction in California’s uninsured rate.
State-funded Medicaid coverage for DAPA and DACA grantees and the new coverage opportunity for children regardless of immigration status is unique to California and a few other states. But, all states cover citizen children in immigrant families. And, the majority of other states (twenty-eight) provide coverage to lawfully residing children in immigrant families. Although, there is always more work to be done get these eligible children enrolled in health coverage.
In 1997, The Children’s Partnership joined with a small group of children’s advocates and supporters and set an audacious goal—securing health coverage for every child in California. With a name that was aspirational, accountable, and determined, we called our effort the “100% Campaign.”
When our journey began, California had nine million children, and 1.74 million of them (nearly one in five) had no health insurance. The reasons varied from lack of affordable coverage options, to a 28-page application form, to policies that precluded eligibility for most immigrant children.
During this time, the Clinton Administration’s effort to enact health care for all Americans was blocked, and the bipartisan Children’s Health Insurance Program (CHIP) emerged to address the needs of children whose families make too much money to be covered by Medicaid, but cannot afford private insurance. Meanwhile, California was battling a voter-passed initiative (Proposition 187) in the courts that would have denied most public benefits to immigrants without documentation. At this juncture, our campaign knew there would be an uphill climb to this goal.
The 18-year trek included numerous efforts and hard-won, step-by-step progress—a testament to the persistent, at times creative and at times heroic efforts of policymakers and their staff, foundations who stayed the course, health providers, community organizers, and consumer advocates. Beginning in 2001 with a local pilot in Santa Clara County that demonstrated the health and cost benefits of covering all kids, local Children’s Health Initiatives were expanded over time to become available to children in 30 of California’s 58 counties at their peak. A dedicated group of California leaders tried most every tack possible, including a state legislative and budget effort, a tobacco tax measure on the 2006 ballot, and an attempt by Governor Schwarzenegger to enact state health reform. But budget setbacks, tobacco industry opponents, and legislative opponents frustrated the progress.
Amidst these attempts that came close to covering all kids but failed, impressive progress was made over the years. The Healthy Families Program—California’s CHIP—grew to provide subsidized coverage to hundreds of thousands of children in working families; the 28-page application form was replaced by a far shorter one; and Express Lane Eligibility made it easier to enroll large numbers of uninsured children already certified for other income-tested programs like the National School Lunch Program in health coverage programs. The passage of the landmark Affordable Care Act in 2010 opened up coverage options to many more families, but still the job was not complete.
Even with setbacks, we were not defeated, our resolve strengthened with the knowledge that the public was in favor of coverage for all kids, including undocumented immigrants.In 2005, four out of five voters (78 percent) supported a statewide plan to “ensure that every child in California has health insurance,” with more than half (55 percent) saying they “strongly support” it. In 2014, a majority supported expanding existing health care programs to cover all low-income Californians, regardless of immigration status.
After nearly two decades, policymakers’ actions caught up with public support. Last week, a historic budget was signed by Governor Jerry Brown extending health benefits to undocumented children. Now, we can finally say the original goal of securing coverage for 100 percent of California’s children is a practical reality.
Any good advocate will point out that the job isn’t finished as we work to implement these changes and actually enroll children, and to be sure that securing health coverage translates into meaningful access to health care and improved health for children. In addition, it is time for policymakers to step up and support offering affordable coverage for family members as well as children.
But, it is just as important to herald this moment and acknowledge the work of our state leaders and countless others to achieve a goal so important and so right as making sure that every child in the Golden State has a chance to grow up healthy. It is a 100 percent great moment for California and our kids.
Despite the successful implementation of the Affordable Care Act two years ago, over one million individuals remain uninsured in California simply because of their immigration status. But that number could change shortly thanks to unprecedented momentum in favor of health for all in the state. Two weeks ago, the California State Senate made history with a 28-11 vote in favor of a bill that would be the first step to ensure health coverage options to undocumented immigrant residents. With ayes from both sides of the aisle, the bill now moves on to the Assembly. And last week, the California legislative budget conference committee voted to provide $40 million to extend Medi-Cal to undocumented children. Now, the question is whether the legislative leadership will hold firm and send the bill and the budget with this funding to the Governor—and whether the Governor will sign them.
SB 4, authored by California Senator Ricardo Lara, would allow undocumented immigrants to purchase health insurance through the state’s health care marketplace (with a section 1332 waiver from the federal government) as well as provide coverage for low-income children through Medi-Cal, California’s Medicaid program. Low-income adults can also qualify for Medi-Cal, but enrollment is capped based on available funds. An estimated 170,000 undocumented California children could receive comprehensive care as a result.
By offering affordable insurance options to immigrant family members, the whole family is more likely to enroll, including their citizen and lawfully present children who already qualify but are not yet enrolled in coverage. One in six kids in California has an undocumented parent locked out of health coverage, and the majority of these children are citizens. When parents get health coverage, their children are much more likely to be enrolled and to get preventive care.
More and more, leaders are recognizing that investing in the health of hardworking immigrant parents and their children has substantial long-term impacts that benefit all Californians. States already provide emergency care coverage for undocumented immigrant residents, even though preventive care and early treatment are far superior and much more cost effective. A growing body of research shows that if every single parent and child had preventive and ongoing care, we could reduce overall health care costs, avoid preventable emergency room visits, and foster more productive communities. Providing full-scope Medi-Cal coverage would cost less than Medi-Cal emergency services coverage the state is currently providing for undocumented immigrant children.
A study of local programs that extended health care to low-income children estimated that 6,324 childhood hospitalizations were prevented over a five-year period, resulting in approximately $6.7 million in savings to the health care system. Moreover, children need regular checkups to assess healthy childhood development and identify and treat problems early.
When children have health coverage, they are considerably more likely to graduate from high school and complete college. Children newly enrolled in health coverage pay closer attention in class, resulting in a 63 percent improvement in school performance. Expanding health care to undocumented immigrants truly is the remaining piece in ensuring all of our kids are healthy and ready to learn.
The recent Senate vote reflects the opinion of the vast majority of Californians across the political, geographic, and demographic spectrum—undocumented immigrant children should have access to affordable health coverage options. A majority of Californianssupport affordable health options for all low-income undocumented immigrant residents. The broad and diverse coalition of Californians—from business leaders, churches, health care providers, workers, and families across the State—will be watching and urging our policy makers to support options for the remaining uninsured. If SB 4 is enacted into law, California will continue to demonstrate its leadership in laying the foundation needed to extend health care coverage to all. We hope California finishes the job and brings health coverage to all Californians and that other states shortly follow suit. Extending coverage to all children and families is not only cost effective—it’s the right thing to do.