How California’s Medi-Cal expansion to undocumented immigrants could affect Sonoma County

It’s only within the past year that Sonoma Valley native Angie Sanchez and her six siblings have seriously considered sending their parents to Mexico in hopes of increasing their access to affordable health care.

Sanchez’s parents, who live in Northern California and moved to the United States from Mexico as children, are both undocumented. As such that means — despite being low-wage earners — they do not qualify for full Medi-Cal benefits.

In their early 50s, they both have significant health issues. Sanchez said her father’s jobs in agriculture and construction aged him beyond his years and he was forced to stop working last year after carpal tunnel hindered his use of his hands.

Her mother, Sanchez said, has only one kidney as the other was removed a decade ago. And, she has bone loss in her teeth, but has put off seeing a dentist because of the high out-of-pocket costs of dental care.

“I wish we could just be like, ‘OK, let’s take her to the dentist, just for check ups,’” Sanchez said. “Once my dad could not continue working, I was like ‘No, he can’t continue like this, we need to figure something out.’”

Despite her frustration, the answer to Sanchez’s wishes came last week when Gov. Gavin Newson signed into law a plan OKing the extension of Medi-Cal to low income, undocumented immigrants who are age 50 or older.

“I cried because I was like, ‘We actually don’t have to decide whether we have to be separated or not,” Sanchez said upon learning of the measure. “This is a huge game-changer.”

In order to qualify for the new coverage, which takes effect next year, individuals and families need to make ​138% of the federal poverty level or less, or no more than about $36,100 a year for a family of four.

Currently, undocumented immigrants 26 or older who meet all the requirements for Medi-Cal except for providing proof of legal immigration status are able to receive a restricted form of the health benefits that covers emergency services and pregnancy care.

In 2016, California previously extended full Medi-Cal coverage to children under age 19, and then in 2020 to young adults under the age of 26, regardless of immigration status. Both groups have to meet all other eligibility requirements, including income limits, to receive the state-funded benefits.

Approximately 235,000 people statewide are expected to benefit from this latest Medi-Cal expansion, which is expected to cost California taxpayers $1.3 billion a year. The new, full scope Medi-Cal program for older undocumented immigrants could go into effect as soon as May 2022, state officials say.

In Sonoma County, the latest expansion is projected to benefit nearly 1,500 people by the time the program takes effect, though the numbers could fluctuate as more people become eligible, said Alycia Asai, a program planning and evaluation analyst for the Sonoma County Human Services Department.

Intake workers there review and authorize Medi-Cal applications for Sonoma County residents. About a quarter of county residents rely on Medi-Cal for benefits, the department said.

While the department expects a slight bump in the number of new Medi-Cal applications after the law goes into effect, Asai said it’s likely some of the people who will benefit from the expanded benefits have already been in touch with the county for the restricted Medi-Cal services.

People ages 50 and older who have been unable to provide proof of legal immigration status to receive the full scope of Medi-Cal benefits should expect to receive notices about the automatic benefit expansion, Asai said.

“We already have a majority of the people, so for them, it’s a seamless transition,” she added.

Pedro Toledo, the chief administrative officer at Petaluma Health Center, which provides health care services on a sliding fee scale, said the new law will help the center get closer to its goal of providing health coverage for everyone in the community regardless of income level.

“If there’s one reoccurring lesson in the past few years, it’s that inequalities cost lives,” Toledo said. “We’ve seen (this) after the death of George Floyd and the disproportionate rate of COVID infections among low-income workers of color.”

Currently, about 4,200 of the center’s patients are uninsured, likely because of their immigration status, Toledo said. It’s not yet clear, though, how many of those patients will qualify for the new expanded Medi-Cal program, which will increase access to preventative care that could lead to early diagnoses, he said.

“If we can catch things early, there’s a chance we can either reverse the issues or prevent it from getting worse,” Toledo added. “But if we don’t catch it until late, often times it means that we have to deal with a chronic issue.”

At Santa Rosa Community Health, another primary health care center that works in underserved areas, just over a quarter of the 40,000 patients its medical staff sees annually are without health insurance, and like at the Petaulma Health Center, most are assumed to be undocumented immigrants, said Annemarie Brown, the communications director for the Santa Rosa center.

The past few years have had a chilling effect on immigrants who might have qualified for even the most basic health care benefits, Brown said.

Contributing factors include challenges to the Affordable Care Act under President Donald Trump’s presidency, as well as a 2019 public charge rule that made undocumented immigrants ineligible to become a lawful permanent resident if they received public benefits, including health care, she said

That public charge rule, however, was undone earlier this year.

“Even though we don’t report that kind of information to the government, it doesn’t matter when there is so much fear in the environment,” Brown said.

While the new Medi-Cal extension, signed into law last week by Newsom, solves the concerns of Sanchez and her parents, for Petaluma resident Leonor Navarro and her husband it does next to nothing.

The pair, both of whom are undocumented immigrants, will likely be disqualified from the extension because her husband, who is in his 50s, received a raise at his landscaping job, Navarro said.

The $53,000 her husband makes annually puts them outside the maximum income a family of five can make to receive Medi-Cal benefits, according to the California Department of Health Care Services website.

Navarro’s three kids, who were born in the country, are still eligible for low-cost health coverage, she said.

And, while she and her husband make regular visits to the Petaluma Health Center, which offers regular health care services on a sliding fee scale, the ongoing pandemic has done little to ease her concerns.

A history of breast cancer in her family is also top of mind, she said.

“The fear of going to a hospital isn’t what they’ll do to you,” Navarro said. “It’s how much you have to pay. It’s either go to the hospital or eat, or pay rent.”

You can reach Staff Writer Nashelly Chavez at 707-521-5203 or nashelly.chavez@pressdemocrat.com. On Twitter @nashellytweets.