Thousands of undocumented immigrants in Sonoma County likely left out of Medi-Cal expansion

A new state law that extends Medi-Cal health insurance to undocumented immigrants took effect this week, a move that is expected to reduce the population’s uninsured rate by half.

But thousands of people in Sonoma County — and more than half a million statewide — who would qualify for the coverage because of their immigration status are expected to be left out because they earn too much to be eligible but not enough to buy health insurance on their own.

What’s more, under federal rules, undocumented immigrants do not qualify for subsidies through Covered California, the state’s health insurance exchange under the Affordable Care Act, commonly known as Obamacare.

At the Petaluma Health Center alone, most undocumented patients who receive medical care there earn too much to qualify, said Pedro Toledo, the center’s chief administrative officer.

Toledo said only about 577 of Petaluma Health Center’s 4,103 uninsured patients are “income eligible” for Medi-Cal, the state’s Medicaid program, meaning more than 85% of that group will miss out on the expansion of health care coverage.

As is, undocumented immigrants make up close to 90% of the health center’s uninsured patients, he said.

“Unfortunately, because the federal income guidelines are so low, many of our uninsured patients make too much to enroll in Medi-Cal,” said Toledo.

The new state law is set to eventually cost the state about $3.1 billion a year and advances California closer to Democrats’ goal of providing universal health care to its roughly 39 million residents.

Democratic Gov. Gavin Newsom and lawmakers agreed in 2022 to provide health care access to all low-income adults regardless of their immigration status through Medi-Cal.

California is the most populous state to guarantee such coverage, though Oregon began doing so in July.

Toledo said some undocumented immigrants do get health insurance through their employer or by purchasing it directly on the private market. But employer-sponsored health insurance for undocumented immigrants is the exception, and private market costs are exceedingly prohibitive.

Last spring, the UC Berkeley Labor Center, a public service and outreach program of the university’s Institute for Research on Labor and Employment, published a report that found more than half a million undocumented immigrants in California would be left out of the state’s Medi-Cal expansion this year.

The report found that 520,000 uninsured undocumented immigrants would make above 138% of the federal poverty level, which is the threshold for qualifying for Medi-Cal coverage. Medi-Cal is the state’s version of the federal Medicaid program.

Laurel Lucia, health care program manager of the UC Berkeley Labor Center, said Tuesday that federal poverty guidelines are extremely low.

She said 138% of the federal poverty level is “equivalent to about $20,000 for a single person or $34,000 for a family of three”

“The definition of low income for Medi-Cal purposes, is quite low, especially when you consider the cost of living in California,” Lucia said. “People earning above the Medi-Cal income limit are still likely to be struggling to make ends meet. A single person earning about $20,000 (a year) is going to face extreme difficulty trying to afford private coverage at full cost.”

It’s unclear exactly how many undocumented immigrants in Sonoma County will not be eligible for the Medi-Cal expansion and also lack employer health coverage. Lucia said reliable county-level estimates could not be done with the statistical model used in the report.

However, she said some 80,000 undocumented immigrants in the nine-county Bay Area region, including Sonoma County, would be left out.

Estimates provided by the county’s large community health centers provide a window on the gap in coverage for undocumented immigrants. The Petaluma Health Center and Santa Rosa Community Health serve 41,200 and 40,805 patients, respectively.

In 2022, there were 7,356 uninsured patients at Santa Rosa Community Health, many of them undocumented. Only 1,600 of these patients will be eligible for Medi-Cal expansion based on income, said Annemarie Brown, spokeswoman for Santa Rosa Community Health.

But Brown said the total number of immigrants who are ineligible could be less because some of the health center’s undocumented patients have “emergency Medi-Cal” or the county-operated Path to Health/Camino de Salud program. Both of these groups will become covered under the Medi-Cal expansion, she said.

Gaby Bernal Leroi, chief executive officer of Santa Rosa Community Health, said the entire health care landscape benefits from reducing the number of uninsured patients. People with health insurance access care services more frequently and thus have better health outcomes, she said.

“At the same time, we remain committed to providing access to full-scope, high quality health care for all people, regardless of their insurance status,” Bernal Leroi said.

Lucia said several states have launched programs for those who are not eligible for federal health insurance subsidies due to their immigration status. Both Colorado and Washington provide subsidies to help make private coverage more affordable for undocumented immigrants, she said.

Lucia pointed to California legislation that also seeks to close that gap. AB 4, introduced by Assemblymember Joaquin Arambula, D-Fresno, directs Covered California to seek a federal waiver from the rule that prevents undocumented individuals from purchasing coverage through state health exchanges.

“After that structural option is in place, then state policymakers could decide to provide subsidies to make that coverage more affordable,” Lucia said.

The Medi-Cal update will be California’s largest health care expansion since the 2014 implementation of former President Barack Obama’s Affordable Care Act, which allowed states to include adults who fall below 138% of the federal poverty level in their Medicaid programs. California’s uninsured rate dropped from about 17% to 7%.

Sonoma County Human Services Department Director Angela Stuckmann said she welcomed the current expansion of Medi-Cal coverage for all Sonoma County residents, regardless of their immigration status.

Struckmann said the county will continue to seek ways to insure those who are ineligible through its own programs.

“We can also help with enrollment in other affordable health plan options for individuals who are not eligible for Medi-Cal, including the County Medical Services Program,” Struckmann said.

The Associated Press contributed to this story.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.