Shelley: Can California afford health care for undocumented immigrants?

California is now providing the full scope of Medi-Cal benefits to undocumented immigrants.

Full-scope Medi-Cal, called Medicaid in other states, covers primary and preventive care, specialists, prescription drugs and other services. Previously, immigrants without legal status were eligible only for restricted scope Medi-Cal, which provided benefits for such things as emergency room visits and pregnancy-related care.

But effective Jan. 1, all California residents who meet the income eligibility requirements, regardless of immigration status, are eligible for full scope Medi-Cal benefits.

The policy was advanced piecemeal. Beginning in 2016, full scope Medi-Cal benefits were granted to children under the age of 19, regardless of immigration status, as long as they met the other eligibility criteria. That was expanded to young adults through age 25 in 2020. Two years later, the policy was expanded again to include anyone age 50 or older. And on Jan. 1 of this year, the missing group, adults age 26 through 49, became entitled to exactly the same full-scope Medi-Cal benefits available to low-income citizens and legal residents of California.

There are now approximately 14 million people, roughly one-third of the state population, on Medi-Cal. State officials said the latest addition could add another 700,000 people to the rolls and will cost about $3.1 billion per year.

In truth, no one has any idea how many people will be added to the rolls, or what it will cost.

Medi-Cal is an entitlement program. Everyone who meets the eligibility requirements is entitled to enroll in it, and then they’re entitled to have Medi-Cal cover the cost of whatever medical services they need.

The latest expansion was approved by lawmakers in 2022 and tucked into SB 184, one of those lengthy budget trailer bills that are rushed through the Legislature in a matter of days without going through the usual committee process where policies can be more thoughtfully considered.

If lawmakers had taken the time to read the bill, this sentence might have jumped out at them: “The federal Medicaid program prohibits payment to a state for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law.”

That means California will not receive federal matching funds to help pay for the extension of full scope Medi-Cal benefits to undocumented immigrants. The cost of this new entitlement is on California taxpayers.

But the highest cost will be borne by the Californians who already depend on Medi-Cal for health care.

Politicians can stand pompously in front of cameras and declare, “Health care is a human right,” but that’s a lie. Health care is a service provided by skilled and trained people. There can’t be a right to anything that has to be provided by someone else. What about their rights?

To stretch the state’s funds while enrolling more people to receive benefits, California sharply limits the amount that health care providers will be paid for treating Medi-Cal patients, and as a result, doctors sharply limit the number of Medi-Cal patients they will accept.

Medi-Cal reimburses providers at roughly 70% of the rate that Medicare pays, and Medicare pays far less than employer-paid health insurance.

In 2015, groups representing California Latinos filed a civil rights complaint with the U.S. Department of Health and Human Services alleging that long wait times for care had resulted in lower survival rates for cancer patients on Medi-Cal. Then in 2017, the Mexican American Legal Defense and Educational Fund sued the California Department of Health Care Services. The complaint stated that Medi-Cal reimbursements were among the lowest in the nation, causing Medi-Cal patients to have substantially worse access to health care than Californians who had different insurance.

MALDEF’s lawsuit, filed in Alameda County, cited the Department of Health Care Services’ own data to show that between 2000 and 2016, the percentage of Medi-Cal recipients who were Latino went up, and at the same time, Medi-Cal fee-for-service reimbursements went down. “Medi-Cal now only pays 52 percent of what Medicare pays for the same service, compared to 65 percent in 2000,” the complaint stated, adding that managed-care reimbursement rates also dropped.

MALDEF argued that Medi-Cal’s low reimbursement rates violate the law. The federal Medicaid act requires that reimbursement rates to health care providers must be “adequate to enlist providers for the level of care and services … available to the general population” and that medical care must “be provided with reasonable promptness to all eligible individuals.”

In 2017, there were “only” 13 million Californians on Medi-Cal. Now it’s 14 million, with an estimated 700,000 more eligible to enroll as a result of the latest expansion.

But is it 700,000 or will it be even more? Asked last week how many illegal immigrants have been released into the U.S. during the Biden administration, Homeland Security Secretary Alejandro Mayorkas admitted it was “well more than a million per year.” The number of border crossings in December alone was reported to be 302,000, an all-time record. How many will come to California?

Assembly member Bill Essayli, R-Corona, just introduced legislation, AB 1783, to “remove all taxpayer funding for healthcare for illegal immigrants in the California state budget.”

Gov. Gavin Newsom, who will unveil his annual budget proposal this week, was asked if he plans to roll back the latest expansion of Medi-Cal. “No,” he said, “I’m committed to it. I believe in universal healthcare. I believe it’s a fundamental right.”

California is facing a $68 billion budget shortfall. What’s the plan? Can you guess?

On Wednesday, the Assembly Revenue and Taxation Committee will hold a hearing on a “wealth tax” proposal, AB 259, to be accompanied by a constitutional amendment, ACA 3, that would allow the Legislature to define wealth and tax it. You can watch the hearing at arev.assembly.ca.gov/hearings.

Susan Shelley is a columnist for the Southern California News Group.

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