California has been slowly erasing legal immigration status as a requirement for medical coverage under the state’s healthcare program for low-income residents, allowing children and, this month, young adults living in the U.S. illegally to enroll. Now, Democratic lawmakers expect Gov. Gavin Newsom to embrace an effort to include seniors without legal status in the state’s Medi-Cal program — either in his new state budget or with his signature on legislation.

Newsom will send the Legislature a full state spending plan this week and is expected to unveil it Friday. State Sen. Maria Elena Durazo (D-Los Angeles) said she expects it to include the Medi-Cal expansion after the governor told her in September that he would champion the effort in his next budget. Durazo said that assurance prompted her to hold her bill last year that would have expanded coverage to adults 65 or older who are living in the U.S. illegally.

“He made a very explicit commitment that he would include it in his budget,” Durazo said Monday, adding that she had not heard anything since then to change that understanding.

“I’m hopeful,” she said. “I have no reason to think it won’t be included.”


Newsom’s office declined to comment on whether his budget will include the Medi-Cal expansion. The relatively small population of seniors who live in the state without legal immigration status means the cost of covering them — estimated to be $121 million a year — is a fraction of the state’s overall $215-billion budget. But Medi-Cal already covers a third of California’s residents, and critics of expanding the program argue it is already struggling with long wait times because of too few doctors who are willing to accept the state’s low reimbursement rates.

“There are issues with access,” said state Sen. Patricia Bates (R-Laguna Niguel) in opposing the bill in May, adding that extending coverage to more people when those currently enrolled struggle to get appointments would constitute a “false promise.”

This month, California became the first state to cover adult immigrants younger than 26 who lack legal status through the state’s Medi-Cal program under Newsom’s proposal to spend $250 million a year on the effort, which was included in last year’s budget. The state first expanded the healthcare program in 2015 to children living in the U.S. illegally, which has allowed more than 200,000 minors to enroll in the benefit at a cost of $300 million a year.

Supporters of the expansion say covering seniors is the logical — and less costly — next step toward universal healthcare coverage, a policy goal central to Newsom’s campaign platform. One of the largest groups of uninsured Californians is immigrants in the U.S. illegally, with an estimated 1.5 million adults eligible based on income but excluded because of their immigration status. The administration estimated last year that expanding Medi-Cal to all income-eligible adults regardless of age or immigration status would cost $2.4 billion a year.


Though Medi-Cal is funded by both federal and state money, the cost of expanding coverage to immigrants who are in the U.S. illegally falls solely to California because the Affordable Care Act prohibits the use of federal dollars for covering such immigrants. Adult immigrants without legal status can enroll in limited scope Medi-Cal coverage, which covers pregnancy, some cancer treatments, emergency services and long-term care.

“We believe fundamentally that primary and preventative care makes our healthcare system more efficient and effective for everyone,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group. “It’s important that we take these important steps to provide real relief to Californians who are excluded due to eligibility or affordability.”

Durazo’s legislation to expand coverage to seniors here illegally passed the Senate last year and was set for a vote in the Assembly when she held it. Durazo said she would push for an Assembly vote on Senate Bill 29 if Newsom does not include the expansion in his budget this week. The bill would have to return to the Senate for a concurrence vote.

A legislative analysis of SB 29 estimated that 25,300 people who are 65 or older and lack legal status would enroll in Medi-Cal coverage. The Newsom administration formally opposed Durazo’s bill last year, saying that it would “create significant general fund pressure.”


“For many of these seniors, they have made a lifetime of contributions to California — to our economy, tax base and our society — and right now they are excluded from healthcare programs,” Wright said. “It makes sense to focus on those who need this the most. It doesn’t mean we don’t want to get to everyone, so we will continue to press on that as well.”