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For undocumented immigrants past retirement age in Sacramento County, the only place to go for medical care is also the most expensive—the emergency room.

Already ineligible for Covered California and Medi-Cal, undocumented immigrants who are 65 and older are also excluded from a Sacramento County program that provides basic medical benefits to undocumented residents who are low income. But that’s about to change.

The Sacramento County Board of Supervisors last week removed age caps from its Healthy Partners program, part of a broader effort to enroll a thousand more undocumented adults in a program that currently has 3,000 members and spends little of the money in its budget.

The board’s unanimous vote came amid calls from advocates to end what they considered age discrimination, and over the concerns of the county’s head of Health and Human Services, the department that oversees the program.

“This is important to a significant part of the population,” said David Ramirez, a member of the Healthy Partners Advisory Group. “These are good people, people who work hard, people who are adding more than color to Sacramento.”

The county is home to an estimated 56,000 undocumented immigrants, according to the Public Policy Institute of California and UC Berkeley’s Center for Labor Research and Education.

More than 500 applications to the Healthy Partners program were denied last year due to age, income or county of residence ineligibility, a county staff report shows. Ten enrollees were kicked off once they turned 65.

Despite heavy interest in the program, Healthy Partners has spent little of its $2.5 million budget. The program returned about $2 million to the county in the fiscal year that ended June 30, 2017.

That money went unspent even as hundreds waited to get into the program.

By the end of last year, 321 people were on the Healthy Partners wait list, county data shows. One individual died while waiting to be enrolled.

Supervisor Phil Serna, who led the county’s effort to reinstate basic health care services to undocumented residents following the recession, expressed frustration at last week’s meeting. “I’m just saying, let’s spend what we budget for,” he said.

Part of the problem has been finding medical facilities to perform more complex procedures, as volunteering doctors sometimes must work out of smaller, less equipped clinics. “For some specialties, physicians are not comfortable providing services, since Healthy Partners does not pay for hospitalizations or expensive treatments,” a county staff report states.

The program has been more successful at connecting patients to basic checkups and lower-priced medications, mostly thanks to doctors who work pro bono. Supervisors heard from physicians last week about women who received their first mammograms at age 50 and patients who, prior to enrolling in Healthy Partners, juggled multiple jobs to afford diabetes medication.

Undocumented immigrants over the age of 65 can have a notoriously difficult time obtaining health care. Many private insurers cap eligibility at age 65 under the assumption that aging adults will transition to Medi-Cal, the state’s version of Medicare. Undocumented immigrants aren’t eligible for those programs.

“They go off the cliff,” Ramirez told supervisors.

The county’s Health and Human Services agency initially pushed for a more conservative “pilot” expansion of the program—capping the number of 65-plus enrollees at 200, and admitting only those who were previously enrolled in Healthy Partners. Agency Director Sherri Heller told supervisors that staff would face challenges coordinating the additional care and medications for a thousand new patients, many of them older.

Age caps aren’t uncommon in health-care programs serving low-income populations. The County Medical Services Program, which operates in 35 predominately rural counties in California, restricts enrollment to adults age 21 to 64.

In removing its age cap, Sacramento joins counties such as Los Angeles and San Francisco with health programs for undocumented immigrants 19 and older. Since May 2016, Medi-Cal has fully covered health care for undocumented children up to age 19.

Healthy Partners, which took effect in May 2015, spent $141,508 during its inaugural fiscal year, and $403,944 the following year. Even with a goal of enrolling 1,000 new members this year, Healthy Partners is expected to stay well within its budget. The county is projecting that $900,000 will be spent on medical services this fiscal year, leaving $1.6 million in the account.