A bill introduced in the California state Senate would make the state the first to allow undocumented immigrants to receive Medicaid and enroll in its health care exchange, extending coverage to more than 1 million people.
The measure from Democratic Sen. Ricardo Lara would change state law to allow illegal immigrants access to Medi-Cal, the state's Medicaid program. It would also direct the state Health and Human Services Agency to seek a waiver from the federal government to allow illegal immigrants to enroll in the state's exchange, Covered California.
California has an undocumented-immigrant population of 2.6 million. The 1.6 million people who have health insurance receive it through their employers or county-based programs, said Ronald Coleman, government affairs manager of the California Immigrant Policy Center.
"I think one of the final frontiers to ensure equity and equality across the spectrum is to ensure folks have access to good health care," said Jesse Melgar, a spokesman for Lara.
Health exchanges created under the Affordable Care Act cannot provide coverage to undocumented immigrants. Typically, Medicaid can't either, with the exception of funding for hospital emergency services, according to the National Association of Medicaid Directors.
Lara's bill is part of an ongoing effort to offer insurance to the undocumented-immigrant population. Last year, Lara proposed a bill that would create a second exchange—similar to Covered California but accessible to immigrants in the country illegally—but it never made it out of the state Senate Appropriations Committee. If the request for a waiver is denied, however, this year's bill calls for the establishment of a mirror exchange.
Lara's new bill would add around $350 million to the state's Medi-Cal bill, Coleman said. He was unsure of the additional cost for Covered California, but said the total cost was less than last year's proposal.
"This proposal actually finds ways to minimize costs by using existing infrastructure," Coleman said. "It just makes sense to ensure Californians can save money over the long run, to make sure we can provide insurance to individuals and make sure they can see a doctor before they get sicker."
The number of people impacted by the bill could also change in the coming months if President Obama's deferred-action expansion is enacted. Health insurance under Medi-Cal would become available to about 400,000 undocumented immigrants, according to Coleman.
"We know deferred action is going to make its way through the courts and it will be upheld," he said.
State Senate Republicans, while acknowledging the need for immigration reform, are reluctant to impose more budget demands on the state.
"The federal government's failure to act has unfairly shifted the burden to the states, and California is taking the brunt of it," wrote Senate Republican leader Bob Huff in a statement addressing numerous immigration bills that have been introduced, including Lara's. "We understand the burdens facing immigrants ... and the rationale behind these bills is admirable. But without money from Congress and President Obama it will be very difficult and costly for California taxpayers to fund all of these bill proposals."
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Caitlin Owens is a health care reporter at National Journal. Her work has previously appeared in the Los Angeles Times, The News & Observer and The Charlotte Observer. She is a graduate of the University of North Carolina at Chapel Hill.