On a recent rainy morning in Los Angeles, Maria Bernal’s stove clicks to life with a bright blue flame to toast bread on a griddle for her 9-year-old son Edwin to smear with peanut butter. As she scoops papaya chunks into the blender for a smoothie, she recalls her worry during all the years when she couldn’t afford health care and he suffered painful ear infections.
The waiting six months to get an appointment for Edwin at a county facility. The nights trying to calm him as he cried in constant pain. The months-long wait for each of three surgeries to insert tubes into his ears. The fear when the medical bills arrived.
At the time, she couldn’t afford health care, and he was not eligible for regular government-funded Medi-Cal coverage because she had brought Edwin to the United States illegally from Mexico when he was 1 year old. He qualified for a local program and emergency Medi-Cal, but that didn’t provide all the care he needed. Then last year, she heard on TV that California was creating a new program under Medi-Cal to fully cover poor children in the U.S. illegally. Relieved, she rushed to sign Edwin up. As a result, she says, "I can take him in whenever he needs to go."
Now, however, the ability of Edwin and some 164,000 poor unauthorized immigrant California children to see a doctor for regular medical care hangs in the balance: Several experts predict they could be among the first to lose health coverage if the Trump administration carries out its promise to end much of Obamacare, leaving California to try to make up the difference.
To be clear, the federal government does pay limited medical costs for kids in the country illegally under the restricted-scope Medi-Cal program, which is available to anyone regardless of immigration status for emergency and prenatal services only. Last May, however, California became one of a handful of states to provide state-funded full-scope Medi-Cal, California’s Medicaid program. About 71 percent of the program is funded by the state, according to the state Department of Health Care Services, with 29 percent paid for out of federal funds for emergency coverage. Also of note: Because the federal government funds emergency services, the state shares enrollee information with federal health officials.
In his most recent budget proposal, Gov. Jerry Brown allocated $279.5 million to cover approximately 185,000 kids in the coming year in what the state has dubbed its Health for All Kids program—double what the program was estimated to cost when it was approved.
With the election of Donald Trump, some health policy experts and advocates say the fledgling program is in danger. Assuming the new administration carries out plans to change how Medicaid is funded, California could stand to lose $17 billion the federal government currently provides for the Medi-Cal expansion that California adopted under the Affordable Care Act.
Such a cut would leave state leaders unable to fully make up the funding difference—and could force them to revisit a decades-old debate over whether the state has an obligation to care for sick children regardless of their immigration status, or should focus limited resources on citizens and legal residents.
It’s impossible to precisely predict the ripple effects. But "the first things that are going to go are these optional programs," said Nancy Gomez, organizing director of the health advocacy organization Health Access California. "They are not optional to us. But Health for All Kids are discretionary funds and they may be the first to go."
Trying to make up the gap would be nearly impossible, experts say.
"These federal cuts to the broader Medi-Cal program would force California policymakers to make some difficult decisions—raise revenue by unprecedented amounts to maintain the current program, cut benefits, reduce eligibility, or make other cuts to the program," said Laurel Lucia, manager of the Health Care Program at the UC Berkeley Center for Labor Research and Education. But, she acknowledged, "if the Legislature decides to take a 'last in, first out' approach to making eligibility cuts in response to federal cuts, state-funded Medi-Cal for unauthorized immigrant kids would especially be at risk because the expansion started less than one year ago."
That’s as is should be, according to those who insist that anyone in the country illegally should not receive state resources—especially if funding is cut short.
"Sacramento should be focused on helping American citizens," said Robin Hvidston, executive director of We The People Rising, a Claremont-based organization that fights against legislation that it says promotes illegal immigration. The group opposed the expansion, which she contends is merely an open invitation for illegal immigration. "It’s a program our state cannot afford."
Nonetheless, the lawmaker who authored the expansion to cover unauthorized immigrant children, Sen. Ricardo Lara (D-Los Angeles), has vowed to protect them.
"I will fight to ensure that they remain a priority population in terms of receiving adequate healthcare and meeting their health needs," Lara said. "It makes economic sense, it’s the moral thing to do."
But in an unmistakable sign that the Democratic-controlled state is changing tactics in response to a less receptive White House, California recently withdrew its request for a federal waiver that it had hoped would allow unauthorized immigrants of all ages to buy unsubsidized health care via California’s Affordable Care Act exchange. Lara labeled it the "first California casualty of the Trump presidency."
President Trump and the Republican-controlled Congress favor establishing caps on Medicaid and changing funding to a block grant formula that sets limits on total spending per state regardless of how many people are in the program. Currently it is funded as an entitlement for all enrollees who qualify.
A study by the Center on Budget and Policy Priorities found that the proposals to reorganize Medicaid funding would decrease funding by one-third to one-half within a decade. That would likely trigger a cascade of cuts.
If kids like Edwin Bernal lose Medi-Cal overage, their health care will depend largely on where they live.
Los Angeles County offers a basic low-cost program to everyone regardless of immigration status. But in 11 California counties, including Orange and San Diego, there are no programs for families in the U.S. illegally to find care for their children outside of charitable clinics and hospital emergency rooms.