The story of California’s expansion of Medicaid to undocumented immigrants didn’t turn out the way I’d envisioned

Not long after I began my in-depth reporting journey on California’s Medicaid expansion to undocumented immigrants, I realized how much the topic would both challenge me as a person and help me grow as a journalist. 

In January, California became the first state in the nation to offer public health insurance to all eligible undocumented immigrants. I wanted to tell a story that highlighted both the triumphs of those who had fought for this historic win and the innovative practices that would come forward to ensure the Medicaid expansion to all eligible immigrants would go smoothly. But I quickly realized that my reporting would need to explore the ways in which the state’s medical and health insurance systems have not been equipped for immigrants.

I did not want my report to be, as I explained to my father, “pessimistic.” I wanted my report to be a fresh breath of air for undocumented people and those fighting for that community to read about the ways the new Medi-Cal expansion could be life-changing. Although that is true, sometimes to fully celebrate the wins, we must also look at where the faults remain. 

Pick a topic you feel passionate about, but don’t prescribe the way you want your report to go. 

This topic has always been important to me. My father was one of the many immigrants, who never sought health care or health insurance in the U.S. and who despised going to doctors’ appointments. He avoided them until his diabetes landed him in the hospital. He was always on my mind when writing this story.

In 2022, as I was getting ready for my last semester in higher education, he landed in urgent care and was hospitalized for two weeks before he was then transferred to at-home care and in bed for six months. Part of his leg was amputated. 

My father never felt like he belonged in the U.S., and even less inside the country’s health care system. 

Undocumented Californians, who make up the largest group of the state’s remaining uninsured,  do not trust or feel included in the current health system. There is a lot more work needed to be done for that community to feel as if the health care system is also there for them.

Deeply listen to your sources.

When I talked to one of my main sources, Veronica Granados, a 49-year-old immigrant originally from Guanajuato, Mexico, I realized the extent to which undocumented people have lost faith in the system. I also realized the importance of being listened to, heard and acknowledged. 

I first talked to Granados in her comfort place, a community garden in South Central Los Angeles. The interview lasted about three hours. She told me how she felt discriminated against in hospitals, clinics, and other facilities. She told me about the times she had come out of her community clinic feeling frustrated, crying, or anxious. 

I initially had an optimistic view of what the state’s expansion of Medi-Cal to all eligible undocumented immigrants would bring. In speaking to Granados, I realized it will take years before millions of immigrants can fully trust the health system. I realized that there’s fear and distrust deeply rooted in many immigrants’ minds. I did not have to help her change that outlook; I just had to listen. 

“I’ve complained about certain kinds of treatment, but no one has ever called me back or asked me about it. I feel like no one ever listens,” Granado told me. Many people like her have turned to alternative care and medicine, such as medicinal plants and gardening. Instead of pointing fingers at the practices that soothe both their soul and sometimes physical pain, it’s important to understand why many of them have turned away from the existing health care system. 

Accept where your reporting is going, even if it differs from what you planned.

After I started my interviews, I realized that although health professionals want to do better, they also must contend with many barriers when it comes to patients’ insurance. 

David Kane, senior attorney at the Western Center on Law and Poverty, talked to me about the ways Medi-Cal applications take a long time to process. Those applying often cannot reach county representatives by phone or are not able to get help in their language. He also pointed out the Medi-Cal application is the section that asks people for their social security number. 

Andrew Kazakes, senior attorney at the Legal Aid Foundation of Los Angeles, shared the ways he has worked with many patients who were unfamiliar with California’s health care system and navigating Medi-Cal’s application process. He explained how navigating these different systems is confusing, even for doctors, social workers, and attorneys, and even more so for undocumented immigrants. 

I realized that my reporting was not going to deliver a great deal of optimism, but that the truth was important: the state’s Department of Health Care Services has historically excluded immigrants and many systemic barriers need to be broken down for the Medi-Cal expansion to be successful.

Continue to follow your reporting and topic even after the fellowship — you will be surprised.

I continue to write and follow legislation, research, and community opportunities that talk about Medi-Cal for all, and since then I have written numerous pieces on the subject. The central message that my reporting conveys is that there is still much work to be done at the local, state and national level for immigrants and health care.

Recently, a KFF/LA Times survey of immigrants confirmed the same findings. According to the study, although many low-income people in California are now eligible for programs like Medi-Cal, nearly three-quarters of immigrant adults — including nine in 10 who are likely undocumented — report uncertainty about how the use of these programs may impact immigration status or incorrectly believe use may reduce the chances of getting a green card in the future. About a quarter of likely undocumented immigrants and nearly one in 10 lawfully present immigrants say they avoided applying for food, housing, or health care assistance in the past year due to immigration-related fears.

What I learned through the reporting is that to be able to begin to fix the issues at fault, we must first admit the mistakes of the past and repairs must be worked on with those communities that have been directly affected.