Two women's stories suggest why California’s expansion of Medicaid to undocumented older adults is a big deal

When Ericka Rosas Aranda got sick, she was faced with a troubling choice: Spend hundreds of dollars in diagnostic tests or pay her rent. 

As an undocumented Californian without full health insurance, she decided to postpone care – until she landed in the emergency room, no longer able to walk. While there, she received a diagnosis: her cancer had progressed to stage 3, and she struggled to eat or drink. 

Through a conversation while waiting in a clinic, she learned she might be eligible for Medi-Cal, the state’s Medicaid health care program for low-income children and adults. As of last month, she qualified for full-scope Medi-Cal and is now receiving care for the cancer and its side effects. After more than two decades in the United States, Aranda said she’s grateful to finally receive health care – but also frustrated that she was forced to delay critical care in the process.  

“If I had had Medi-Cal, I wouldn’t have gotten to this point: Stage 3 cancer that’s metastasized,” she said, speaking in Spanish to fellows at the Center for Health Journalism’s 2022 California Fellowship, held via Zoom last week. “I would have been taken care of more quickly.”

Like Aranda, many undocumented residents routinely skip or delay health care over a lack of coverage and cost concerns. Now, California is on the path to changing that. Starting May 1, nearly a quarter-million residents age 50 and older will become eligible for Medi-Cal, regardless of immigration status. And, if Gov. Gavin Newsom’s budget proposal is approved, all low-income California residents will qualify for the program by 2024. The state’s trailblazing move is an important step in improving access and reducing health disparities, patient advocates say.   

“We want to make sure…. people are getting into the right programs now and not postponing care, it’s so critical,” said Celia Valdez, the director of outreach and education for the social services nonprofit Maternal and Child Health Access. “People postpone their care which is the saddest part.” 

High cost of care delays 

Zahide Kelleci, an immigrant from Turkey who came to California seeking asylum, also experienced delays in care because of cost. She was once told it was cheaper to lose her teeth than treat the source of her dental pain.

Kelleci also struggled with uterine fibroids that caused such intense bleeding that she fainted several times. 

“When you see yourself covered fully in blood, you get scared,” she said. 

She struggled to navigate an unfamiliar system, seeking help in the emergency room, paying out of pocket in clinics and spending hours on the phone seeking help. One doctor even suggested she return to Turkey for health care. As a single mom, she said she couldn’t do that to her son.

“If he stays here, he’s going to have a better life,” she said. “It’s better I should risk it.” 

Ultimately, one phone call paid off, and a patient navigator realized she was eligible for Medi-Cal under a little-known provision, and she received the benefits late last year. She was able to get a much-needed surgery for the fibroids. That patient navigator “saved my life and she saved my son’s life,” Kelleci said. 

A common story 

Such stories of postponing care are far too common, says Valdez of Maternal and Child Health Access. 

Too often, people don’t know what specific programs and benefits they’re eligible for. Others might have had a bad experience with the system and feel too discouraged to persist. Others are too busy with work to spend time researching eligibility and enrollment. Still others might not be able to find help in their native language.

Valdez’ organization screened both Aranda and Kelleci and found they were eligible for Medi-Cal despite their undocumented status. They fell under a provision that extends benefits to people who known to be present in the United States and are awaiting a status change, such as a family member or employer’s petition, or someone seeking asylum. Often clients are unfamiliar with the little-known program referred to as PRUCOL, or Permanently Residing Under Color of Law. 

“It’s very confusing,” she said. “For the most part, we find people who have no clue they’ve been eligible for full scope Medi-Cal.” 

She’s hopeful that the sweeping changes ahead will help more people gain coverage, although outreach and navigation aid will be essential to getting as many eligible people as possible enrolled. Even for people who might earn too much to qualify, there are other Medi-Cal programs and provisions that might fit their distinct situation. The complexity of this maze of programs underscores the importance of patient navigators who can screen individuals.  

California’s groundbreaking strides

California is poised to be the first state in the country to offer Medi-Cal for all qualified people regardless of their immigration status.

“This is a really exciting time,” said Laurel Lucia, the director of the Health Care Program at the UC Berkeley Labor Center.

The state has made progress in expanding coverage incrementally, first by expanding the program to all qualified children regardless of immigration status in 2016. That was followed by another Medicaid expansion to young adults ages 19 to 25 in 2020. In May, the expansion will extend to all low-income adults ages 50 and older, which should add about 235,000 individuals. 

Gov. Newsom’s proposed budget, which the legislature will vote on in June, has proposed providing the final missing piece and the largest group remaining: all low-income adults ages 26 to 49, regardless of immigration status. That move would represent the state’s biggest coverage expansion since the Affordable Care Act’s implementation, and comprises about 670,000 people, Lucia said. 

That expansion would reduce disparities in the state’s uninsured populations. For Latinos in California, for example, the uninsured rate would drop from 15% to 10%, she said. The number of undocumented individuals without insurance is projected to drop from 58% to 28% under that scenario.

Those numbers include people with urgent health crises like Aranda, for whom it would mean no longer having to decide whether to spend money on health care or rent. A large body of research connects Medicaid expansion to improved access to care for cancer diagnosis and treatment, among many other health improvements, Lucia said. 

“The benefits of expanding Medicaid are really widespread,” she said.

**