By Ana B. Ibarra November
21, 2019
Starting
in January, young adults can sign up for California’s Medicaid program
regardless of immigration status.
But a
fundamental question looms: Will they?
Some
young people already say they won’t enroll in public coverage because they fear
federal immigration policies could later penalize them for participating —
though that fear might be unfounded.
Add to
that their age. Young adults — both immigrants and non-immigrants — are
notoriously hard to convince of the necessity of health insurance. The
insurance industry even has coined a special term for them: “young invincibles.”
“Young
adults, undocumented or not, tend to consider themselves healthy,” said Cathy
Senderling-McDonald, deputy executive director of the County Welfare Directors
Association of California, which represents county human services directors.
“They’re not thinking ‘This is something I need to worry about.’”
Medi-Cal
is California’s version of the federal-state Medicaid program for low-income
residents. In May 2016, the state began offering undocumented immigrant
children up to age 19 full Medi-Cal coverage, funded by state money. Nearly
129,000 were enrolled in the program in March 2019, according to the most
recent data available.
During
budget negotiations this year, California lawmakers voted to use more state
dollars to expand the program to all income-eligible adults ages 19 to 25,
which will make California the first state to offer full Medicaid coverage to
unauthorized immigrant adults. The state Department of Health Care Services
expects to enroll about 90,000 young adults in the first year.
Of
those, nearly 75% are currently enrolled in limited Medi-Cal coverage, which
includes emergency and pregnancy-related care. The department plans to
transition those individuals into comprehensive coverage, it said.
That
leaves health officials and immigrant rights advocates grappling with how to
persuade everyone else who is eligible to apply.
Undocumented
immigrant adults make up the majority of
California’s uninsured population, about 58%, according to the Insure the
Uninsured Project.
“The
message we have to spread is to think about prevention and chronic conditions,
which could start early in life,” said Jeffrey Reynoso, executive director of
the Latino Coalition for a Healthy California.
Advocates
must meet young adults where they are, Reynoso said, which means social media
is key. His group is creating a social media toolkit that includes Instagram
posts and sample tweets tailored to young adults, which will be available to
partner organizations.
It also
plans to use radio and ethnic media, in cooperation with other groups, to
spread the message to families so parents and grandparents can encourage
younger family members to sign up, he said.
“We
can’t use traditional media to reach this population,” said Sarah Reyes,
managing director of communications at the California Endowment, a foundation
that promotes health insurance coverage for all Californians, regardless of
immigration status. The endowment also is planning social media posts and radio
spots on stations that cater to younger people, and is designing ads for
display in convenience stores and markets, Reyes said.
Those
who make up to 138% of the federal poverty level are eligible for Medi-Cal.
This year, that means individuals with annual incomes of up to about $17,200
qualify.
Because
Medi-Cal is free for most participants, most young people won’t have to worry
about taking a financial hit, said Sarah Dar, senior manager of health and
public benefits for the California Immigrant Policy Center. That makes them
different from the so-called young invincibles — who
generally fall into the 18-to-34 age group — looking for private health
coverage, where cost is a major consideration.
But age
is not as great a barrier to enrollment as fear of federal immigration rhetoric
and policies, Dar said.
For
example, since 2017 the Trump administration has been fighting to end the
Deferred Action for Childhood Arrivals (DACA) program, which allows some
undocumented people, whose parents brought them into the country illegally as
children, to live and work in the U.S. temporarily. The fate of the program
rests with the U.S. Supreme Court, which heard oral arguments
in the case Nov. 12.
The
Trump administration is also trying to expand its “public charge” rule,
which would allow immigration officials to more easily deny permanent residency
status to those who depend on certain public benefits, such as Medicaid.
Federal judges temporarily blocked it
from taking effect in mid-October.
But the
fears may be misguided, Dar said. Participants of the DACA program already are
eligible for Medi-Cal if they meet the income guidelines. And applying for
Medi-Cal wouldn’t count against undocumented young adults should they become
eligible to apply for permanent residency later because their coverage will be
paid for with state, not federal, money, she said.
“We
need to get out a clear message that public charge should not be a concern,”
Dar said.
Esmeralda,
20, of Santa Maria, Calif., works in the fields picking strawberries and
attends community college when the fruit isn’t in season. She agreed to speak
to California Healthline on the condition that her last name not be used.
She
needs glasses and has struggled with occasional but debilitating back pain
since she was a child in Mexico. The pain sometimes forces her to stop working
for the day.
The
last time she went to a doctor was almost five years ago, when she started
school in the U.S. and had to get vaccinated, she said.
Esmeralda
said she would like to sign up for Medi-Cal but will wait to see how the
process works for others. She wants to know whether they feel their personal
information is being kept safe from federal immigration officials, she said.
“I
would wait to make sure there are no problems,” she said in Spanish.
“Obviously, with being undocumented, there is fear.”
This KHN story first published on California
Healthline, a service of the California Health Care Foundation.
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