Immigration barriers to Medi-Cal go away Monday for 16,000 in Ventura County

More than 16,000 people in Ventura County who have been blocked from health insurance by immigration status become eligible for government-paid Medi-Cal as of Monday.

The expansion makes California the first state in the nation to remove immigration barriers for all ages from the government insurance program for low-income people. Here’s what we know.

What changes?

As of the new year, people age 26 to 49 will qualify for full Medi-Cal regardless of their immigration status as long as they meet income limits and other eligibility requirements. They are the last age group that had been blocked from full coverage if they are not able to show legal residency.

In 2016, people 18 and younger became eligible for care regardless of immigration status. In 2020, the age limit moved to 25 and younger. People 50 and older became eligible in 2022.

How many are impacted?

Across California, the expansion could bring coverage to about 700,000 people ages 26 to 49 in the biggest insurance expansion since Obamacare, according to research from UCLA and UC Berkeley.

In Ventura County, 15,613 people in the age group are blocked from full insurance benefits because of immigration status and receive restricted Medi-Cal insurance. They are covered for emergency and pregnancy care.

As of Monday, they qualify for comprehensive medical insurance as well as dental, mental health, vision, prescriptions and additional care.

The wild card is how many people do not have legal status, have not applied for restricted coverage and are not in the health care system. They also become eligible. Officials with the county Human Services Agency said state data suggests the group encompasses about 700 undocumented people but also called the number a “pure estimate.”

It is a population that is difficult to count, in part, because of fear that coming forward will trigger action from immigration authorities. Dr. Felix Nunez, chief medical officer for the Gold Coast Health Plan, thinks it’s possible a total of 20,000 people, including the nearly 16,000 who have restricted Medi-Cal status, will be eligible for full coverage.

They will likely enroll over time and won’t all hit the system at once, Nunez said. Gold Coast administers Medi-Cal for more than 240,000 people in the county.

Will total enrollment grow?

Medi-Cal membership numbers are in flux for a different reason. During the COVID-19 pandemic, annual eligibility reviews were stopped to prevent people from losing coverage.

Earlier this year, eligibility reviews resumed in a nationwide process called “unwinding.” From June to October, more than 13,000 Ventura County residents have been determined to be no longer eligible for coverage at least temporarily. The process continues through May 2024.

County officials have said as many as 50,000 people could lose coverage. They said it appears unlikely the total Medi-Cal population will grow even with the expansion.

What is the financial impact?

David Grau, a board member for the Ventura County Taxpayers Association, said actual care will cost more than what the government reimburses. He thinks taxpayers will shoulder some of that gap in terms of increased funding for the county-run health system.

“It’s not just Sacramento paying the bill,” he said, referring to a state funding commitment CalMatters estimated at more than $4 billion a year. “It’s Sacramento and local taxpayers paying the bill.”

Others contend the changes could reduce some costs. They noted uninsured people still receive care but often get it in medical emergencies when it is more expensive. Providing preventive and coordinated care will drive down some of the costs.

"This is a net plus. This means people who were otherwise uninsured are becoming paying patients," said Anthony Wright, executive director of nonprofit Health Access California.

Will people get healthier?

The change means some barriers to care will be reduced. Parents in their 20s, 30s and 40s who were blocked from coverage though their children are eligible will be able to get more care.

“They are able to take care of their overall health needs and not only react in a crisis mode,” said Eve Gelb, chief innovation officer for the Gold Coast Health Plan.

Other barriers remain. People who don’t meet income limits for Medi-Cal still won’t be eligible for coverage and if they don’t have legal immigration status, they don't qualify for the Covered California insurance marketplace created by the Affordable Care Act.

The study from UC Berkeley and UCLA projects the expansion will reduce California’s uninsured population to record lows but also asserts about 520,000 undocumented Californians won’t be eligible for Medi-Cal because of their income levels and will remain uninsured because their employer doesn't offer affordable insurance.

How do people sign up?

People who currently receive restricted coverage because of immigration status will automatically be enrolled in full coverage as of Jan. 1.

Other people who become eligible can visit BenefitsCal.com to apply for coverage. They can also contact a Medi-Cal navigator at 833-607-2650 or for help in Mixteco and Spanish at 805-215-0730.

Tom Kisken covers health care and other news for the Ventura County Star. Reach him at tom.kisken@vcstar.com or 805-437-0255.

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This article originally appeared on Ventura County Star: Medi-Cal's final immigration barriers go away Monday in Ventura County