For California immigrants, Medi-Cal coverage now hinges on one deadline

Every year, low-income Californians must renew their Medi-Cal coverage by proving they still qualify for the program. But for undocumented immigrants, this year, the process has higher stakes. Because of new state policies, if they miss their renewal timeframe, they won’t be able to recover coverage later.  

That’s where San Francisco’s community clinics come in. For decades, these clinics have helped their immigrant patient base figure out how to access affordable healthcare in San Francisco. When the state began expanding Medi-Cal access for undocumented Californians over the past decade, they strived to connect as many people as they could to the free and low-cost insurance program. 

Now, staff at the clinics are racing against the clock to make sure these same immigrants stay enrolled. 

Facing a budget deficit, California froze Medi-Cal enrollment last June for adults with “unsatisfactory” immigration status last June. Since January, only those already enrolled in Medi-Cal can keep the coverage, making renewals critical. 

But for many immigrants, navigating the renewal process has become more complicated under the new rules.

 “There are now really strict time limits within which we can reapply,” said Jesus Martell González, chief operations officer at Mission Neighborhood Health Center (MNHC). “But there is hope. And we’re here to help people.” 

Getting help with reenrollment

About 90 days before their coverage expires, Medi-Cal sends patients a renewal packet in a yellow envelope they need to submit in order to keep the public health insurance for another year.  

Residents can renew Medi-Cal on their own, either online or via phone call: (855) 355-5757. After coverage ends, they also have  a 90-day grace period to get it back before they are unenrolled. 

Still, healthcare advocates note that their immigrant patients often face language and cultural barriers that can slow down or stall their renewal process. 

Some people have moved homes and forgotten to update their new address, so they miss the renewal notices, explained Cynthia Campos, a Health Enrollment Navigator with MNHC. Other patients might not be aware how the Medi-Cal process works, or get confused and overwhelmed by the new restrictions and requirements. 

Community clinics around the city have dedicated staff to help patients with renewals during one-on-one appointments. They can explain the forms in multiple languages and suggest alternative documentation to provide, for instance, if people are paid under the table or have variable income. They can print out documents for patients and help mail them out. They also help break down the new restrictions and policies. 

“Some [patients] are just scared that they won’t even qualify no more because of the new restrictions that they put,” Campos said. “They right off the bat assume ‘Oh, I’m not eligible,’ but we go ahead and tell them that if your Medi-Cal stays open, you still have Medi-Cal.”

Sometimes, Campos has to do deeper problem solving. At the beginning of the year, she said some of her undocumented patients were automatically switched from the full-scope Medi-Cal plan into Emergency Medi-Cal. When patients visited MNHC’s enrollment office because their Medi-Cal was inactive, Campos and other enrollment navigators called the offices and sorted out the situation, which ended up being a reversible glitch.  

Staff from city-run and nonprofit clinics are also increasingly focused on deadline awareness. They go through patient lists and call them to remind them of their upcoming renewal dates. And when hard-to-reach patients attend the clinic to seek a service, health care specialists make sure to offer reenrollment support. 

“The big push has been impactful,” said Johanna Liu, President of the San Francisco Community Clinic Consortium, which has organized outreach workshops for healthcare workers. “When we looked at projected versus actual numbers [of people losing status] folks that wanted to stay on have been able to stay on.” 

Fear of sharing data keeps immigrants from getting coverage

Still, healthcare workers say they’re encountering more immigrants who understand the re-enrollment process, but aren’t sure if they want to keep their Medi-Cal. 

“It was hard for us to understand these changes,” said Maria Sanchez, a promotora with MNHC. “And it’s twice as hard for the community because of fear. People are worried about the government having access to the data they share.”

Last summer, the Centers for Medicare and Medicaid Services (CMS) signed an agreement with U.S. Immigrations and Customs Enforcement (ICE) that let immigration officials access Medi-Cal enrollees’ private information. 

Since news of the agreement broke in late July, the number of immigrant San Franciscans enrolled in Medi-Cal through its expansion program has dropped every month: from 32,625 in July to 30,935 in December.

A federal ruling currently limits Medicaid to sharing the addresses, phone numbers, date of birth and immigration status of undocumented immigrants in some states like California with immigration authorities, though states say the Trump administration is ignoring these limits. 

As part of their community outreach efforts, healthcare advocates say they want to create a space where people feel comfortable asking questions about these policies, so they can better understand what is at stake with their decisions. 

“What’s true is that if you already requested Medi-Cal, you’re in the system. If you had children, you’re in the system. Your record is already there,” Sanchez said. “So why not keep benefiting from the service? We don’t know what else is going to happen yet.”

Knowing your health care options beyond Medi-Cal

At the top of health workers’ minds is the worry that, without Medi-Cal, immigrants might forsake care until their health conditions worsen significantly or they end up in the emergency room. 

“What I’ve seen with the [Latino immigrant] community is that when they don’t have health insurance — and have to decide whether they cover medical bills or their food, their rent — they’re not going to prioritize their health,” said Angélica Rosas, a promotora with MNHC. 

Still, uninsured immigrants have options to subsidize their care, and enrollment staff say they are ready to connect patients to these alternatives. 

Emergency Medi-Cal covers emergency room visits for all residents, while full Medi-Cal remains available for all children, pregnant people and those who gave birth within the past year. San Francisco’s Healthy SF program also offers low-cost care for uninsured residents regardless of immigration status, and many clinics provide services on a sliding scale. 

Regardless of their situation, staff at community clinics urge patients to call or to drop by their local clinic, where dedicated staff can help them figure out what they are eligible for. 

“Our hope is that anyone who finds themselves in the position of not having [Medi-Cal], or also any newcomers who are new to the city who are not eligible to enroll in the first place [will] come and talk to us,” said Kirsten Day, Medical Director of Operations at the Family Health Center at San Francisco General Hospital. “Come in anyway and we will get you something. We’ll figure it out.”