Starting next month, California will become the first state in the nation to make its version of Medicaid available to children in the U.S. illegally.
The state Department of Health Care Services estimates that about 170,000 kids under 19 without legal status will be eligible for Medi-Cal under a law passed last fall. Half of those expected to enroll live in Los Angeles and Orange Counties, according to experts.
The expansion will cost an estimated $40 million the first year and about $132 million annually in the future, according to Health Care Services, which oversees Medi-Cal, the state's health care program for the poor.
While Medi-Cal is the state version of the federal Medicaid program, California will cover the cost of care for unauthorized immigrant kids, since they are ineligible to receive federal funding.
Children in families earning up to 266 percent of the federal poverty limit are eligible for free or low-cost Medi-Cal; the income limit is currently about $64,000 a year for a family of four.
Officials have had some logistical difficulties enacting the law, but they expect it to go into effect May 16. Coverage will be retroactive to May 1.
Senator Ricardo Lara (D-Bell Gardens), who authored the law, said moving low-income children without legal status to Medi-Cal will save taxpayers money.
"This is a step forward, ensuring the state cuts costs in providing comprehensive Medi-Cal for a population that ends up being treated in our emergency rooms," Lara said. "It makes financial sense and is the right thing to do."
Critics disagree. They argue it is too expensive, it could cause immigrants without legal status to put down deeper roots in the state and it could encourage more people to come here illegally.
"California is formally incorporating people who shouldn’t be in the country into our institutions," said Mark Krikorian, executive director of the Center for Immigration Services, a Washington, D.C. organization that advocates for immigration restrictions. "The result of that is enormous costs."
Efforts like this and others, including California's granting of driver’s licenses, in-state tuition, financial aid and shelter from immigration enforcement are "a broader attempt to undertake a piecemeal amnesty of illegal immigration," he said.
Lara, who is behind an effort to ask the federal government to allow people in the country illegally to buy unsubsidized health insurance through Covered California, counters that many of those without legal status contribute to the economy by working and paying taxes.
About half of the kids in California who don’t have legal status are already on some kind of health program – either public or private – and the new law will help streamline care, said Daniel Zingale, a senior vice president at The California Endowment.
"A lot of money is being spent on a patchwork of emergency Medi-Cal programs and other special programs to deal with this inconsistency," Zingale said. "Now money can be directed to a program that treats all children the same."
Some kids may be on restricted Medi-Cal – which lasts for 60 days at a time – and is used primarily for emergency situations. Kids on this program will be automatically transferred to regular Medi-Cal when the law goes into effect. For that reason, experts are encouraging parents to sign their kids up for restricted Medi-Cal now.
Kids in other programs may have to submit an application to Medi-Cal or will be transferred by their plan.
Many counties offer programs that are open to those without legal status that are paid for with taxpayer dollars, foundation grants and other private funding, according to the California Coverage and Health Initiatives, which helps organize many of these programs.
Los Angeles County’s My Health L.A. program, which provides primary care coverage for people who are not eligible for insurance, has about 10,000 kids age six and up enrolled, said Amy Viste, of My Health LA.
Kaiser Permanente also offers a program, known as Kaiser Kids, that provides free or low-cost insurance for kids from low- to middle-income families who do not qualify for other insurance, according to a Kaiser spokeswoman.