Unauthorized immigrants could lose health care in states : NPR

Democratic governors in states offering health insurance coverage for immigrants without legal status are proposing to roll back coverage that they signed into law.

As states grapple with budget holes, efforts to limit access to the programs are becoming a common thread. Debates about rolling back coverage or eliminating it entirely come as Congress considers a proposal that would reduce state Medicaid funds from 90% to 80% if they offer health insurance coverage to immigrants without proper authorization.

California 

On Wednesday, Gov. Gavin Newsom announced that he wants to freeze new enrollments for unauthorized people 19 or older on Medi-Cal, California’s insurance plan for lower-income people, and charge a $100 monthly premium starting in January 2026. There would be exceptions for pregnant people and emergency care.

“I don’t want to be in this position, but we are in this position,” Newsom said.

California expanded Medi-Cal to include all adults without legal status in 2024, and 1.6 million immigrants in California currently receive health insurance through the program. Under the proposal, those already enrolled by year’s end would still be eligible for coverage, but other adults without legal status couldn’t enroll.

Republicans, who were against the program’s expansion from the start, have criticized Newsom for continuing to spend on coverage under his latest proposal.

“The governor showed his priorities,” said California Assembly Minority Leader James Gallagher, a Republican. “He wants to continue to spend on health care for illegal immigrants. Billions and billions of dollars.”

The Democratic governor also faces pushback from state lawmakers in his own party, including members of the Latino Caucus in the Legislature, who say they’ll fight to maintain some form of coverage for those without legal status during the final month of budget negotiations.

“We can look at options for budget cuts elsewhere,” said Democratic state senator Lena Gonzalez, who chairs the Legislative Latino Caucus. “We can be a little bit more mindful of how we do this without always having to look at our most underserved communities.”

Experts, lawmakers, and Newsom point out that the state pays for coverage either way. Those without health insurance often seek care in emergency rooms, so some lawmakers and advocates initially pushed for expanding access so people could have regular care, like doctor’s visits and prescription medications.

In states where lawmakers granted Medicaid access for undocumented immigrants, hospital administrators and faith groups, along with immigrant advocates, have helped push for the expansion of benefits.

Minnesota

That’s true in Minnesota, where the proposal to strip the state’s health insurance coverage for adults in the country without authorization emerged as part of a compromise budget framework.

That drew immediate opposition from some Democrats and immigrant advocates.

Thursday, a group of Democratic lawmakers banged on the door to the room where Gov. Tim Walz, a former vice presidential candidate, was laying out his budget plan with legislative leaders.

They yelled out, “You’re killing our communities,” and said they would vote against the provision to make adult immigrants without legal status ineligible for MinnesotaCare, the state’s Medicaid program, in 2026. Under the proposed budget, children would still be eligible for coverage.

In 2023, Democrats passed a bill granting all people in the country without legal status access to state-funded health coverage and Walz signed it. The program took effect in January, and more than 20,000 people without legal status have enrolled, including about 3,000 children.

Walz and Democratic legislative leaders said they opposed the change but had to accept it as part of a budget framework. The state Legislature is nearly split, with 101 Democrats and 100 Republicans, so they said they needed to accept the proposal that was a priority for GOP lawmakers.

“I’m not going to sugarcoat how difficult this was,” Walz said as lawmakers pounded on the door outside his news conference. “We didn’t expect everybody to be happy in this; I think many of us compromised.”

State House Speaker Lisa Demuth, a Republican, agreed that it was a compromise that could help plug a projected $6 billion budget deficit over the next four years.

“It’s not a measure of being uncaring. It’s a fiscal issue, and there are still opportunities,” Demuth said. “They can still join the private market, so it’s not that health care is being denied in any way,” she added. “We had to make hard decisions in that room, and when we looked at numbers and we looked going forward, this was a compromise that we were all able to come to any negotiation. No one walks out completely happy.”

Some Democratic lawmakers who fought for the program say they’ll oppose the rollback. Without their votes, the measure in a broader health budget bill could stall.

“Although we protected the children, which is a very noble thing to do, those children will lose moms, dads, grandfathers, aunts, uncles, siblings,” said Rep. Cedrick Frazier, a co-chair of the Minnesota People of Color and Indigenous Caucus. “That is what we are faced here with today.”

If Minnesota lawmakers can’t pass a budget before July 1, they could face a state government shutdown.