How will providers be affected by California’s new coverage of undocumented immigrants?

The change, which took effect on New Year's Day, allows those ages 26 to 49 to enroll in the state's health insurance system of last resort regardless of immigration status. The move by Gov. Gavin Newsom fills the remaining age gap in the coverage picture. In 2020, California expanded Medi-Cal access to undocumented immigrants age 26 and younger and took the same step in 2022 for those age 50 and older.

Political support for these moves has been largely divided along party lines, with Democrats generally supporting the governor and Republicans often saying the cash could be better spent on American citizens. San Diego County Supervisor Jim Desmond, for example, said in a statement released Tuesday that he would halt the expansion.

"Our local resources are meant to address our community's needs, not fund services for those who have just entered our country," Desmond said. "If the Federal government chooses to allow migrants into our country, they should foot the bill. Not our residents."

Local medical providers, however, have a more pragmatic view.

In an email, Chris Van Gorder, chief executive officer of Scripps Health, noted that hospitals and doctors offices have never had the option of sitting on the sidelines when those without immigration papers need care.

"We are already treating undocumented migrants," Van Gorder said. "Any expansion of Medi-Cal eligibility that provides payment for patients we are already caring for is a good thing.

"But sadly, the state has not increased hospital base rates for Medi-Cal in a decade, so Medi-Cal does not even cover the cost of care."

According to the American Hospital Association, hospitals in the United States, on average, "received payment of only 88 cents for every dollar spent" caring for patients in 2020.

For Medicaid, hospitals received payment of only 88 cents for every dollar spent by hospitals caring for Medicaid patients in 2020.

Sharp HealthCare said in its own statement Wednesday that the expansion may help, rather than hurt crowded emergency departments. Many in the 26-to-49 age bracket do qualify for restricted Medi-Cal benefits if they are suffering an emergency or if they are ready to give birth and they reside in San Diego County.

The hope, Sharp said, is that covering those in their mid-20s to late 40s will allow much care to be handled in clinics rather than emergency departments. Medi-Cal requires its enrollees to pick a health management organization to administer their benefits, assigning a "medical home" that allows for routine care outside hospitals.

"What will change is the ability to secure full scope benefits (vs. restricted) for undocumented residents," Sharp said. "In theory, these individuals would enroll in an HMO and would be eligible for preventive care and scheduled services (infusion therapy, for example), encouraging continued care in the lower cost care settings.

"With this change, undocumented immigrants who had to wait until their condition warranted a visit to the ED would be able to receive concurrent care and hopefully avoid a future ED visit or hospitalization."

According to the state, about 700,000 adults age 26 to 49 are affected by the expansion. It is unclear, said Rick Wanne, director of self sufficiency services for San Diego County, exactly how many of those reside in San Diego County; however, about 34,000 people who had previously received restricted Medi-Cal coverage while receiving emergency care were transitioned to full-scope benefits on Jan. 1.

This story originally appeared in San Diego Union-Tribune.

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