California has been making strides toward ensuring that all populations have access to health coverage. In 2021, Governor Newsom proposed, and the legislature enacted, an expansion of full-scope Medi-Cal to older adults age 50 and over regardless of their immigration status. This builds on California’s previous Medi-Cal expansions to children in 2016 and young adults in 2020 regardless of immigration status. The older adult expansion will go into effect on May 1, 2022. It is estimated that 235,000 individuals will be eligible under this health coverage expansion.

Under the expansion, eligible individuals will be able to receive full-scope Medi-Cal benefits. This includes a broad range of services including outpatient services, emergency services, hospitalization, mental health and substance use disorder services, prescription drugs, transportation, podiatry, physical and occupational therapy, laboratory services, preventive and wellness services, chronic disease management, dental care, in-home services and supports, and vision and hearing services. Currently undocumented immigrants are only eligible for restricted scope or “emergency” Medi-Cal which includes pregnancy-related services and emergency services. Because undocumented immigrants are not eligible for the program under federal Medicaid rules, these limited services are the only ones that may receive matching funds from the federal government. California is able to expand full-scope Medi-Cal to this new older adult population because the state is exclusively using state funds to finance it.

Although this population is not eligible for full-scope Medicaid until May 1, individuals who aren’t already enrolled may sign-up for restricted scope Medi-Cal now. DHCS will automatically transition anyone who is age 50 and over in restricted scope Medi-Cal to full-scope Medi-Cal on May 1. For more information about the expansion, you can view a recent webinar held by the National Health Law Program and other advocacy groups.

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What are potential barriers to successful implementation? 

• Fear of Public Charge: Although the Biden Administration quickly reversed the chilling Public Charge rule promulgated and finalized by the previous administration, the rule has had a lasting effect on immigrants throughout the United States, keeping them from signing up for public benefit programs like Medicaid. Unless a person needs institutional long-term care services, Medi-Cal does not count towards a public charge determination.

• Outreach: Outreach funds were not included in the budget to implement the expansion, yet community outreach is a critical component to finding, educating, and enrolling this older adult population into Medi-Cal. The Department of Health Care Services (DHCS) plans to use navigators from the Medi-Cal Health Enrollment Navigators Project to reach and enroll eligible older adults, but funding for the navigators ends June 30, 2022 and there are no plans to continue the project. For more about the work of Medi-Cal navigators in one area of the state, you can read a report that Transform Health co-authored with the Sierra Health Foundation.

What’s next?

DHCS will begin to mail out notices and an FAQ to 244,000 potentially eligible older adults informing them about the expansion the week of March 7. As more information becomes available, you can find it on the Older Adult Expansion page of the DHCS website.

Later this year, we hope to report on more exciting and groundbreaking Medi-Cal expansion news. Governor Newsom proposed expanding full-scope Medi-Cal to adults ages 26-49 regardless of immigration status beginning in 2024. If the legislature passes the initiative in this year’s budget, California will achieve universal healthcare coverage.

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If you would like to learn more or work with Transform Health, please contact Heather Bates at heather@transformhc.com.