In the past few months, Maria, a 55-year-old caregiver for the elderly in Orange County, has been trying hard not to smile.
She is worried that if she opens her mouth too wide, people will see her chipped and plaque-covered teeth. An undocumented immigrant, Maria does not have medical or dental insurance. When her teeth start to ache, she takes painkillers. Last summer, a dentist told her that fixing her teeth would cost $2,400. It’s more than she can afford.
"It’s very expensive," said Maria, who typically works 12-hour days helping clients with their daily activities. "I need money for my children, for rent, for transportation, for food. Sometimes, I have nothing left for myself."
An immigrant worker advocacy organization connected KFF Health News with Maria. Due to fear of deportation, she requested that only her first name be used in this article.
Maria is among the 2.6 million immigrants living in California without legal status, according to federal government estimates.
The state had been gradually incorporating these immigrants into its Medicaid program, known as Medi-Cal.
But now, with the freezing of state enrollments, low-income California residents without legal status, along with the providers and community workers who assist them, are weighing the benefits of moving forward with Medi-Cal applications against the risks of being discovered and deported by the federal government.
The California Legislature, aiming to close a projected $12 billion budget deficit, approved a proposal by Democratic Governor Gavin Newsom to end Medi-Cal enrollment for those over 19 without legal status by January 2026. Lawmakers are finalizing the details of the budget agreement before the new fiscal year begins.
Meanwhile, federal immigration raids, which appear to have impacted at least one health clinic in the state, are already causing some people to fear seeking medical care, according to immigrant advocates and health providers.
The recent news that Trump administration officials are sharing Medicaid beneficiary data, including immigration status, with immigration authorities is expected to further erode confidence in the program.
Andrew Nixon, a spokesman for the U.S. Department of Health and Human Services (HHS), stated that the agency, which oversees the Centers for Medicare and Medicaid Services (CMS), had the legal authority to share the data to address "unprecedented systemic neglect under the Biden-Harris administration, which allowed undocumented immigrants to exploit Medicaid while millions of Americans struggled to access healthcare, particularly in states like California."
To make matters worse, the Trump administration has threatened to withhold funds from states that offer medical coverage to people without legal status.
Currently, around 1.6 million undocumented individuals are enrolled in Medi-Cal.
In 2016, California began expanding Medi-Cal to low-income individuals without legal status, starting with children, and then gradually expanding to young adults, seniors, and, in January of this year, individuals aged 26 to 49. The state’s Department of Health Care Services, which oversees Medi-Cal, partnered with community health clinics to help enroll eligible individuals.
It is too early to determine the impact of the latest state and federal actions on enrollment figures, as data is only available through March. However, many providers and advocates said they anticipate a negative effect on immigrant enrollment due to fear.
Sepideh Taghvaei, dental director of Dientes Community Dental Care in Santa Cruz County, witnessed this phenomenon in 2009 when the state cut dental benefits for Medi-Cal adults. Patients would arrive with swollen faces and unbearable pain, with conditions so advanced that they required hospital treatment. "It’s not cost-effective," she said.
State Senator Roger Niello, a Republican and vice-chair of the Senate budget committee, believes that California should not fund Medi-Cal for people without legal status, especially considering the state’s fiscal challenges. He also expressed concern that providing coverage to undocumented individuals may encourage others to move to California.
The Californians are also changing their minds. In a May survey conducted by the Public Policy Institute of California, 58% of adults opposed the benefit.
For Maria, the changes in healthcare policies have left her paralyzed. Since arriving in the country five years ago, her priority has been to earn money to support her three children, whom she left with her parents in her home country.
She only learned that she might be eligible for Medi-Cal earlier this year and had not had time to complete the paperwork. After a friend told her that the state might freeze enrollment in January, she began to hurry to complete the enrollment process.
But then she learned that Medi-Cal data had been shared with immigration authorities. "Disappointed and scared," is how she described her reaction.
Suddenly, signing up for Medi-Cal no longer seems like a good idea, she said.
Phil Galewitz and Bram Sable-Smith contributed to this article.
This story was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
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