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Providing Health Care to Undocumented Residents: Program Details and Lessons Learned from Three California County Health Programs

October 4, 2016

While the number of people without health insurance has declined dramatically since the Affordable Care Act went into effect, undocumented immigrants continue to be excluded from many health coverage options under this law. In California, approximately 1.8 million individuals are projected to remain uninsured due to their immigration status. Without resources to pay for costly health care, undocumented immigrants may delay care and eventually seek treatment in the emergency room or go untreated entirely. Undocumented adults in California are generally eligible for only emergency and pregnancy-related services through Medi-Cal, the state's Medicaid program, though undocumented children and those granted deferred action may be eligible for full-scope Medi-Cal. Many of California's counties provide primary and preventive health care services to low-income undocumented residents through safety-net programs. These programs are of interest to advocates and policymakers in other states who are looking for local solutions to offer non-emergency health services to undocumented immigrants. This report profiles three county programs that offer health care services to undocumented residents and aims to serve as a resource for designing and implementing similar programs elsewhere across the nation. It is based on interviews with county program staff, statewide informants, provider organizations, consumer advocacy groups, and published reports and documents gathered in June and July of 2016. This report will present a brief history, basic enrollment and eligibility information, and available cost and revenue data for each of the highlighted county health care programs, and then describe lessons learned about building provider networks, engaging in outreach and enrollment, and evaluating the program.

Preliminary Regional Remaining Uninsured 2017 Data Book, California Simulation of Insurance Markets (CalSIM) version 2.0

August 11, 2016

This data book provides estimates of the remaining uninsured in California in 2017 by Covered California rating region and for large counties using a preliminary version of the California Simulation of Insurance Markets (CalSIM) model v 2.0.

Medi-Cal Expansion under the Affordable Care Act: Significant Increase in Coverage with Minimal Cost to the State

January 1, 2013

Since 2011, California has been taking steps towards expanding Medicaid under the Afordable Care Act (ACA) by implementing Low Income Health Programs (LIHPs) in most California counties. Under the "Bridge to Reform" Medicaid §1115 waiver, just over 500,000 California adults are currently enrolled in coverage in advance of ACA implementation using federal and county funds. he vast majority of these LIHP enrollees can become eligible for Medi-Cal coverage under the ACA beginning January 1, 2014, and the remainder will be eligible for subsidies through Covered California (the California Health Benefit Exchange).In early 2013, California legislators will consider bills to implement a key provision of the ACA that would expand Medi-Cal to low-income adults under age 65, including those without children living at home. Lawfully-present childless adults with income up to 138 percent of the Federal Poverty Level and parents with income between 106 percent and 138 percent of the Federal Poverty Level will be newly eligible. Some unenrolled children and parents who are already income-eligible for the program under existing eligibility rules could also enroll due to the minimum coverage requirement to obtain insurance created by the ACA, improved eligibility, enrollment and redetermination processes, and enhanced awareness of coverage options.In this report, we estimate the growth in Medi-Cal enrollment among both the newly and already eligible using the UC Berkeley-UCLA California Simulation of Insurance Markets (CalSIM) model. We discuss the broader impact of the Medi-Cal Expansion in terms of health outcomes, providers and the economy. We estimate the federal and state spending on increased Medi-Cal enrollment, along with the state tax revenues generated by new federal Medi-Cal spending and potential savings in other areas of the budget.