One afternoon this past January, Felicitas was selling natural food products at La Pulga, an open air market in East Oakland, when she noticed her left eye was covered in blood.
Eye hemorrhages are usually not a sign of serious underlying health issues, but Felicitas, 51, had a pacemaker, which was implanted in her chest after she suffered a stroke.
The incident happened a year after she lost her health coverage through Medi-Cal, the state’s Medicaid insurance program, for making $300 over the eligibility limit. Because she is undocumented, Felicitas, who is originally from Mexico and has asked the newsroom to identify her by first name only due to fears of retribution from immigration officials, could not purchase insurance through Covered California, the state’s health insurance marketplace. So, on the day when her eye bled and she feared she was having a second stroke, she had no choice but to head to the emergency room at Highland Hospital.
Doctors didn’t find anything serious and discharged her within hours that day. But in July, she opened the mailbox to find a medical bill totaling $5,262.72.
“I was shocked,” she said in Spanish. “That’s a fortune! How am I going to pay for it when my income is less and less?” This month Felicitas, who is a housekeeper, found out that her medical debt had gone to collections.
She is now facing an impossible conundrum: earn less to regain her health coverage, or keep the paycheck she depends on and live without health insurance.
And the clock is ticking. Starting in January 2026, she will be permanently locked out of state-sponsored insurance as California will freeze new enrollments to Medi-Cal, California’s version of Medicaid, for adults 19 or older who are undocumented, and for a range of other immigrants with varying degrees of status, including TPS holders, asylum applicants, juveniles with a pending special immigrant juvenile status, and people with a work or student visa who are over 20.
In July, 2027, the state will also add a monthly premium of $30 for undocumented and some lawfully-present immigrants, halting a decade of programs that had made health care for low-income immigrants accessible.
Health advocates and providers fear that without health insurance coverage, immigrants, who are more likely to be uninsured and have chronic-disease conditions such as diabetes and hypertension, would delay care, rely on emergency services, and incur medical debt. Over time, premiums and the enrollment freeze could result in more than 1 million fewer immigrants with Medi-Cal insurance, according to a report from the UC Berkeley Center for Labor Research and Education.
“We have greatly appreciated how much leaders have stood up to ICE and stood up to the uptick in deportations for immigrant communities. But at the same time, these are the same policymakers that are making decisions to take away their healthcare,” said said Ronald Coleman-Baeza, Managing Director of Policy at the California Pan Ethnic Health Network.
In May, Gov. Gavin Newsom signaled that he would be scaling back coverage for undocumented and other immigrants, saying that the state overestimated enrollment, and that it needed to cut benefits for some in order to maintain broader services. The state is also trying to close a $12 billion budget deficit. The freeze is expected to save the state $78 million through next year, and up to $3.3 billion annually beginning in 2028.
In anticipation of the new changes, experts and community clinics are turning to local county governments to step in and serve a dual purpose: help those still eligible for Medi-Cal stay enrolled to avoid losing coverage, and find ways to keep pace with what may soon be a growing number of uninsured immigrants. But, with the approved federal cuts under President Donald Trump’s reconciliation bill, these local agencies will attempt to do so as they face shrinking budgets.
A final line of defense when there’s nowhere else to turn
When Felicitas learned she could not re-enroll in Medi-Cal because of her income, she tried to apply for an Alameda County program which helps uninsured residents, including undocumented immigrants, receive limited care. But after filling out paperwork, and going back and forth with the county, she said she was told that she made 25 cents too much for even this basic medical care.
“I would have to live under a bridge to get health insurance that at least covers emergencies,” said Felicitas who said she and her husband paid $6,000 in state and federal taxes this year. “It makes me sad because for everything we do, we pay taxes on.” She is considering lowering her work hours to qualify for the county program, but she plans to first apply to Kaiser Permanente’s charity-care program in November.
In California, counties are required by law to provide last-resort care for residents who have nowhere else to turn. These safety-net programs serve people who make a little too much to qualify for subsidized insurance coverage. They serve them mostly through county clinics and hospitals, or contracted providers. While they are not insurance plans, they offer low-cost preventative care, referrals, and mental and dental services.
For years, those county systems were one of the state’s key lines of defense for the uninsured. That changed after the Affordable Care Act expanded Medi-Cal, cutting the uninsured rate nearly in half, from 15% to 8% in 2024. As a result, county dollars for the safety net programs were shifted to help the state run the Medi-Cal program, which over time broadened to include undocumented immigrants, beginning with children in 2016 and gradually adding, younger, older and all adults regardless of immigration status through last year.
Bay Area counties such as Alameda, Contra Costa, and San Francisco currently care for a small pool of uninsured residents. In Contra Costa, the Basic Health Care program enrolled only 39 undocumented residents as of June, while more than 30,000 low-income undocumented residents were covered by Medi-Cal during the same period, according to state and county data El Tímpano reviewed. Contra Costa spent $100,000 providing care for all uninsured residents last year, and it was mainly paid for with the county’s hospital enterprise fund, a county spokesperson said in an email.
Now, as the number of uninsured is expected to climb again, counties could be asked to step back in with fewer resources than before.
“If the state is now giving the responsibility for some of the uninsured back to counties, where’s the money going to come from?” said Len Finocchio, an expert on Medicaid and programs for the uninsured. He was appointed by Gov. Jerry Brown to help California implement the Affordable Care Act expansion.
No new funding has been proposed by the state for local health departments that are likely to see more uninsured patients in their clinics, said Griselda Meldoza, a spokesperson from the California Department of Health Care Services. In addition to the state deficit, federal dollars are also going away soon. Trump’s July reconciliation bill cut nearly $1 trillion in Medicaid funding over the next decade, which for California could mean a loss of up to $20 billion a year. The bill penalizes states that provide health care coverage to undocumented residents by reducing federal matching funds, and it restricts coverage for many lawfully-present immigrants, including refugees and asylees (those who have already been granted asylum).
“We’re seeing how Republicans in Congress are trying to find ways to expand the categories of non-qualified immigrants, which would then mean that California would lose dollars that it gets today,” said Coleman-Baeza.
Many uninsured immigrants will also be caught in between programs, as each county has different eligibility rules, leaving gaps even for those willing to pay something for care. In Alameda county, applicants must earn between 138% to 200% of the federal poverty line, be over 19, and be ineligible for Medi-Cal. While in Contra Costa, the county caps coverage between 138% to 300% of the poverty line and covers all ages. Ten counties, including Sacramento, exclude undocumented immigrants from their programs for the uninsured, according to a 2025 issue brief by the California Health Care Foundation.
Finocchio said counties could widen eligibility to include immigrants who lose Medi-Cal coverage, but that’s a tough sell. “So long as Medi-Cal is [still] open to undocumented populations, I think they will be reluctant to change their eligibility requirements,” he said. “They’ll say…let’s just make sure you’re enrolled in Medi-Cal.” Counties that cover undocumented residents could also draw scrutiny from the Trump administration, which has been investigating states that offer health care coverage for undocumented immigrants, alleging waste, fraud, and abuse.
“What we’re seeing so far from the federal government is that they’re very vindictive,” he said.
Contra Costa and Alameda county health officials said they’ll continue serving immigrants who qualify for their programs next year but would not say whether they plan to adjust eligibility. Contra Costa, which included undocumented residents in its program just two years ago, said it is focusing on expanding first-time visits, well-child exams, preventative screenings, and shorter wait times.
The next challenge isn’t just treating those without coverage, it’s keeping low-income immigrants who are already enrolled in Medi-Cal from falling off the rolls altogether because of missed paperwork or additional costs, said Finocchio.
‘¡Apúrece!’
Claudia Rodríguez-Briones, community health education department manager at La Clínica de la Raza in Oakland, has spent 26 years helping immigrants navigate California’s safety-net clinics. She said she chose the phrase ‘¡Apúrece!’ or ‘Hurry up!’ as the name of the clinic’s campaign to encourage all low-income immigrants across Alameda county to sign up for Medi-Cal by Dec. 31—the last day for all low income immigrants regardless of status to enroll for Medi-Cal before the freeze—because it conveys a sense of urgency, warning them to act before coverage slips away.
“If you don’t have health insurance, apply before December 31. If you have health insurance, make sure you know when you can renew it,” said Rodríguez-Briones.
With funding from the Alameda County Public Health Department, La Clínica is working with immigrant-rights groups, including one serving Maya-Mam residents, and local media, to reach as many people as possible through outreach events, canvassing, and online training.
Though anxiety over immigration deportations lingers, Rodríguez-Briones said, most encounters end with relief. “People come to us, they come with questions, saying ‘please, help me fill out this form, I want to apply for Medi-Cal again,’” she said.
Educating immigrant families about the policy changes has become just as important as enrollment itself, she said. Many remain unaware that the Medi-Cal rules are shifting or about the steps they need to take to qualify for other local programs. When it’s time to renew their insurance, she said, many don’t receive any notice about the paperwork they have to fill out. Missing this crucial step now may have devastating consequences, as low-income immigrants who are eligible will only have 90 days after Jan. 1, 2026, when California freezes new enrollments, to fix the problem and keep their insurance. Otherwise, they will be permanently locked out.
Enrollments for undocumented children and pregnant women will not freeze. All groups will remain eligible for limited Medi-Cal, which covers emergency care, pregnancy-related care, and nursing home care.
Roughly 1.6 million undocumented immigrants have enrolled in state-sponsored health insurance coverage since the expansion began. Counties, which are in charge of enrolling people to Medi-Cal and renewing the benefit, must do everything in their power to keep people enrolled, said Coleman-Baeza.
A matter of time
At the César E. Chávez library in Fruitvale, Felicitas logs onto her iPhone to join a group of people in their 50s who meet weekly to talk about strategies to stay healthy.
“Write down why you want to do well,” the instructor says in Spanish from Tepic, Mexico, before offering tips to boost the immune system and improve sleep. The suggestions include a list of natural products the instructor sells in Mexico and the United States.
Felicitas pays $35 a month for these classes, which, for now, have replaced routine medical visits. In March she needed to see a cardiologist to ensure the pacemaker she has in her chest has enough battery. But because she is uninsured, she worried about the high cost of paying for the visit completely out of pocket and did not see the specialist. Instead, she uses a wrist monitor to track her heart rate and oxygen levels.
Some days that brings anxiety and headaches, she said. She still earns too much to qualify for Medi-Cal. “I’m concerned about this more than anything else,” she said. “It seems illogical to me to pay taxes and not qualify for any type of health insurance.”
Without a primary care doctor, she has even swapped her prescription pills for extracts and powders that she hopes will “burn fat in the arteries.” She also follows a strict diet of home-made spinach, apple and lime smoothies, pan-fried chicken breasts, long walks, and daily garlic and oregano oil extracts.
Still, Felicitas, who hasn’t been able to pay off her medical debt, knows that if her heart falters again, there’s only one place she can turn.
“I might have to go to the emergency room again,” she said. “It’s a matter of time.”
Note: El Tímpano’s civic engagement team supported La Clínica de la Raza’s ¡Apúrece! campaign as a paid partner with outreach to our SMS subscribers. Such partnerships in no way influence El Tímpano’s journalism.
