Gregoria works in the fields in Contra Costa County and makes $16 an hour. She became eligible for Medi-Cal in 2022 when it was expanded to adults 50 and older regardless of their immigration status. Gregoria said it saved her life. She had a severe shoulder tendon injury and lived in pain at the time. She was finally able to get her shoulder checked out and eventually had surgery.
“If I hadn’t had Medi-Cal, I would have lost my arm, practically,” Gregoria said in Spanish. She asked to withhold her last name because of her immigration status.
She’s the only breadwinner in her household of four and having Medi-Cal has allowed her to receive regular check-ups, which she finds reassuring. “It means being able to lie down and sleep peacefully without thinking about or enduring pain in my arm, my shoulder, sometimes in my back,” Gregoria said. “It’s a peace of mind, not to have the stress of not being able to go to a doctor because we can’t afford it.”
But this source of relief is now a worry for Gregoria, as federal and state budget cuts may jeopardize her health and that of other undocumented immigrants.
The convergence of President Trump’s sweeping federal health care cuts and California’s budget crisis threaten recently expanded health care access for undocumented immigrants.
The “Big Beautiful Bill” signed into law by President Trump on July 4 imposes approximately $1 trillion in federal Medicaid cuts over the next decade. At the same time, it penalizes states that provide health care coverage to undocumented residents.
California, facing its own $12 billion budget deficit, passed legislation in June that freezes enrollment for undocumented adults in Medi-Cal, California’s Medicaid program, starting in January 2026. People who are already enrolled will continue to be eligible but must pay a $30 monthly premium starting in July 2027. Undocumented immigrants who are 19 and older will lose their Medi-Cal dental benefits on July 1, 2026.
The federal legislation specifically targets states like California that have used their own funds to extend health care coverage to undocumented immigrants. Under the new law, states providing such coverage will see their federal Medicaid expansion matching rate reduced from 90% to 80%. The penalty alone could cost California billions in lost federal funding, forcing the state to choose between maintaining immigrant health care programs or absorbing massive budget shortfalls.
These changes come less than two years after California made national headlines by becoming the first state to offer full-scope Medi-Cal to all low-income adults, regardless of immigration status. Last year’s expansion was the final phase of an eight-year effort to extend Medi-Cal to undocumented immigrants, as part of the state’s initiative to expand health care access to all Californians.
Over time, premiums and an enrollment freeze could result in more than 1 million fewer immigrants with Medi-Cal, according to a report from the UC Berkeley Center for Labor Research and Education.
Lawmakers and Newsom argued that Medi-Cal cuts were necessary to close the state’s $12 billion budget deficit, especially in light of rising health care costs and soaring enrollment in recent years.
But advocates including Ronald Coleman Baeza, Managing Director of Policy at California Pan-Ethnic Health Network, say the legislature could have done a number of things to protect immigrant communities from these cuts, like increasing taxes on the wealthy and corporations. Those options were not considered, he added. “I think that this population was in many ways sacrificed,” he said.
Approximately 1.6 million undocumented immigrants are enrolled in Medi-Cal, many of them working in low-wage, high-risk industries such as agriculture, hospitality and elder care – sectors critical to the state’s economy.
Starting in January 2026, the enrollment freeze will mean that undocumented people who are not already participating in Medi-Cal won’t be able to enroll. They’ll only have access to Emergency Medi-Cal, also known as restricted-scope Medi-Cal, which covers life-threatening conditions or emergency hospitalizations, but not routine care such as checkups, cancer screenings or chronic disease management.
Emergency rooms will be affected significantly, according to Carlos Alarcon, Health & Public Benefits Policy Analyst at California Immigrant Policy Center. “What we’re going to see is individuals foregoing preventative care, waiting for their conditions to be severe enough to be able to get emergency services,” Alarcon said.
In Gregoria’s case, a $30 monthly premium coupled with a minimum wage salary means she may have to choose between paying a new monthly bill or buying food for her family. “I have that fear of not being able to pay it, and then having it taken away because I can’t afford it,” she said.
She’s worried she’ll need to self-diagnose or put up with pain as she once did.
All Bay Area counties, including San Francisco, Contra Costa, San Mateo and Santa Clara, will still provide some health care to people without insurance regardless of immigration status, as long as they meet income requirements.
In Alameda County, undocumented residents can enroll in HealthPAC, the county program that provides affordable health care to people without insurance, which is available to low-income individuals who don’t qualify for Medi-Cal. “Our agency and health partners are committed to serving all members of our community,” said Alameda County Health Interim Director Aneeka Chaudhry.
The federal bill also includes mandatory work requirements of at least 80 hours a month for adult Medicaid recipients 19 years and older that will start as early as January 2027. The elimination of federal funding for people with “unsatisfactory” immigration status, such as undocumented individuals, is effective in 2026.
Once these changes are fully implemented, health policy experts warn, they will dramatically reduce state Medicaid funding and enrollment, forcing states like California to either absorb the costs or cut services.
Advocates and experts advise that immigrants currently enrolled in Medi-Cal should continue accessing their health care, including preventive and urgent care, and get any necessary dental work done before July 1, 2026.
“We hope that policymakers continue listening to their communities and provide opportunities for the communities to share their needs and experiences, and to explore co-creating solutions,” Chaudhry said. “There’s so much going on, and it’s important we keep all of our community members in mind as we navigate the major changes that are happening.”
