Maria is a meticulous woman. She’s organized, brushes her teeth after every meal, counts her calories, works out daily with her son—she tries to control what she can. But as in all things with life, even our own health can’t be completely controlled. A few years ago, she began to feel an intense abdominal pain but avoided going to the doctor because it was too expensive for her.
Eventually, the pain was too much for her to handle and she conceded. Maria was told it was a hernia. Hernias left untreated are incredibly dangerous; they can become strangulated, resulting in necrotizing enterocolitis (severe inflammation of the intestine) and sepsis. She needed surgery, the sooner the better.
Meticulous Maria put forth a savings plan because, like half of the undocumented immigrants in the United States, she was uninsured. As an undocumented woman raising a young boy completely alone, she didn’t have any options but to work and hope she could save enough money before it was too late. She had been saving for a full year when she received a letter from Medi-Cal that would change everything.
It is estimated that there are 1.8 million undocumented immigrants in California (as of 2022). Immigrants who go to work, pay taxes and contribute to society everyday, people trying to live better lives beside you. Immigrants contribute to our economy without being able to partake in the fruit of their labor. Yet, in 2022, undocumented immigrants in California contributed $8.5 billion in state and local taxes.
Many immigrants are working to the bone, avoiding doctors for their aches and pains, because they can only afford vapor rub and prayers. In recent years, California has taken steps to change that.
Access to Medi-Cal for undocumented individuals in this state has gradually expanded. In 2015, children aged one to 18 became eligible. By 2019, young adults ages 19‒25 were included. In 2022, adults ages 50 and older gained eligibility, and this year, the program further extended to cover adults ages 26‒49. This momentous change has made California the first state to offer medical insurance to all its low-income residents, including undocumented immigrants.
At age 33, Maria (or Mari as her friends call her) wasn’t in any qualifying age groups and hadn’t even considered applying. “I didn’t even apply. It was offered to me. I had even spent a year already saving up for the surgery.”
She had received a letter in the mail in November 2023 after her nurse had told her to look into a new law extending the qualifying ages in 2024. In December, she was approved and by early January she received her Medi-Cal card. The same card he’d get to use later that month to cover her surgery.
She went on to explain how life-changing that was. She had not been close to saving the amount she needed, but this money would now cover bills for the three weeks she wasn’t able to work to recover from surgery.
Another immigrant, who asked to be called Veronica Ruiz, had a slightly different experience with Medi-Cal. Ruiz is a 56-year-old undocumented immigrant from Mexico. She’s lived in the Central Valley for more than two decades, raising her now adult son and daughter on her own.
She has battled with diabetes for more than half her life and almost lost that battle about 10 years ago. At that time, she didn’t qualify for Medi-Cal and had heard that signing up for these types of benefits could endanger her with ICE (Immigration and Customs Enforcement) or even ruin her chance at ever obtaining a green card in the future. This is part of the confusion that surrounds “public charge.”
What exactly is a public charge?
The public charge rule is used to determine whether a noncitizen applying for a visa, admission or adjustment of status in the United States will likely become dependent on government support and resources.
If the government believes you are likely to depend on public assistance, the application can be denied.
What falls under public charge has varied and changed because the term is so broad. Receiving cash assistance for income maintenance, such as Supplemental Security Income (SSI) or Temporary Assistance for Needy Families (TANF), and long-term institutionalization at government expense would be considered a public charge.
Other factors t such as age, health and income are considered. Some groups are exempt such as green card holders, humanitarian immigrants, crime victims and individuals with specific visas or statuses, such as U or T visas, and asylum seekers.
Notably, benefits such as health, food and housing assistance, as well as Covid-related services, are not considered under this rule anymore.
Back in 1999, the Department of Justice sought clarity for the definition of public charges and suggested that immigration officers should not hold non-cash public benefits (other than institutionalization) with much importance when reviewing an undocumented immigrant’s admissibility or eligibility.
However, in 2019, the Trump administration broadened the public charge rule, adding health, nutrition and housing programs previously excluded from consideration. The new regulations redefined a public charge as an “alien who receives one or more public benefits for more than 12 months in total within any 36-month period,” with multiple benefits in a single month counting as separate months.
This was a significant change that terrified and confused undocumented immigrants. The rule would also establish a set of negative factors, such as having previously received any public benefits for more than 12 months within the previous 36 months and an income below 125% of the federal poverty level. These factors increased the likelihood of an individual being deemed a public charge.
These changes rightfully terrified immigrants across the United States. “A 2021 KFF survey of Hispanic adults found that 1 in 4 potentially undocumented Hispanic adults and over 1 in 10 lawful permanent resident Hispanic adults reported that they or a family member did not participate in a government assistance program in the past three years due to immigration-related fears.”
Now, the rules have changed again, and Trump’s changes were revoked in 2021. The Biden administration worked to codify the 1999 version, so that these types of benefits could not prevent someone from getting their green card in the future. Receiving Medi-Cal will not endanger you either, as California does not give your Medi-Cal info to ICE.
For more than a decade of Ruiz’s life here, she did not go to the dentist (resulting in various cavities and a chipped tooth) and only went to her local family healthcare center (which offered reduced pricing for low-income individuals without insurance) whenever symptoms became too overwhelming.
One night, she began feeling an incredible stomach pain that did not dissipate for three days. An acquaintance drove Ruiz to the emergency room. Ruiz had developed acute pancreatitis and would remain hospitalized for several days.
Her family was advised that an organ failure had begun and there was a real possibility she would not survive. “When I was finally being discharged, I told my nurse, ‘I survived the pancreatitis, but I don’t think I’ll survive the bill.’”
She was now meant to pay more than $13,000 in medical bills and would need further expensive treatment she could not afford. Yet again, a nurse came to the rescue, suggesting Ruiz apply for emergency Medi-Cal that would be granted to undocumented immigrants in severe cases at the time.
She was granted Emergency Medi-Cal, which helped cover most of her medical bills and allowed her to see a doctor for her diabetes. That doctor pushed for her to apply for Medi-Cal again in 2022 when she was finally within a qualifying age group. Thanks to the care Medi-Cal has afforded her, Ruiz has had another life-saving surgery, has lost weight and is currently healthier than she has been in decades.
“I’m really lucky to have had nurses and doctors that care enough about my well-being to push me to apply despite my fears,” says Ruiz. “I’ve known so many people, farmworkers, that won’t go because they’re scared.
“Even with Covid—people that knew they had Covid from the symptoms but never went to get tested or for treatment because they thought they couldn’t afford it. Health is everything—it affects every aspect of your life.”
It is completely safe for undocumented immigrants to apply for Medi-Cal. Everyone deserves the dignity of having their basic health requirements met. To begin an application for Medi-Cal, visit benefitscal.com.
