Immigration fears are harming public health Dragnets, policy changes and new premiums are prompting local drops in insurance enrollment

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By George B. Sánchez-Tello

Maria Zarate speaks daily with immigrant residents of the Salinas Valley.

As a community health worker, she goes where the women gather, whether it’s before they clean homes in Salinas, after work harvesting in the fields or at community events where Mujeres en Acción can set up their pop-up canopy.  

Part of her job is to enroll low-income women who are eligible for state health care. 

But the single most common question she gets about that process is whether federal ICE agents might be able to access the enrollment documents with their names, addresses and phone numbers. 

This concern is preventing many residents eligible for public health care from signing up, Zarate said. 

Time is running out for undocumented residents to enroll in Medi-Cal  — they have until Dec. 31 to register for the state’s health care program. Designed as a medical insurance plan for individuals who earn less than $22,000 annually, Medi-Cal was extended to all undocumented immigrant adults last year to ease financial burdens on local health care providers.

But now local hospitals, county health departments and public health organizations are struggling to address residents’ fear of their legal status being shared with federal immigration officials, as well as paying the cost of new health care premiums levied by the state.   

In late June, California’s Assembly and Senate agreed to a compromise with Gov. Gavin Newsom that ends new Medi-Cal enrollment for undocumented, low-income adults beginning Jan. 1. In addition, the state Legislature agreed to a $30 monthly premium beginning July 1, 2027 for adults ages 19-59. Pregnancy-related treatment and emergency services will remain available to anyone uninsured, including undocumented residents. 

The limits on Medi-Cal enrollment and the new fee were part of Newsom’s effort to balance the state’s budget shortfall. They also bring an end to the state’s effort to offer public health care to undocumented residents, which began with children in 2016 and only opened to all adults last year. 

Adriana Santana, Zarate’s colleague, said with all the changes to state and federal health care policies, it’s hard for the people working directly with campesinos in the region to offer a clear and helpful answer.

The concern about revealing names and addresses coupled with fear of aggressive immigration dragnets have kept residents at home, Santana said. Many are planning to just forgo health care or not re-enroll, despite losing access to medicines for chronic illnesses like diabetes and high blood pressure, she said. 

Alejandra Ruiz, another community health worker with Mujeres en Acción, said for those considering staying enrolled, the cost of the new premiums raises the specter of possibly skipping a payment for another monthly bill — like electricity, food or even rent. 

Santana encourages residents to attend community meetings or visit family health centers and ask questions rather than go uninformed. 

A major drop in Medi-Cal enrollment

It’s not just the state changes to Medi-Cal rules that are impacting public health, explained Gabriela Chávez, a community engagement manager with the Central California Alliance for Health. There were changes to Medicare and the end of pandemic-era practices like automatic enrollment and re-enrollment, which ended in March.

In addition, there are uncertainties about the federal budget, dubbed the “Big Beautiful Bill” by President Trump, which includes cuts to health care funding. 

In response, on Sept. 30 the Monterey County Board of Supervisors voted to allot $250,000 for social media and traditional media advertising, as well as public outreach to encourage enrollment among residents eligible for Medi-Cal. 

Local hospitals and public health agencies are aware of the impact of deportation fears on health care enrollment. 

Since July, new Medi-Cal enrollment in the county has been down 20-25% —  approximately 130 fewer new patients a month, said Christine Barajas, a program manager with the Monterey County Department of Social Services. 

Barajas said she understands that undocumented residents want clarity on who can access their status if they enroll in state health care. She also acknowledges that patient information is shared with government officials as part of federal reporting requirements. 

But she said it’s not that simple. “The federal government would have to decipher state insurance coding,” she said.

Numbers of uninsured on the rise

Enid Donato works at Natividad hospital in Salinas. In the past, 10-12% of patients at Natividad were uninsured, Donato said, but the Affordable Care Act and Medi-Cal enrollment for undocumented residents lowered that to 3 percent.

That’s good news, because residents who are not insured are less likely to seek regular medical care, which places a greater strain on emergency medical services, studies have found. Access to affordable health care reduces reliance on emergency visits and hospitalizations, research shows. Preventative care also reduces taxpayer costs and improves individual health. 

Now, the hospital is starting to see a rise in uninsured patients. A daily report from early October reveals 3.7% of patients are uninsured, Donato said. While it’s not the 10% seen in the past, it’s creeping up and gives medical practitioners cause for concern. 

Part of Donato’s responsibility is to enroll patients who qualify for Medi-Cal. 

Every day on the second floor of Natividad hospital, she attends a regular 2 p.m. meeting with doctors, case managers and financial counselors to discuss uninsured patients who are eligible for Medi-Cal but refuse to enroll. 

The county’s Department of Social Services will help patients expedite enrollment to avoid excess fees, she said. Yet despite being confronted with the health cost of forgoing treatment, more patients are resisting enrolling in Medi-Cal. 

“Those are the choices our families are faced with: the real fear of being discovered or what the body can go through without medicine or treatment,” Donato said.

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