Q&A: Preparing for California’s Behavioral Health Services Act (BHSA)

California is home to the largest share of immigrants in the United States. Immigrants are an integral part of California’s social fabric, pay taxes, and contribute to its economic success. Over 1 in 4 Californians are immigrants, totaling almost 11 million people who are family members, neighbors, friends, and community members. Federal actions to carry out mass raids and deportations, along with restrictions on legal immigration, humanitarian visas, and temporary protection programs, will have detrimental effects on families, communities, and the state’s entire economy.

Undocumented immigrants alone contribute $8.5 billion in taxes to help pay for California’s public services, many of which they cannot benefit from. Together, immigrants in California are responsible for over $1 trillion in economic output. With federal attacks on immigrants putting millions of California families in fear and danger, state leaders should take action to ensure families and communities are safe and supported.

Who Makes Up California’s Immigrant Population?

The nearly 11 million people who are immigrants in California are a diverse group of naturalized citizens and about 4.8 million non-citizens, each with different immigration stories and aspirations. Within this group, nearly 18,000 people seeking safety in the United States — about 3,700 refugees and 14,000 asylees — settled in California in 2023. The state also consistently ranks among the top states home to temporary guest workers, with about 80,000 H-1B visa holders for highly skilled workers, and 45,000 H-2A visa holders for agricultural workers, welcomed in a single year.

Among California’s immigrant population, there are nearly 70,000 people with Temporary Protected Status (TPS) and over 150,000 Deferred Action for Childhood Arrivals (DACA) recipients, who are protected from deportation and have permission to be in the United States, and about 1.8 million people are undocumented. Undocumented Californians are inextricably embedded in our communities. In fact, nearly three-quarters of undocumented Californians are estimated to have lived in the United States for over a decade, the overwhelming majority are in school or working, nearly a quarter are homeowners, and most live in a mixed-status household with a child or spouse who is a US citizen.

How Much More Might the Federal Government Spend to Increase Detentions and Deportations?

After approving in March additional funding for the current fiscal year to help the Trump administration carry out its detention and deportation agenda, Republicans in Congress are now advancing new legislation to significantly boost this funding further over the next several years. In late April, House committees began moving forward legislation that would allocate roughly $80 billion in fiscal years 2025 through 2029 largely to US Immigration and Customs Enforcement (ICE) for immigrant detention, deportation, and related efforts. This represents a dramatic increase in funding for ICE relative to its approximately $9 billion budget in fiscal year 2024. This additional funding includes:

• $45 billion to increase ICE’s capacity to detain families and individuals apprehended by the Department of Homeland Security (DHS). This is 13 times ICE’s budget for detention in fiscal year 2024 and would substantially increase detention capacity.
• $14.4 billion for “transportation and removal operations.”
• $8 billion to hire new ICE officers and other personnel as well as roughly $1.5 billion for employee recruitment, training, and bonuses. This legislation also directs ICE to hire a minimum of 10,000 new personnel by fiscal year 2030, with minimum annual targets which would increase staff by roughly 50% over the more than 20,000 law enforcement and support personnel ICE employed in fiscal year 2024.

Although it is not yet clear what the specific impact of increased funding for detentions and deportations would be on Californians, ICE representatives have indicated that they are exploring options to expand detention capacity in the state. There are currently six active detention facilities in California, all with well-documented track records of human rights abuses, and all operated by private, for-profit companies that stand to profit further from significantly increased federal spending.

Additional legislation moving through House committees in late April would significantly increase funding for Customs and Border Protection (CBP) over the same five-year period, including $46.5 billion for border wall construction, nearly $8 billion for recruiting, hiring, training, and retaining CBP agents and other personnel and the acquisition of additional patrol vehicles, and $5 billion for CBP facilities and checkpoints. This represents a large increase in CBP’s budget, which totaled just under $20 billion in fiscal year 2024, and together with increased funding for ICE, would dramatically expand the federal government’s capacity to carry out its anti-immigrant agenda.

H.R. 1 and the Federal Budget

H.R. 1, the harmful Republican mega bill passed in July 2025, will deeply harm Californians by cutting funding for essential programs like health care, food assistance, and education.

See how California leaders can respond and protect vital supports.

Learn More

What Is the “Chilling Effect” and How Does it Impact Families?

Restrictive and harsh immigration policies have been shown to produce a “chilling effect” throughout immigrant communities, wherein immigrant families avoid interacting with public services and institutions for fear of being exposed to deportation threats. Even the threat of these policies being enacted, as has been the case during the current administration, is enough to trigger a chilling effect among immigrant communities across California.

The consequences of this chilling effect are especially acute for the over 3.3 million people in mixed-status families in California. Mixed-status families often become isolated from communities and avoid applying for jobs, talking to police, and/or traveling for fear of drawing attention to themselves or an undocumented family member. This could mean a loss of household income if individuals feel unsafe going to work, making it difficult to pay bills and put food on the table. Children may stop going to school for fear of risking their parents’ deportation, hindering their educational attainment. In addition, research found that children in mixed-status families suffered adverse mental and physical health outcomes due to the fear of deportation and family separation.

In practice, the chilling effect means families often refrain from applying for and utilizing benefits they legally qualify for, like income, nutrition, and housing assistance programs. The lack of uptake in these programs, especially CalFresh and Medi-Cal, means community members often suffer adverse health outcomes. The impact on usage of public benefits can be further exacerbated by “public charge rules.” A public charge rule proposed during the first Trump administration, which would have expanded the criteria under which immigrant applicants could be denied residency for having used or being projected to receive public benefits in the future, caused a significant chilling effect. Any similar proposals during the current administration would likely make families even more hesitant to utilize public services even if they qualify.

What Are the Ripple Effects of Deportations on Families?

The adverse health and financial consequences of deportation on families are well documented. Living near areas that are the target of immigration enforcement raids has been shown to negatively impact the educational and health outcomes among children of immigrants. The actual deportation of family members who financially support households can have severe economic consequences for families due to the abrupt loss of income. In 2021, 1.55 million children in California lived with an undocumented parent, underscoring that the strain of deportation goes beyond the individual at risk of removal. Children whose parents are detained and deported are at greater risk of entering the child welfare system. Even if these family members end up being allowed to stay in California, it can be nearly impossible to find steady employment, leading to long-term income loss.

The financial strain on families after the deportation of a primary earner often leads to housing instability, making it difficult to afford rent and increasing the risk of eviction or, in severe cases, homelessness. In 2019, an estimated 58% of renter households with undocumented residents were paying unaffordable rents with about one-third paying more than half of their income toward rent. More recent figures indicate that nearly two-thirds of undocumented immigrants were burdened with housing costs, ten percentage points higher than their US-born counterparts.

Undocumented and immigrant tenants also face heightened discrimination, further limiting their housing options and making it harder to secure stable living arrangements. To cope, families may be forced to move in with relatives, leading to overcrowded living conditions that pose physical and mental health risks while also attracting greater scrutiny from landlords or housing providers. This instability can disrupt children’s education, strain community resources, and push families into unsafe or substandard housing, further deepening economic and social hardships.

Federal Policy

The federal government plays a major role in shaping California’s budget, economy, and the well-being of its people.

Learn how federal policies shape California’s budget, economy, and vital programs — and how state leaders can respond to protect and support Californians.

Explore Federal Resources

How Do Immigrants Help Drive California’s Economy?

Undocumented immigrants play a vital role in stimulating the economy as workers, business owners, taxpayers, and consumers. Their contributions boost national economic growth and lower the US deficit, according to recent research by the Congressional Budget Office. Given this, large-scale deportations would have a devastating impact on the economy, depriving businesses of workers and consumers, and depriving public services of critical tax dollars.

California’s economy would be especially hard hit. In California, all immigrants, including those who are undocumented, are estimated to contribute to more than $1 trillion in economic output — nearly one-third of the state’s total output — putting immigrants’ contributions on par with the economic output of Ecuador. One study suggests that undocumented immigrants in California are the source of $152 billion in economic output, roughly 5% of the state’s total output.

Undocumented Californians also make essential contributions by paying billions of dollars in taxes each year. In 2022, they paid nearly $8.5 billion in state and local taxes, including sales taxes, individual and business income taxes, property taxes, and unemployment taxes, among others. These tax dollars benefit all state residents by supporting education, roads and transit, emergency response, the social safety net, and much more. Deportations would reduce state and local tax revenue at a time when California and several large cities in the state, including Los Angeles and San Francisco, are facing structural budget deficits.

What Effect Would Restrictive Immigration Policies Have on Key Industries in California?

Immigrants are essential to California’s labor force, with a total of 6.1 million immigrants employed in California from 2021 to 2023, representing 1 in 3 workers in the state, who help power the fourth largest economy in the world.

Policies that limited immigration both prior to and during the pandemic decreased the share of immigrant workers in the US, which resulted in more job openings than available workers. Having enough workers is crucial to keeping the economy going and immigrant workers serve a key role in this. Specifically, in California, nearly two-thirds of workers in the agriculture, forestry, fishing, and hunting industries are immigrants. Additionally approximately 2 in 5 workers in the manufacturing, construction, other services, and transportation and utilities industries are immigrants. Therefore, deportations and other actions that restrict immigration would have compounding effects on several key industries in California including housing, agriculture, and caregiving. 

How Would Deportations Harm Employment Opportunities for US-Born Workers?

Immigrants, including those who are undocumented, not only help fuel the economy by filling key jobs thereby closing gaps in the local labor markets, but also help generate jobs for US-born workers, both directly through entrepreneurship and indirectly.

Entrepreneurship is another key way immigrants make vital contributions to California’s economy that would be undermined by deportations. Nearly 900,000 immigrants in California are entrepreneurs, collectively generating $28.4 billion in business income. In fact, roughly 2 out of 5 entrepreneurs in the state are immigrants, compared to just under one-quarter in the US as a whole. Research finds that undocumented immigrants, particularly those of Mexican origin, were the primary drivers of a surge in self-employment and entrepreneurship among Latinx immigrants over the past two decades.

Immigrant workers also benefit US-born workers by indirectly creating jobs. Research has also consistently shown that deportations harm US-born workers. Specifically, for every 13 foreign-born workers who leave the labor force because of direct removals and the chilling effect of deportations, 10 US-born workers lose their jobs, making clear that immigrants are generating jobs for US-born workers, not taking them. This is because immigrant workers are not substitutes for US-born workers. Undocumented workers hold essential jobs, like construction workers, farm workers, and caregivers, that are crucial to society and are not easily filled by US-born workers. When the share of immigrant workers falls, there are negative impacts for all workers. For example, a decline in the number of immigrant caregivers may cause US-born workers to leave the workforce to care for their children, or a decline in the number of immigrant construction workers may reduce the need for construction managers, who are more likely to be US citizens. Additionally, because immigrants generate economic activity as workers and consumers, deportations reduce business revenue, which in turn leads to fewer jobs available for US-born workers.

What Can State Leaders Do to Protect Immigrant Communities?

With federal attacks on immigrants putting millions of Californians in fear and danger, state leaders should take action to ensure families and communities are safe and supported. 

This should include increasing state funding for immigrant legal services, which provide a lifeline to immigrants, helping them access relief they are entitled to under federal law. Increased funding is needed to meet the high demand for these services among children, families, and workers as federal policymakers dismantle immigrants’ access to justice. State policymakers should also strengthen protections that create safety for immigrants and their children at schools, child care facilities, health care facilities, and other essential community spaces, and they should strengthen data protections to prevent sensitive information, such as immigration status, held by public entities from being used for unauthorized or harmful purposes. Strengthening support for California immigrants and their families in the face of federal threats is not just a moral imperative but a strategic investment in our communities, economy, and collective prosperity.

Medi-Cal saves lives. It’s a lifeline that provides free or low-cost health coverage for over one-third of California’s population. Yet Congressional Republicans and the Trump administration are actively pushing proposals to cut Medicaid funding in favor of tax breaks for the wealthy. Such cuts would mean taking critical care away from millions of people across the state, including children, pregnant individuals, seniors, and people with disabilities. Without access to health coverage, Californians would face impossible choices that put their health and economic security at risk while also driving up long-term costs for the state.

What is Medi-Cal?

Medi-Cal is California’s Medicaid program that provides free or low-cost health care to over one-third of the state’s population. The program serves individuals with modest incomes, including children, seniors, people with disabilities, and pregnant individuals. Medi-Cal is a lifeline for millions, ensuring access to essential health services that support public health and economic stability.

Who Is Eligible for Medi-Cal?

Most people qualify for Medi-Cal based on their income, a category known as Modified Adjusted Gross Income (MAGI) Medi-Cal. Eligible groups include:

• Adults with incomes up to 138% of the federal poverty level (FPL). 
• Pregnant individuals up to 213% FPL.

Children in families with incomes up to 266% FPL are also eligible through the Children’s Health Insurance Program (CHIP), which is fully integrated into Medi-Cal. In certain counties, like San Francisco, San Mateo, and Santa Clara, coverage extends up to 317% FPL, reflecting the high cost of living in those counties.

Some individuals qualify under non-MAGI Medi-Cal, which is based on factors other than income. This includes:

• People who are blind, disabled, or age 65 and older. 
• People receiving Supplemental Security Income (SSI). 
• Residents in long-term care facilities. 
• Former foster youth until age 26.

What Services Does Medi-Cal Cover?

Full-scope Medi-Cal covers a wide range of services, including doctor’s appointments, emergency services, physical and occupational therapy, dentist appointments, laboratory services, prescription drugs, vision care, preventive and wellness services, and behavioral health services. Medi-Cal also offers transportation to and from appointments for services that are covered by Medi-Cal.

In addition to these core services, Medi-Cal also covers services for specific populations, such as in-home supportive services (IHSS) for individuals with disabilities and expanded postpartum coverage for new parents.

How Is Medi-Cal Funded?

Medi-Cal is primarily funded by the federal and state government. The federal government contributes a share of the costs through a formula called the Federal Medical Assistance Percentage (FMAP). In California, the standard FMAP is 50%, though certain populations and programs receive an enhanced FMAP, such as the Children’s Health Insurance Program (CHIP) and Medicaid expansion under the Affordable Care Act (ACA). In addition to federal and state funds, Medi-Cal is supported by local government contributions, provider taxes, and fees from health plans.

How Does Medi-Cal Deliver Care?

Medi-Cal delivers care through two main models: managed care and fee-for-service (FFS). The vast majority of Medi-Cal members (88%) receive their care through managed care plans (MCPs). Under this model, the state contracts with health plans to coordinate and deliver services. These plans receive a fixed monthly payment from the state per enrollee regardless of how many services an individual uses. The remaining 12% of Medi-Cal enrollees receive care through the FFS model. Under FFS, enrollees can see any provider who accepts Medi-Cal, and providers are reimbursed per service delivered rather than receiving a set monthly amount.

California has expanded managed care over time to improve health outcomes, enhance care coordination, and control costs. Through initiatives like CalAIM (California Advancing and Innovating Medi-Cal), the state is shifting more services into managed care to provide integrated, person-centered care. These efforts aim to integrate physical health, behavioral health, and social services to support individuals experiencing homelessness, those with chronic medical conditions, and people involved in the justice system.

How Do Medi-Cal Reimbursement Rates Impact Access to Care?

Medi-Cal reimburses health care providers for services that they deliver to Medi-Cal patients, with rates varying based on the type of service, provider, and setting. Reimbursement rates are set by the state and approved by the federal government. However, these reimbursement rates are typically lower than those of Medicare and private insurance, which has discouraged provider participation.

Increasing provider participation in Medi-Cal is critical to improving access to a wide range of health care services, especially in historically underserved areas where there is often a shortage of providers. By increasing the number of providers in the Medi-Cal network, patients can receive more timely care, which can help improve health and well-being for all Californians. Revenue from Proposition 56, a tobacco tax increase which voters passed in 2016, provides additional funding to support provider payments. However, revenue from this tax has been on the decline.

What Is the Potential Impact of Medicaid Cuts?

Congressional Republicans have proposed cuts to Medicaid to pay for tax breaks for the wealthy. Medicaid is a lifeline for nearly 1 in 4 people nationwide, including children, seniors, people with disabilities, and adults with low incomes. For California, where Medi-Cal covers 1 in 3 people, these cuts would be devastating. Any reduction in federal funding would lead to a significant budget shortfall and could force the state to make difficult choices such as reducing Medi-Cal benefits, limiting provider payments, or restricting eligibility.

If federal funding losses approach or exceed $10 billion per year, California would not be able to replace federal funds with existing state resources alone. As a result, low-income Californians, communities of color, seniors, people with disabilities, and children would face the greatest harm, further deepening health disparities and reducing access to essential care. Reducing Medicaid funding in any form would likely leave more people uninsured and weaken California’s health care system overall.

How Would Medi-Cal Members Be Impacted by Work Requirements?

Work requirements are essentially cuts that cause significant health coverage losses. Such proposals would require Medicaid beneficiaries to regularly prove they are working, looking for work, or participating in job training programs in order to maintain coverage. However, these requirements are burdensome and unnecessary, as the vast majority of Medicaid enrollees under age 65 are already working or are not able to work due to caregiving responsibilities, illness or disability, or school.

Research shows work requirements are an ineffective policy tool that fail to increase employment. Instead, they create bureaucratic hurdles that cause people to drop off Medicaid — particularly people with disabilities, caregivers, and those working in unstable or low-wage jobs.

If implemented, work requirements would put over 8 million people in California at risk of losing their health coverage. (See this resource for details on the impact by congressional district.) Health coverage losses on this scale would not only harm people’s health and well-being but also weaken state and local economies.

Work requirements undermine the very purpose of Medicaid: it is health insurance, not a jobs program.