California’s Undocumented Residents Make Significant Tax Contributions

Immigrants are an integral part of California’s communities and the state’s social fabric. Over the years, California has set itself apart from other states by advancing inclusive policies that support immigrants while fostering economic growth. A key example is the state’s efforts to make coverage through Medi-Cal, California’s state Medicaid program, more accessible for immigrants. This year, California became the first state in the nation to expand comprehensive Medi-Cal coverage to all eligible Californians, regardless of immigration status. The timeline below shows the steps that state leaders have taken to end the unjust exclusions in Medi-Cal.

A look at reported health status shows promising signs that Medi-Cal expansion to undocumented Californians is positively impacting health.¹Our analysis focuses on the Medi-Cal expansion to undocumented children. Data for the most recent Medi-Cal expansion are not yet available for analysis. Analysis for the 2020 expansion to young adults is excluded due to potential confounding effects stemming from the COVID-19 pandemic. Data show that the proportion of non-citizen children who reported being in excellent health after the expansion increased by 10 percentage points from 20% to 30%. In contrast, citizen children, who were not affected, did not experience any change in their reported health status. At a high level, this analysis suggests there is a link between access and improved health status.

While California has led the nation in closing health coverage gaps, access is still limited for undocumented Californians who do not qualify for Medi-Cal or lack employer-based health insurance. The percentage of uninsured Californians hit a record low in 2022 at 6.5%, but the gains are not distributed equally. Research suggests that over one in four undocumented immigrants under 64 will remain uninsured due to their exclusion from Covered California.

Ensuring that everyone has access to health care benefits all Californians, as health coverage is critical for preventing poverty and fostering economic stability. People without coverage are more likely to face high health care costs or medical debt and are less likely to receive preventive care or treatment for chronic health conditions.

Policymakers can continue to advance health equity by ending unjust exclusions in Covered California, our state’s health insurance marketplace. By building on the historic Medi-Cal expansions and investing in other equitable health policies, policymakers can ensure all Californians can be healthy and thrive.

Continuous access to health care is necessary for everyone to be healthy and thrive. Unfortunately, paperwork challenges often prevent people from obtaining and maintaining health coverage. A clear example of this: Too many individuals continue to be disenrolled from Medi-Cal, California’s Medicaid program, due to paperwork challenges.

Last year, California began processing Medi-Cal renewals for the first time since the start of the pandemic. As a result, over 1.4 million Californians have lost Medi-Cal coverage from June 2023 to February 2024. About 9 in 10 Californians (87.4%) who lost Medi-Cal coverage during this period did so because they did not complete the renewal paperwork or had incorrect or missing information in their forms.

Completing the renewal process often involves complex paperwork and documentation requirements, which can be difficult to navigate. Additionally, many Californians have experienced extended call wait times when attempting to contact county Medi-Cal workers regarding their application.

Certain groups, including older adults and people with disabilities, are at greater risk of losing Medi-Cal coverage during the unwinding period.¹Jennifer Tolbert and Meghana Ammula, 10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision (Kaiser Family Foundation, June 2023). Immigrants and their family members face unique obstacles in remaining covered, such as language barriers, privacy concerns, and fear of immigration-related consequences. Many Californians who are losing Medi-Cal coverage due to paperwork challenges may still meet the eligibility criteria.²Of the redeterminations that were received and processed in February 2024, about 9% were ineligible. See California Department of Health Care Services, Medi-Cal Continuous Coverage Unwinding Dashboard (February 2024), 14.

The high disenrollment rate due to paperwork challenges underscores the need to further streamline the renewal process and alleviate the paperwork burden on beneficiaries during the unwinding period and beyond. Addressing these challenges is essential to ensure that those who are eligible for Medi-Cal continue to receive vital health coverage.

While state leaders have implemented measures to reduce barriers to accessing and maintaining Medi-Cal coverage, they can take additional steps to prevent Californians who remain eligible for Medi-Cal from losing coverage. These include:

By taking additional action, state leaders can reduce barriers and ensure that all Californians, regardless of race, age, disability, or immigration status, can access and maintain the critical health coverage they need to be healthy and thrive.

The California Work Opportunity and Responsibility to Kids (CalWORKs) program is a critical component of California’s safety net for families with low incomes. The program helps over 650,000 children and their families, who are predominantly people of color, with modest cash grants, employment assistance, and critical supportive services. However, the program has a problematic history of prioritizing work over family well-being, exemplified by financial penalties against families and counties that don’t meet narrowly defined performance indicators.

For many families, receiving cash assistance is conditional on engaging in employment or other specified “welfare-to-work” activities intended to lead to employment, such as on-the-job training or unpaid work experience. Additionally, families must navigate through various other paperwork-related stipulations, which further exacerbate the barriers to accessing the much-needed aid. Families who do not comply with all the requirements set forth by the state can be subject to a financial sanction that reduces their monthly cash grant.

California’s sanction policy is harsher than what is required by the federal government. The punitive approach to this safety net cash assistance is counterproductive. Research shows that sanctioned recipients are often those who face the most barriers to employment, such as limited education, learning disabilities, limited work history, physical and mental health problems, and a history of domestic violence.¹Rachel Kirzner, TANF Sanctions: Their Impact on Earnings, Employment, and Health (Center for Hunger-Free Communities, Drexel University, March 23, 2015). These participants are often not aware of the financial penalties or cannot fully navigate the overly burdensome processes due to limited resources and information.

As states across the country are learning that harsh sanctions do not directly lead to gainful employment and family stability, many have reduced the amount by which cash grants are cut, recognizing that pushing families deeper into poverty only further jeopardizes their well-being. California, which is often at the vanguard of providing cash and safety net support, is unfortunately trailing significantly behind.

How do CalWORKs sanctions impact California families?

CalWORKs families cannot afford to be sanctioned. These artificial barriers put families at risk of falling deeper into poverty. Briana, a Parent Voices California advocate, experienced this reality firsthand. As a mother of four living in Contra Costa County, Briana has been on and off of CalWORKs since the age of 17. Even though her CalWORKs case manager did not help her to utilize the full scope of CalWORKs services (i.e., child care, school tuition assistance), Briana received her certified nursing assistant certification (CNA) and achieved her goal of working in the medical field, which she did for several years. A CNA certification course at Contra Costa College is approximately $322 in fees and CNA students pay over $100 in books, costs that could have been covered by CalWORKs benefits and not paid through Briana’s cash aid.

While experiencing postpartum depression following the births of her son and daughter, Briana went back on CalWORKs assistance to help make ends meet. During this time, Briana was sanctioned several times for reasons such as:

• Not having an up-to-date immunization card;
• Not having one of her children’s birth certificates on file; 
• Not turning in a check stub (despite the stub already being in the CalWORKs system); 
• As well as other reasons unknown to Briana.

These sanctions cost Briana hundreds of dollars, as highlighted in the preceding chart. With the $242 recouped from sanctions, every month, Briana could have paid for:

• Six days of groceries for her family;
• Three-quarters of her monthly utility bill;
• 48 gallons of gas; or
• Funds to support rent and car payments.

Briana’s sanctions coupled with remaining cash aid paying for her CNA certification exacerbated her financial insecurity. At the time that Briana shared her story at a March 2024 Assembly hearing, she was $300 short on her rent and car payment and had $0 left on her EBT card.

Briana’s story is just one example of how CalWORKs sanctions perpetuate the cycle of poverty and are rooted in a racist and sexist history popularized by figures like then California Governor Ronald Reagan that punished Black and other mothers of color, in particular. In the words of Briana: “Our future generations, our grandkids, somebody down the line is gonna need help. And I just want it to be easier for them. We need to defend these programs against cuts, get rid of these unnecessary sanctions, and reimagine CalWORKs into a program that opens those doors to help us get to where we want to go.”

How can policymakers ensure families in need have access to CalWORKs?

The governor’s commitment, outlined in his January budget proposal, to apply to a federal pilot aiming to center family well-being over work requirements offers California a great opportunity to reevaluate its sanction policy. Policymakers can make a significant difference in CalWORKs families’ lives, like Briana’s, by eliminating non-federally required sanctions and minimizing the amount sanctioned families lose each month. Additionally, policymakers should continue investing in CalWORKs and protect the program from harmful cuts. CalWORKs should center the well-being of families by removing barriers instead of amplifying them.