California’s planned cuts to immigrant health care could overwhelm Santa Cruz County ERs, providers warn

Local health care leaders are warning that proposed changes to California’s Medi-Cal coverage for undocumented residents will create more challenges to accessing health care, potentially increase the costs for everyone and overwhelm local emergency rooms. 

The changes, announced last week by Gov. Gavin Newsom as part of his effort to address a $12 billion state deficit, would freeze enrollment for undocumented residents over 19 and impose new monthly premiums, reversing years of expanded health care access in Santa Cruz County.

“Is that really the way we’re going to balance the budget? On the back of undocumented residents of California?” asked Raymon Cancino, CEO of Community Bridges. The Watsonville-based nonprofit helps residents across Santa Cruz County access resources, such as enrolling in Medi-Cal. The organization has nearly 8,000 undocumented clients enrolled in the state’s health care program, Cancino said. 

The impact could be particularly severe in the county’s hospital emergency services. At Watsonville Community Hospital, where the emergency department’s 12 beds served 35,000 patients last year, CEO Stephen Gray predicts longer wait times and worse health outcomes.

Taking away access to health care coverage and eligibility will just make people sicker and die earlier, said Gray. “It will put further constraints on an already financially challenged health care system in our community,” he said. 

Medi-Cal — California’s Medicaid program — provides free or low-cost health care to more than a third of the state’s population, and nearly 1.6 million of recipients are undocumented. Children enrolled in the program will not be affected.

Nearly a year after expanding Medi-Cal coverage to undocumented immigrants, Newsom is proposing to freeze enrollment for any new undocumented recipients over the age of 19, starting next year. Newsom also wants to implement a $100 monthly premium for all adults beginning in 2027. If passed by the state legislature, the changes are expected to save the state more than $5 billion. 

In addition to an enrollment freeze and monthly premiums, Newsom’s proposed budget suggests eliminating dental and long-term care coverage under Medi-Cal for undocumented recipients. 

Adults who enroll in Medi-Cal before the end of the year, and those already enrolled, will still be eligible for coverage in 2026. There will also be an exception for pregnant people and emergency care. 

Newsom’s proposed cuts almost feel like the state is walking back on its promise to offer universal health care, said Donna Young, CEO of Salud Para La Gente — which runs 13 health service sites across Santa Cruz County and in northern Monterey County.

California became the second state, after Oregon, to offer full-scope health care to all immigrants without legal status. The state began to expand its coverage to immigrants in 2016 in phases, and opened the eligibility for adults between 19 and 49 years old in 2024.

As a result of the expansion, the percentage of uninsured patients using Salud’s services went from 15% at the end of 2023 to 8% by the end of last year, said Young. 

Cancino said he understands that California’s budget is “extremely tight,” but believes state officials are taking a one-sided approach to address their budget issues by not accounting for the possibility of families getting into significant medical debt, and discouraging people from accessing preventative care. 

Echoing Watsonville Community Hospital’s Gray, cuts to coverage, such as eliminating dental care for undocumented residents, will only end up flooding local emergency rooms, said Laura Marcus, CEO of Dientes — which provides dental care for free or at a reduced cost to low-income families across the county. 

Dientes is the largest dental care provider for Medi-Cal recipients in the county, serving 15,000 patients in its four clinics — with a fifth opening up in August, said Marcus. “This is really going to hurt about 10% of the Medi-Cal beneficiaries in our community,” Marcus said. 

This year’s planned cuts remind Dr. Sepi Taghvaei, chief dental officer for Dientes, of when the state decided to eliminate dental coverage for adults in 2009 due to budget issues, prior to expanding its coverage for immigrants in 2016. The state reinstated dental coverage in 2018. Taghvaei said she believes the same scenarios will happen now as happened after 2009: people ending up in hospital emergency rooms for problems, such as cavities or root canals, that could have been prevented. 

“People were not coming to us because nothing was covered,” Taghvaei said. “They weren’t coming to us until it was too late. Their faces were swollen. They were in pain, they had an infection.” 

Taghaevi said the recent expansion of coverage for undocumented residents was a huge benefit to the population Dientes serves. “We’ve always had a huge demand for our services in the county,” she said, adding that there was an influx of patients signing up for dental coverage through Medi-Cal thanks to the program’s expansion.

Patients who couldn’t afford to pay for the already reduced fees Dientes charges uninsured patients were able to get the treatments, said Taghaevi. But those reduced fees will face changes in the coming months. 

Starting in July, Dientes will be increasing its sliding scale fees for uninsured patients by 10% as a result of rising costs of living and possible cuts to Medicaid at the federal level, said Marcus. The organization is already thinking about potential budget impacts, like having to temporarily close one of its clinics, if both the federal and state governments cut health care funding, she said. 

“The reality is we can’t afford to keep seeing uninsured patients at the lower rates that we’ve been seeing them, so we have to pass along some of that cost to them,” Marcus said. 

Young said she’s been advocating for Medi-Cal coverage to state legislators, visiting Sacramento to speak with legislators and also connecting with county officials. “The plan for me is to really help them understand the impact of Salud, community-based organizations and health centers,” she said. 

If these cuts go through at both the state and federal level, Young said it might reverse the progress that community organizations like Salud have made in lowering barriers to accessing health care. 

“Medi-Cal is just a lifeline for so many in our community,” Young said. “I’m concerned about the destabilization of the broader health care system, and most importantly, I’m concerned about the impact on the health and well being of the members of our community and those that we serve.”

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