California’s Undocumented Kids Could be First to Lose Medical Care Under Trump

 On a recent rainy morning in Los Angeles,
Maria Bernal’s stove clicks to life with a bright blue flame to toast bread on
a griddle for her 9-year-old son Edwin to smear with peanut butter. As she
scoops papaya chunks into the blender for a smoothie, she recalls her worry
during all the years when she couldn’t afford health care and he suffered
painful ear infections.

The waiting six months to get an appointment
for Edwin at a county facility. The nights trying to calm him as he cried in
constant pain. The months-long wait for each of three surgeries to insert tubes
into his ears. The fear when the medical bills arrived.

At the time, she couldn’t afford health care,
and he was not eligible for regular government-funded Medi-Cal because she had
brought Edwin to the United States illegally from Mexico when he was 1. He
qualified for a local program and emergency Medi-Cal, but that didn’t provide
all the care he needed. Then last year, she heard on TV that California was creating a new program under
Medi-Cal to fully cover poor undocumented children. Relieved, she rushed to
sign Edwin up. As a result, she says, “I can take him in whenever he needs to
go.”

Now, however, the ability of Edwin and some
164,000 poor undocumented California children to see a doctor for regular
medical care hangs in the balance:  Several experts predict they could be
among the first to lose health coverage if the Trump administration carries out
its promise to end much of Obamacare, leaving California to try to make up the
difference.

To be clear, the federal government does pay limited medical costs for
kids in the country illegally under the restricted-scope Medi-Cal program,
which is available to anyone regardless of immigration status for emergency and
prenatal services only. Last May, however, California became one of a handful
of states to provide state-funded full-scope
Medi-Cal, California’s Medicaid program. About 71 percent of the
program is funded by the state, according to the state Department of Health Care Services,
with 29 percent paid for out of federal funds for
emergency coverage. Also of note: Because the federal government funds
emergency services, the state shares enrollee information with federal health
officials.

In his most recent budget proposal, Gov. Jerry
Brown allocated $279.5 million to cover approximately 185,000 kids in the
coming year in what the state has dubbed its Health for All Kids program—double
what the program was estimated to cost when it was approved.

With the election of Donald Trump, who took
office last week, some health policy experts and advocates say the fledgling
program is in danger. Assuming the new administration carries out plans to
change how Medicaid is funded, health policy experts say California could stand
to lose $17 billion the federal government currently provides for the Medi-Cal
expansion the state adopted under the Affordable Care Act.

Such a cut would leave state leaders unable to
fully make up the funding difference—and could force them to revisit a
decades-old debate over whether the state has an obligation to care for sick
children regardless of their immigration status, or should focus limited
resources on citizens and legal residents.

It’s impossible to precisely predict the
ripple effects. But, said Nancy Gomez, organizing director of the health
advocacy organization Health Access California:
“The first things that are going to go are these optional programs. They are
not optional to us. But Health for All Kids are discretionary funds and they
may be the first to go.”

Trying to make up the gap will be nearly
impossible, experts say.

“These federal cuts to the broader Medi-Cal
program would force California policymakers to make some difficult
decisions—raise revenue by unprecedented amounts to maintain the current
program, cut benefits, reduce eligibility, or make other cuts to the program,”
said Laurel Lucia, manager of the Health Care Program at the UC Berkeley Center for Labor Research and Education. But, she
acknowledged, “if the Legislature decides to take a ‘last in, first out’
approach to making eligibility cuts in response to federal cuts, state-funded
Medi-Cal for undocumented kids would especially be at risk because the expansion
started less than one year ago.”

That’s as it should be, according to those who
insist that anyone in the country illegally should not receive state
resources—especially if funding is cut short.

“Sacramento should be focused on helping
American citizens,” said Robin Hvidston, executive director of We The People Rising, a Claremont-based
organization that fights against legislation that it says promotes illegal
immigration. The group opposed the expansion, which she contends is merely an
open invitation for illegal immigration.

“It’s a program our state cannot afford,” she
said. “We have a burgeoning homeless crisis in this state, we have disabled
people in this state that need help. This energy and our tax dollars should be
going to help our suffering American citizens in this state and not those here
illegally.”

Nonetheless, the lawmaker who authored the
expansion to cover undocumented children, Democratic Sen.
Ricardo Lara of  Los Angeles, has vowed to protect them.

“I will fight to ensure that they remain a
priority population in terms of receiving adequate healthcare and meeting their
health needs,” Lara said. “It makes economic sense, it’s the moral thing to
do.”

But in an unmistakable sign that the
Democratic-controlled state is changing tactics in response to a less receptive
White House, California recently retracted its request for a federal
waiver that it had hoped would allow undocumented immigrants of
all ages to buy unsubsidized health care via California’s Affordable Care Act
exchange. Lara labeled it the “first California casualty of the Trump
presidency.”

He said the state could always renew its quest
for such a waiver, but won’t until it first ensures that the state can protect
the data immigrants would be sharing with the federal government by using the
health exchange.

“It’s very clear and apparent that we are dealing
with a hostile administration toward our immigration community,” Lara said.
“Given the fact that we are working currently on legislation to protect the
privacy of the immigrant communities, we felt that it was appropriate to pull
the waiver and focus on the fights ahead with the incoming administration.”

President Trump and the Republican-controlled
Congress favor establishing caps on
Medicaid and changing funding to a block grant formula that sets limits on
total spending per state regardless of how many people are in the program.
Currently it is funded as an entitlement for all enrollees who qualify.

Medicaid is the largest insurer in the
country, with 73 million people enrolled, mostly low-income or disabled. In
California, 13.5 million people are on Medi-Cal, or roughly one in three
Californians. The program grew by 3.6 million people when it was expanded under
the Affordable Care Act.

A study by the Center on Budget and
Policy Priorities found that the proposals to reorganize
Medicaid funding would decrease funding by one-third to one-half within a
decade.

Such federal cuts would trigger a cascade of
effects, said Senate President Pro Tem Kevin de Leon (D-Los Angeles).

“If the Trump administration decides to remove
and take away access to quality healthcare that could possibly drive a budget
deficit—and if you drive a budget deficit that means cuts would have to be
made,” he said at a health care rally in Los Angeles after the November
election. “If cuts have to be made that means other people could be hurt.”

But others aren’t ready to concede that
outcome and say there are likely alternatives the state can employ to keep as
many people covered as possible.

“The reality is if Congress has enough votes
to change the Medicaid program into a block grant program, California will
struggle to maintain its commitment to the 13.5 million people currently
covered,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “I
suspect the governor and Legislature will give higher priority to cutting
covered services rather than cutting the number of beneficiaries.” 

Sen. Lara said he hopes the state resists
choosing one group over another—adding that he plans to suggest cutting
coverage, as the state has done during lean times, or increasing eligibility
thresholds in his fight to keep health care for the neediest across all groups,
including  undocumented children.

As for 9-year-old Edwin, he says going to the
doctor more often is good for him because of his hearing challenges and ear
tubes.

“My friends talk to me and I’m like ‘what,
what,’ because I can’t hear them that good,” he said. “Same with my mom, she
tells me something and I don’t really hear her and I don’t do the stuff she
tells me because I can’t hear. So it’s better, I can hear her and I’m not
getting in more trouble.”

If kids like Edwin lose Medi-Cal overage,
their health care will depend largely on where they live.

In Los Angeles, the county offers a basic
low-cost program to everyone regardless of immigration status and emergency
Medi-Cal is expected to still be available. Private insurer Kaiser Permanentealso
offers a community benefit program for kids without legal status who live near
their facilities.

“It’s going to be a challenge for us and the
patients,” said Chona de Leon, interim chief operating officer at Eisner
Health in downtown Los Angeles, where Edwin has received care
since he was a baby.

Clinics like Eisner would lose the increased
funding that has come from previously uninsured patients getting access through
the Affordable Care Act. de Leon says they would continue to serve uninsured
patients as always, although they would have to work hard to find outside
funding and donations.

But in 11 California counties,
including Orange and San Diego, there are no programs for undocumented families
to find care for their children outside of charitable clinics and hospital
emergency rooms.

 This story first appeared at CALMatters.