Medi-Cal Enrollment Drops Among Immigrants Amid Policy Fears in California

For months, a cloud of fear has hovered over the immigrant community in San Bernardino, California, making it difficult for María González, a community health worker, to do her job. In this city, where nearly a quarter of residents are foreign-born, González has seen firsthand how immigration policies are deterring immigrants from accessing health care.

The fear intensified over the summer, fueled by reports of immigration raids across Southern California, the Trump administration’s plans to share Medicaid data with Immigration and Customs Enforcement, and the passage of state and federal restrictions on immigrant Medicaid eligibility. In November, the federal government released a new “public charge” proposal, which, if enacted, could block certain immigrants from obtaining permanent legal residency if they or their family members have used public benefits, including Medi-Cal.

Many of González’s clients and their children—often U.S. citizens—still qualify for Medi-Cal, California’s Medicaid program, which provides health coverage to over 14 million residents with low incomes or disabilities. Yet, she says, they are increasingly reluctant to enroll or renew their coverage.

“Many people don’t want to apply,” she said. “There are people who say they don’t even want to go outside and water their plants.”

An analysis by KFF Health News found that from June to December 2024— the latest month for which figures are available— nearly 100,000 immigrants without legal status left Medi-Cal. This represents about a quarter of all disenrollments during that period, even though this group makes up only about 11% of Medi-Cal enrollees. The decline marks a reversal of a steady rise in enrollment among immigrants without legal status in California, which had increased every month since the state opened Medi-Cal to all low-income residents regardless of immigration status in January 2024.

Tessa Outhyse, a spokesperson for the California Department of Health Care Services, which oversees Medi-Cal, attributed the enrollment declines primarily to the resumption of eligibility checks that were suspended during the COVID-19 pandemic. Overall Medi-Cal enrollment peaked in May 2023 and has since declined by about 1.6 million.

However, Leonardo Cuello at Georgetown University’s Center for Children and Families and Susan Babey at the UCLA Center for Health Policy Research noted that California and most other states had fully resumed eligibility checks by mid-2024. This suggests that the recent disenrollment trend is not solely due to pandemic-era policies.

Cuello pointed to the One Big Beautiful Bill Act and additional executive orders as key drivers of the decline. These federal changes, he said, are propelling disenrollment across the country.

Surveys Highlight Growing Hesitation Among Immigrant Families

A KFF/New York Times survey found that immigrant adults nationwide—especially parents—are increasingly avoiding government programs that help pay for food, housing, or health care to prevent drawing attention to their or a family member’s immigration status. This includes lawfully present residents and naturalized citizens. Cuello emphasized the concern around parental avoidance of these programs, noting that about 1 in 4 children in the U.S. have an immigrant parent, even though most of those children were born in the country.