Health coverage and immigration status are inextricably linked for many Californians.
Citizens and many lawfully-present immigrants are eligible for most health care options.
For other immigrants, insurance availability varies by status.
If you鈥檙e an unauthorized immigrant, for instance, you can鈥檛 purchase a plan from , the state health insurance exchange, or get full access to Medi-Cal, the state鈥檚 Medicaid program for low-income residents. , however, may qualify for comprehensive Medi-Cal benefits even if they don鈥檛 have permanent legal status.
But President-elect Donald Trump鈥檚 promises to crack down on unauthorized immigration and rewrite the health care system have hung a cloud of uncertainty over the heads of many immigrants.
As a result, many immigrants are unsure whether they should use the health coverage they currently have 鈥� and if those options will be available to them in the future.
鈥淧eople are very scared. They鈥檙e doubting. They鈥檙e coming to us like we have all the answers, but we don鈥檛 have all the answers,鈥� says Celia Valdez, director of outreach and education for , an advocacy group based in Los Angeles County.
I don鈥檛 have the answers, either, but I鈥檓 going to pass along some information and advice for these uncertain times.
The first and most important tidbit is this: If you currently have health coverage and you need medical care, you 鈥渟hould use it and not wait. Seek the services you need while they鈥檙e available,鈥� says Cary Sanders, director of policy analysis for the California Pan-Ethnic Health Network ().
鈥淣o policies will change until at least after Jan. 20,鈥� which is Trump鈥檚 inauguration day, adds Priya Murthy, policy and advocacy director at Services, Immigrant Rights and Education Network () in San Jose.
鈥淚f you have a doctor鈥檚 appointment, please go to your doctor to make sure you get the proper care you need,鈥� she says.
Should you apply?
Open enrollment for Covered California began before the election and runs through Jan. 31, 2017. You can apply for Medi-Cal any time of year if you鈥檙e eligible.
You may fear that enrolling yourself or your children for coverage can expose you to unwanted attention from immigration officials. But advocates and state officials say that鈥檚 not the case.
鈥淚f you are eligible for Medi-Cal or Covered California, you should recognize there are laws in place to protect the confidentiality of any information you provide,鈥� says Gabrielle Lessard, senior policy attorney for the , which is based in Los Angeles.
The state Department of Health Care Services (DHCS) says it shares Medi-Cal enrollee information only with federal health 鈥� not immigration 鈥� officials, and only 鈥渇or the purpose of administering the Medicaid program.鈥�
鈥淒HCS takes its responsibility to safeguard personal health information seriously,鈥� the department says.
Covered California, too, that 鈥渢he information you provide to Covered California will not be used for immigration enforcement purposes.鈥�
The agency requires immigration details for those requesting coverage. But if you鈥檙e in the country without authorization and are applying for someone else, like your child, you don鈥檛 need to provide information about your own immigration status.
Still, after the election, advocates began to analyze California鈥檚 laws and policies to determine whether there are 鈥渧ulnerabilities in the system 鈥� that could result in the sharing of a California resident鈥檚 information,鈥� says Ronald Coleman, government affairs manager for the .
If there are, advocates will ask state lawmakers to strengthen privacy and confidentiality protections, he says.
For now, don鈥檛 be afraid to enroll, Coleman says. 鈥淯ntil we are able to see what the Trump administration is going to do, we would urge people to continue moving forward with applications for programs they鈥檙e eligible for.鈥�
Up in the Air
, state officials asked the federal government to allow Californians who are in the country illegally to purchase health insurance from Covered California. (They wouldn鈥檛 be eligible for federal tax credits, so they would have to pay the full insurance premiums on their own.)
鈥淭hat will probably not move forward,鈥� says Sarah de Guia, executive director of CPEHN.
Also , California made full Medi-Cal benefits available to unauthorized immigrant children, using only state funding. Since then, about 153,000 of them have enrolled, the Department of Health Care Services says.
Because this program relies on state 鈥� not federal 鈥� money, advocates expect it to remain in place, at least initially.
But if Trump and Congress dramatically alter or reduce funding to the Medicaid program, that could 鈥減otentially trigger big deficits within Medi-Cal, which essentially puts many Medi-Cal programs in jeopardy,鈥� Coleman says.
Dreamers
鈥淒reamers,鈥� young people whose parents brought them to the U.S. illegally, are a group of immigrants with particular anxiety about their health care.
Via executive order, President Obama created the Deferred Action for Childhood Arrivals聽() program for that group in 2012. It defers deportation for two years, allows them to work and can be renewed.
Young people in this category are barred from purchasing insurance from Covered California, but they can sign up for Medi-Cal if they qualify.
As of June, there were about 214,000 immigrants with DACA status in California, Lessard says.
But Trump has vowed to 鈥溾�� Obama鈥檚 executive actions on immigration.
鈥淔or the DACA youth, it鈥檚 just devastating. All questions are left unanswered. Folks are wondering, 鈥楽hould I be exposing myself?鈥欌�� Valdez says.
Because of the uncertainty, the National Immigration Law Center people who are thinking of applying for DACA for the first time to wait 鈥渦ntil we have a better understanding of how things are going to unfold,鈥� Lessard says.
For those whose DACA status will be up for renewal soon, different groups offer different advice, but most suggest you seek the counsel of an immigration attorney or an such as SIREN before moving forward with renewal.
But a related health question looms: If the DACA program ends, does that mean these young people鈥檚 access to Medi-Cal also ends?
That remains to be seen, advocates say.
鈥淥riginally we thought their Medi-Cal eligibility may be at risk. That may not necessarily be the case if DACA goes away,鈥� Coleman says.
Twenty-year-old Yesenia, who asked to be identified by first name only, got DACA status right away in 2012. However, the Los Angeles resident didn鈥檛 sign up for full Medi-Cal benefits until last week, with the help of Maternal and Child Health Access.
For one thing, she needs her tonsils removed. For another, she鈥檚 worried about her future status. 鈥淣ow with Trump, I have to get [Medi-Cal],鈥� she says. 鈥淗e says he鈥檚 going to take DACA from people.鈥�
Yesenia figures that once she鈥檚 enrolled in full Medi-Cal benefits, 鈥渋t will be harder for him to take it away than if I didn鈥檛 have it,鈥� she says.
But that鈥檚 just a guess. Mostly, she鈥檚 just unsure and uneasy.
鈥淚 don鈥檛 know what will happen,鈥� she says.
This story was produced by , which publishes , an editorially independent service of the .