3 Democrat-led states roll back Medicaid access for people lacking permanent legal status
She didn't have legal status, so she couldn't get health insurance and skipped routine exams, relying instead on home remedies and, at times, getting inhalers from Mexico. She insisted on using only her first name for fear of deportation.
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Things changed for Maria and many others in recent years when a handful of
Democrat-led states
opened up their health insurance programmes to
low-income immigrants
regardless of their legal status. Maria and her husband signed up the day the programme began last year.
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"It changed immensely, like from Earth to the heavens," Maria said in Spanish of
Medi-Cal
, California's Medicaid programme. "Having the peace of mind of getting insurance leads me to getting sick less."
At least seven states and the District of Columbia have offered coverage for immigrants since mostly 2020. But three of them have done an about-face, ending or limiting coverage for hundreds of thousands of immigrants who aren't in the US legally in California, Illinois and Minnesota.
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The programmes cost way more than officials had projected at a time when the states are facing multibillion-dollar deficits now and in the future.
In Illinois, adult immigrants ages 42-64 without legal status have lost their health care to save an estimated USD 404 million. All adult immigrants in Minnesota no longer have access to the state programme, saving nearly USD 57 million. In California, no one will automatically lose coverage, but new enrolments for adults will stop in 2026 to save more than USD 3 billion over several years.
Cuts in all three states were backed by Democratic governors who once championed expanding health coverage to immigrants.
The Trump administration this week shared the home addresses, ethnicities and personal data of all Medicaid recipients with US Immigration and Customs Enforcement officials. Twenty states, including California, Illinois and Minnesota, have sued.
Health care providers told The Associated Press that everything, especially the fear of being arrested or deported, is having a chilling effect on people seeking care. And states may have to spend more money down the road because immigrants will avoid preventive health care and end up needing to go to safety-net hospitals.
"I feel like they continue to squeeze you more and more to the point where you'll burst," Maria said, referencing all the uncertainties for people who are in the US without legal permission.
Monthly fees, federal policies create barriers
State lawmakers said California's Medi-Cal changes stem from budget issues - a USD 12 billion deficit this year, with larger ones projected ahead.
Democratic state leaders last month agreed to stop new enrolment starting in 2026 for all low-income adults without legal status. Those under 60 remaining on the programme will have to pay a USD 30 monthly fee in 2027.
States are also bracing for impact from federal policies. Cuts to Medicaid and other programmes in the recently signed massive tax and spending bill include a 10 per cent cut to the federal share of Medicaid expansion costs to states that offer health benefits to immigrants starting October 2027.
California health officials estimate roughly 200,000 people will lose coverage after the first full year of restricted enrolment, though Gov. Gavin Newsom maintains that even with the rollbacks, California provides the most expansive health care coverage for poor adults.
Every new bill requires a shift in Maria's monthly calculations to make ends meet. She believes many people won't be able to afford the USD 30-a-month premiums and will instead go back to self-medication or skip treatment altogether.
"It was a total triumph," she said of Medi-Cal expansion. "But now that all of this is coming our way, we're going backwards to a worse place."
Fear and tension about immigration raids are changing patient behaviour, too. Providers told the AP that, as immigration raids ramped up, their patients were requesting more virtual appointments, not showing up to routine doctor's visits and not picking up prescriptions for their chronic conditions.
Maria has the option to keep her coverage. But she is weighing the health of her family against risking what they've built in the US.
"It's going to be very difficult," Maria said of her decision to remain on the program. "If it comes to the point where my husband gets sick and his life is at risk, well then, obviously, we have to choose his life."
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