On June 27, 2025, Governor Gavin Newsom signed California’s Fiscal Year 2025-26 budget — a $300 billion spending plan that, for the first time, systematically strips health care access from immigrant communities regardless of legal status. The move isn’t just a fiscal adjustment. It’s a policy pivot that turns decades of progressive health expansions into rollback territory. And it’s happening at a time when these communities contribute billions in taxes, labor, and economic activity to the state — California’s economy, by some measures, ranks as the fourth largest in the world.
Who Gets Cut, and When?
Starting January 1, 2026, undocumented immigrants aged 19 and older will be frozen out of new Medi-Cal enrollment. But the scope doesn’t stop there. The definition of "unsatisfactory immigration status" (UIS) has been expanded to include lawfully present immigrants — legal residents, DACA recipients, and even some visa holders with temporary status. That means even people who’ve paid into the system for years are now at risk. By July 1, 2026, adult dental services for UIS populations will vanish — except for emergency extractions. No cleanings. No fillings. No root canals. Just pain management and extraction. Then, on July 1, 2027, a $30 monthly premium kicks in for every household member in the UIS category. For a family of four earning $32,500 a year — barely above poverty level — that’s a 7.5% income hit just to stay on the rolls. The California Pan-Ethnic Health Network calls it a de facto ban. And it’s not just insurance. In-Home Supportive Services (IHSS), which helps elderly and disabled undocumented adults bathe, eat, and move safely at home, will be slashed by $158.8 million starting July 1, 2025. That’s not a rounding error. That’s 12,000+ hours of care lost per month.The Numbers Don’t Lie — But They Don’t Tell the Whole Story
The Legislative Analyst’s Office estimates the enrollment freeze will save $78 million in 2025-26, ballooning to $3.3 billion by 2028-29. Eliminating dental care? That’s another $300 million saved annually. The state is counting on these savings to close a $38 billion projected deficit. But behind those figures are real people. The UC Berkeley Labor Center projects more than 1 million Californians could lose Medi-Cal coverage over the next decade. That’s not a statistic — it’s a public health crisis waiting to unfold. Emergency rooms will fill with untreated diabetic ulcers, abscessed teeth, and late-stage cancer. Hospitals will absorb the cost, shifting it to insured patients through higher premiums. It’s a classic bait-and-switch: cut care now, pay more later.
"Care for Immigrants Is Negotiable"
"This final budget walks back California’s equity commitments," said Mar Velez, Director of Policy for the Latino Coalition for a Healthy California. "It sets a dangerous precedent, signaling that care for immigrants is negotiable. Budgets reflect values, and this one falls short." The Health Access California echoed the sentiment: "People are being kicked off of health care coverage — and that destabilizes our entire system." What’s striking isn’t just the cruelty. It’s the timing. California spent $1.5 billion over five years to expand Medi-Cal to undocumented seniors. Now, they’re dismantling it. The state once led the nation in health equity. Now, it’s chasing fiscal shortcuts that will cost lives.What Happens Next?
Legal challenges are already brewing. Advocates are preparing lawsuits arguing the cuts violate the California Constitution’s right to health care and federal anti-discrimination laws. The federal government, which funds emergency and pregnancy-related care under Medicaid, may also intervene — especially if state cuts force hospitals to shift costs to Medicare or federal programs. Meanwhile, community clinics are bracing. Free dental vans are being deployed. Nonprofits are scrambling to fill the gaps. But they can’t replace a state system. And they can’t reach everyone. The rollout is staggered — January 2026 for enrollment freezes, July 2026 for dental, July 2027 for premiums — giving the state a veneer of gradualism. But the direction is clear: exclusion by design.
Why This Matters Beyond California
This isn’t just a California problem. It’s a national playbook. If a state with 40 million people and a $300 billion economy can justify stripping health care from immigrant workers — who clean hotels, harvest crops, and staff hospitals — what’s stopping other states from following? California’s budget may be the most aggressive yet, but it’s part of a broader trend: treating human need as a budget line item to be trimmed, not a right to be protected. And if the state that once led on climate, education, and health equity can turn its back on its most vulnerable, then the message is loud: safety nets are optional.Frequently Asked Questions
Who exactly is affected by the Medi-Cal enrollment freeze?
The freeze targets undocumented immigrants aged 19 and older starting January 1, 2026, but now also includes any non-citizen with "unsatisfactory immigration status" — a category that now covers legal residents, DACA recipients, and some visa holders. Only emergency and pregnancy-related care remain federally funded. New enrollees in these groups won’t be able to access routine care, mental health services, or preventive screenings.
How will the $30 monthly premium impact low-income families?
For a family of four earning $32,500 annually, the $30 monthly premium per household member adds up to $1,440 per year — a 7.5% cut to their income. Many will simply drop coverage rather than pay. The California Pan-Ethnic Health Network warns this effectively blocks access for working families who already pay taxes and contribute to the state’s economy.
Why eliminate adult dental care? Isn’t that a public health risk?
Dental care for adults with UIS status is being cut entirely except for emergencies — meaning no cleanings, fillings, or crowns. Untreated dental infections can lead to sepsis, heart disease, and strokes. The Legislative Analyst’s Office estimates $300 million in savings, but hospitals will absorb the cost when patients show up in ERs with advanced infections — shifting expenses to taxpayers and insured patients.
What’s the long-term impact on California’s health system?
More than 1 million fewer people with Medi-Cal coverage could mean overcrowded ERs, rising uncompensated care costs for hospitals, and increased chronic disease burden. The UC Berkeley Labor Center warns that delayed care will lead to higher long-term costs and strain on public health infrastructure — undermining the very system the budget claims to protect.
Are there legal challenges planned?
Yes. Advocacy groups, including the Latino Coalition for a Healthy California and the California Pan-Ethnic Health Network, are preparing lawsuits arguing the cuts violate California’s constitutional right to health care and federal anti-discrimination statutes. Federal funding rules for emergency care may also be invoked to block implementation.
How does this compare to other states?
California was once a national leader in expanding care to undocumented immigrants — now it’s leading in rollbacks. Texas and Florida have restricted care, but none have implemented such a comprehensive, multi-year system of premiums, enrollment freezes, and service eliminations targeting both undocumented and lawfully present immigrants. This is unprecedented in scale and scope.
