The consensus among stakeholders throughout California is clear: the 2025 Reconciliation Act (“H.R. 1” or “OBBBA”) is bad policy for the Medi-Cal program. Earlier this year, the Governor’s Office explicitly stated that OBBBA was “not cost-saving” and that the inevitable coverage losses due to OBBBA’s added bureaucracy was “cruel” and “costly.” Other state entities agree and have projected that OBBBA will jeopardize individuals’ health and disrupt the state’s safety nets.
Despite the state’s harsh criticism, California is proposing to expand the scope of OBBBA by imposing its restrictive measures on state-only funded Medi-Cal immigrant enrollees. OBBBA imposes highly harmful Medicaid work requirements and more frequent redeterminations on Medicaid Expansion enrollees. Medicaid work requirement policies increase administrative red tape and reduced access to care for many, especially people with disabilities and caregivers, while not increasing employment rates. These problematic policies do not apply to California’s state-only funded immigrants, who are funded and governed by state rules, yet the Governor’s proposed budget voluntarily expands OBBBA and imposes Medicaid work requirements and six-month redeterminations on certain state-only funded immigrants. This means immigrants not subject to OBBBA would have to meet Medicaid work requirements and have more frequent redeterminations if the budget proposal passes. The state’s proposal would drastically setback California’s efforts to provide affordable health care to all Californians while putting their health and safety in jeopardy.
OBBBA Policies Undermine Public Health for Low-Income Californians
Medicaid work requirements and more frequent eligibility redeterminations do not promote a healthy California. Research demonstrates that imposing work requirements in safety net programs, like Medicaid, not only fails to meaningfully increase employment rates or average earnings, but also decreases Medicaid enrollment and delays access to care. Studies show that people avoid care if they cannot afford it, which disproportionately impacts individuals with lower incomes.
Impacted stakeholders in California have also encountered numerous challenges explaining the upcoming health care changes to the public. Broadening OBBBA obligations would further add to the time-consuming and costly burden facing county eligibility workers and would shift resources away from already depleted outreach and education efforts.
There is no sensible way to impose work requirements and other restrictive eligibility provisions on immigrants enrolled in state-only funded Medi-Cal. California’s decision to extend harmful and restrictive work requirements and increase renewals to six months to state-only funded immigrant enrollees puts many in a legally untenable position — individuals may not have authorization to work in the U.S. and there are legal prohibitions against employers hiring individuals without such authorization. This places immigrant enrollees without work authorization in the position of having to choose which laws to break. If imposed, these policies could effectively put those individuals (and potentially employers) at risk and exclude more people from Medi-Cal, even if they are engaging in work activities, as they would be deterred from reporting compliance.
Immigrant Californians Need Access to Medi-Cal Now More Than Ever in Wake of the Federal Government’s Dismantling, Chilling, and Weaponizing Immigration Agenda
Since the first Trump Administration, immigrant communities have withstood increasingly dehumanizing attacks on numerous fronts, be that to personhood, legality, or socially. The federal administration’s punitive health policies under OBBBA undermine immigrants’ access to much needed care. As noted, these harmful policies deter all immigrants, including lawfully present immigrants and also U.S. citizens, from seeking the health care they qualify for.
Subjecting immigrant communities to work requirements will particularly harm immigrants with disabilities and their family members. Although work requirements theoretically exempt people with medical frailty and those who care for them, the burden of reporting this information to the state will deter people from seeking care. Work requirement reporting hurdles are designed to lock people out of coverage in order to fund the projected cuts.
Additionally, immigrant communities continue to face the immediate threat of detainment as federal immigration enforcement agents conduct daily immigration raids throughout California. Subjecting this population to work or engage in volunteer activities in order to keep essential health care access needlessly exposes people to physical risk.
In the face of the federal government’s persistent dehumanizing attacks against immigrants, California must take a stand to protect immigrant families. Rather than expand harmful federal policies like work requirements, the state must continue its mission to provide affordable health care to all Californians regardless of immigration status. This commitment is especially needed as federal authorities inflict state violence against immigrants and allies. Thankfully, many advocates and legislators are committed to opposing both the federal government’s anti-immigrant policies and the state’s latest proposal.
