Medi-Cal’s Transformation Is Well And Truly Underway

Two years ago, Nomxolisi – Nom for short – and her daughter moved from their home country of South Africa to the United States to live with her American husband. However, life did not turn out as she had hoped for her and her daughter after the move. Her husband was physically and emotionally abusive, and soon abandoned his wife and her daughter, leaving them to fend for themselves in a new country.

“I was homeless for a couple of days. I was in jail,” she said, speaking at a meet-and-greet event organized by Ethnic Media Services on September 18 at Cameo House in San Francisco, where she currently lives.

Like Nom, several women from all over the Bay Area take refuge at Cameo House, a home for justice-involved women and their children. San Francisco-based nonprofit Center on Juvenile and Criminal Justice (CJCJ) manages the house. The organization works with residents to get them on their feet, by providing mental health support, employment assistance, educational opportunities and a smooth transition to stable housing.

“Cameo House was my savior, because I was able to get my daughter back because they (Child Protective Services) couldn’t send her back to me until I got proper accommodation for a child,” added Nom.

Through a slew of new initiatives, the state’s medicaid program Medi-Cal is enabling organizations like CJCJ to deliver more and better services to the justice-involved, unhoused, and undocumented individuals of our communities.

The Medi-Cal Transformation

California’s MediCal healthcare program is in the midst of a historic overhaul . Over the past two years, the Department of Healthcare Services has pushed to include as many California residents as possible under Medi-Cal.

For instance, adults between the ages of 26 and 49 are now eligible for Medi-Cal coverage irrespective of their immigration status , provided they meet the income eligibility criteria.

Similarly, the Justice Involved Reentry Initiative allows youth and eligible adults to access specialized healthcare services up to three months before the end of their prison terms. Another highlight has been CalAIM, or California Advancing and Innovating Medi-Cal. This $12 billion experiment offers healthcare services that go beyond the doctor’s office , and aims to streamline care services for the unhoused, older populations, and individuals with specialized needs.

This expansion of services benefits not only the individuals who need them, but also the nonprofits and other organizations like the CJCJ, that are already working to uplift communities.

“It gives me a sense of hope to be independent”

“The safest communities are not those that have the most police, it’s those that have the most resources,” said Tina Curiel, Communications and Policy Analyst for CJCJ. “Formerly incarcerated folks are often the product of a lack of resources, so to give them that access (to healthcare services) on the front end is really, really important.”

As a result of Medi-Cal’s big push, Cameo House residents can access a variety of those services for themselves as well as their children. Nom and her daughter, for instance, are attending family therapy.

“My two-year-old is autistic, so it’s been a lot more of a challenge to learn everything about him being autistic, and Medi Cal has helped with that,” said Spiritual, a domestic violence survivor who also lives in Cameo House.

Margaret, who is visually impaired, is on an integrated healthcare and social services plan that includes mental health services, and will help her find housing as she transitions out of Cameo House.

“I feel a little bit more at ease not just depending on Child Protective Services, or Adult Protective Services as a person with a disability,” she said. “So it gives me a sense of hope to be independent.”

CJCJ also runs a program of its own called Community Options for Youth, through which the organization provides mental health support to youth and families impacted by the juvenile justice system in San Francisco. Apart from the benefits of increased service delivery, Curiel believes that state funding for these programs is also helping destigmatize the issue of mental health among justice-impacted communities.

“Society, you know, we’re incarcerating people for social problems,” she said. “So I think it’s really important to expand awareness of mental health services.”

Extending coverage to the undocumented

Since immigration status is no longer a criteria to be eligible for Medi-Cal, community health organizations like Asian American Community Involvement (AACI) can serve more individuals with the same amount of resources.

AACI started in 1973 as an advocacy organization for Southeast Asian refugees. Over the next fifty years, the organization expanded its scope to include physical health, behavioral health, and wellness services for underserved communities of all ages, immigration status, genders and ethnicities. Today, the organization serves around 26,000 individuals in the Santa Clara County region, 60% of them non-Asian.

“Our focus is basically to cater to the underserved populations, and folks that are particularly facing barriers to accessing care,” said President and CEO Sarita Kohli. “And the barrier can be because of trauma, it can be because of language, or cultural issues, or just poverty.”

She explained that the state government extended Medi-Cal coverage to undocumented immigrants in three stages: first to youth under 25 years of age in 2020; then to individuals over the age of 50 in 2022; and to all adults between the ages of 26-49 in 2024.

Before this third expansion was in place, close to 10-15% of the individuals AACI serves did not have insurance. Now, almost all of them have Medi-Cal coverage, and if they don’t, AACI navigators can help enroll them for Medi-Cal.

“Since our doors are open to everybody, and we don’t turn anyone away because of their inability to pay, the fact that now all those people are eligible for insurance through Medi-Cal has made a huge difference to us,” she said. “We’re now able to get paid for the services we provide, and that allows us to serve many more people.”

Medi-Cal NOT a Public Charge

Even if they have access to Medi-Cal, many undocumented individuals are afraid to exercise their right, fearing that a “public charge” will appear against their immigration case.

Public charge is a non-citizen who is likely to become primarily dependent on the government for support through CalWorks, Supplemental Security Income, or other cash-based assistance programs. Some categories of immigrants applying for a green card could face a rejection of their application if they have used any of these services. Before 2019, accessing Medicaid services did not constitute a public charge.

But in 2019, the Trump administration made the public charge laws more stringent and added non-cash assistance programs like Medicaid as a public charge qualifying service. This rule change potentially prevented millions of non-citizens from accessing Medicaid in years since.

In 2021, the Biden administration rolled back these laws , and reinstated the previous standard according to which Medicaid would not count towards a public charge. However, the effects of the draconian 2019 law persists, and many undocumented individuals continue to be wary about accessing Medi-Cal.

To counter this resistance, and to support Medi-Cal’s expansion, AACI sends its enrollment counselors out in the community to inform individuals about their rights and help set them up with Medi-Cal.

“Undocumented or not, these individuals are here, and they are actually contributing to the economy, as they are working,” said Kohli. “And so, I think they’re just as entitled to healthcare as anybody else.”

Relief for domestic violence survivors

Kohli adds that the expansion has also been a relief for domestic violence survivors that AACI serves. While many domestic violence survivors are not undocumented in the traditional sense, their immigration status is often uncertain or in limbo in cases where their work authorization or residency permit is linked to their spouse.

“Often the spouse has taken their green card if they had one, or has not applied for immigration for them, and so they don’t have any status,” she said. “as much as they are the ones that need the care. They’re not able to access the care because either they don’t have the means to do it, or they’re afraid of being found out.”

In that sense, the removal of the immigration status criteria has gone a long way in securing healthcare coverage for this precariously positioned group in California.

“I was always getting threats, he (her husband) would tell me, ‘Oh you’re going to get deported, you’ll be living on the streets’,” recounts Nom. “It’s just that I was not aware that I do have rights as an immigrant.”

In June 2024, she came to Cameo House, and turned her life around. Child Protective Services reunited her with her daughter, and Cameo House staff helped set her up with CalWorks to get her back on her feet.

Through Medi-Cal, she was able to access family therapy and is now trying to get one-on-one therapy for herself to address her trauma.

She enrolled in the City College of San Francisco, and studied to obtain her Early Childhood Education (ECE) Certificate, through which she can now get a job and transition to a life of independence for herself and her daughter.

Once back on her feet, she hopes to travel back home to South Africa with her daughter.

“I have no family here, I miss home, but I can’t go home,” she said. “It’s really a challenging situation, but we keep going, because there are people here (in Cameo House) who listen to us and work with us on a daily basis.”

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