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Recent federal and state policies may have improved access to health insurance for farmworkers, who are important contributors to California's economy and an essential link in the food supply chain. The Affordable Care Act (ACA) included an expansion of Medi-Cal to most low-income adults, and a mandate requiring companies with at least 50 workers to offer employer health insurance. California also expanded Medi-Cal to young undocumented immigrants, and will soon extend it to older individuals. This report investigates whether these policies coincided with better insurance coverage or reduced barriers to health care for immigrant farmworkers.Farmworkers are aging and more likely to settle in the US with family; thus, their health care needs—and those of their families and children—will likely grow. Cost or lack of insurance are the most salient barriers to health care for farmworkers; few farmworkers note barriers related to immigration status, although being undocumented is a strong predictor of lacking health insurance. Many documented farmworkers have enrolled in Medi-Cal following the ACA expansion, which has increased coverage rates and lowered cost and insurance barriers to health care. Undocumented farmworkers have not fared as well in these areas. Employer health insurance coverage for farmworkers did not change detectably with the rollout of the ACA employer mandate, regardless of a farmworker's documentation status or whether the worker was a direct hire versus a contractor. These findings take on special importance during the coronavirus pandemic. Farmworkers have continued to work during the public health emergency. Yet with California's high cost of housing, many farmworkers live in crowded conditions, making it difficult to remain socially distant from other household members. Although emergency Medi-Cal covers COVID-19 treatment regardless of immigration status, long COVID and resulting disability may threaten farmworkers' health and livelihoods.
Many immigrant families have avoided safety net and pandemic relief programs in recent years over concerns that their participation would have adverse immigration consequences. These chilling effects on program participation occurred in the context of a restrictive immigration policy environment under the Trump administration, including the expansion of the "public charge" rule. Though the Biden administration has reverted to prior guidance on the public charge rule and reversed many other immigration policy changes, chilling effects may continue to deter adults in immigrant families from seeking safety net supports for which they or their children are eligible.This study draws on Well-Being and Basic Needs Survey data collected in December 2020 and interviews conducted with adults in immigrant families and people who work at organizations that connect immigrant families to health, nutrition, and other support programs in California. The interviews were conducted between March and May 2021, in the early months of the Biden administration, offering unique insights as policy priorities were shifting.
California policymakers continue to weigh strategies for making health insurance universal and health care accessible to all—including for undocumented immigrant residents. The state expanded Medi-Cal to undocumented children and young adults using mostly state funds, and budget negotiations are underway to expand coverage to older undocumented adults. While coverage for all undocumented immigrants has been on the legislative agenda for several years, COVID-19 has underscored how gaps in health insurance coverage for immigrants, fear and avoidance of health care systems, and lack of access to vaccines can have consequences for entire communities.This report updates PPIC's past work on health care and insurance coverage for undocumented immigrants, from presenting updated uninsured rates among immigrant groups to unpacking systematic differences in health care access by documentation status. We also examine aspects of how children in mixed-status families—where at least one member is undocumented—engage with the health care system.