AB 4 (Arambula) Accessing Coverage in Covered California

Undocumented Californians are explicitly and unjustly excluded from accessing and purchasing health care coverage plans through Covered California, the state’s marketplace established under the federal Affordable Care Act (ACA). Assembly Bill 4 (Arambula), the #Health4All Covered California campaign, would address this exclusion by taking the first step toward allowing undocumented Californians to buy health plans through Covered California. Specifically, AB 4 establishes a program to allow undocumented individuals to purchase health care coverage by authorizing Covered California to offer California Qualified Health Plans as a mirror to the plans currently offered on the exchange. The bill also establishes a framework to provide state-based affordability assistance for undocumented individuals in future years.


Past Progress and the Current Problem

Over the last several years, California has made significant progress in removing immigration status as an eligibility exclusion in Medi-Cal. Income-eligible children under the age of 18, young adults ages 19 to 25, and older adults ages 50 and above are eligible for Medi-Cal, regardless of immigration status. Beginning January 1, 2024, adults ages 26-49—the final group of ineligible undocumented Californians—became eligible to access health care coverage under Medi-Cal.
Medi-Cal is a means tested program, available to those below a certain income limit. Californians without employer-based coverage who make too much for Medi-Cal are able to purchase a health care plan on Covered California and receive affordability assistance to help pay for the plan. However, undocumented Californians who earn more than the Medi-Cal income threshold are explicitly and unjustly excluded by the ACA from purchasing plans on exchanges like Covered California—even using their own money—or from receiving federally funded affordability assistance.


The Population

The UC Berkeley Labor Center estimates that by 2024, there will be 2.57 million Californians who remain uninsured.i Of those, 520,000 would otherwise be eligible to purchase plans on Covered California if not for their documentation status. The Labor Center also estimates that there are an additional 110,000 undocumented individuals who pay the full cost of health care plans on the private market but would otherwise be able to purchase coverage on Covered California.ii The regional breakdown of the population of California residents who are undocumented, uninsured, and ineligible for Medi-Cal can be seen in the table to the right. More demographic details about the population are presented in Figure 3 of the UC Berkeley Labor Center’s latest brief, California’s Uninsured in 2024: Medi-Cal expands to all low-income adults, but half a million undocumented Californians lack affordable coverage options.

For 2023, the income threshold for Medi-Cal is 138% of the poverty level. Of the population who are undocumented and uninsured, with incomes above this Medi-Cal threshold, 190,000 of them have incomes at or below 250% of the FPL ($33,975 for an individual and $69,375 for a family of four).iii, iv This indicates that a significant number of these households are still low-income and just barely above the income cutoff for Medi-Cal eligibility. The full cost of private coverage on the individual market is completely out of reach for this population.

Furthermore, over 70% of undocumented Californians are in mixed status families. Covered California should be a one-stop shop to help the whole family get coverage, rather than to turn away parents or other family members that it is unable to serve.


The Solution

AB 4 would take the first step in seeking to include all Californians regardless of their immigration status within our heath care system, Covered California. In doing so, over half a million California residents would finally have access to all health care options, and our system will be set up to provide affordability assistance in the future. AB 4 helps build a more universal, efficient, and equitable health care system for all who call California home. Health care is a human right, and our health system is stronger when everyone is covered.
For more information, please contact:

Sarah Dar sdar@caimmigrant.org with the California Immigrant Policy Center
Diana Douglas ddouglas@health-access.org with Health Access California