California’s Medi-Cal Expansion: Navigating Health Care, Gender Affirmation, and Immigration Dynamics

California is set to enhance its expansive health care system this year, a development that will see an allocation of taxpayer dollars towards supporting gender-affirming procedures, including sex change surgeries, for residents, irrespective of their citizenship status. The details, outlined in a memo circulated in May 2022 and reported by the Daily Caller Foundation, reveal that California’s Medi-Cal program covers expenses related to hormone therapy and procedures aimed at aligning primary and secondary gender characteristics with an individual’s identified gender. This includes ancillary services such as hair removal.

As of January 1, nearly 700,000 undocumented immigrants aged between 26 and 49 are eligible for these federal healthcare services, constituting an estimated cost of $3.1 billion to California taxpayers. For those residing in California illegally within this age range, this translates to approximately $4,058 per year in medical coverage subsidies funded by the state’s general fund.

California's Medi-Cal Expansion
The report highlights the trajectory, surging from 3.7 million in 2021 to almost 4.8 million in 2022 and nearly 6.2 million in 2023

The memo emphasizes that “gender-affirming care” is a covered benefit under Medi-Cal when deemed medically necessary. Requests for such care should come from specialists experienced in providing culturally competent services to transgender and gender-diverse individuals, adhering to nationally recognized guidelines.

Medical necessity is determined and services are recommended by licensed mental health professionals and physicians experienced in treating patients with incongruence between their gender identity and assigned gender at birth.

In the final month of the previous year, from December 1 to December 31, a record-breaking 302,000 migrants were documented attempting to cross the U.S. southern border, marking the first time monthly migrant encounters surpassed 300,000.

A recent report from Immigration and Customs Enforcement (ICE) reveals a notable increase in the number of undocumented immigrants not held in detention. The figure rose from 3.7 million in 2021 to almost 4.8 million in 2022 and nearly 6.2 million in 2023. These individuals have final orders to leave or are in the process of being removed but are not held in ICE custody.

Governor Newsom’s office asserts, “In California, we believe everyone deserves access to quality, affordable health care coverage — regardless of income or immigration status.” Through this expansion, the state aims to ensure that families and communities across California are healthier, stronger, and able to receive the care they need when they need it.

Governor Newsom has announced that California will extend health care coverage to additional undocumented immigrants, supplementing the 1.1 million already in the Medi-Cal system.

With over one-third of California’s population, which currently stands at 39 million, enrolled in the Medi-Cal program, the state has been gradually including undocumented immigrants since 2015. The eligibility was first extended to undocumented children in that year, followed by the inclusion of adults aged 50 and older four years later.

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