What are the costs and budget projections for California's undocumented immigrant health coverage in 2024–2026?
Executive summary
California’s 2024 Medi‑Cal expansion to cover low‑income adults regardless of immigration status created new near‑term spending obligations estimated by state analysts and advocacy groups in the low billions, while the 2025–26 budget introduced freezes and benefit cuts intended to reduce those costs; official Medi‑Cal budget line items show broad program spending rising into the hundreds of billions, with specific estimates for undocumented‑related costs varying widely across sources [1][2]. Multiple partisan and policy organizations provide conflicting dollar figures — from roughly $2.9 billion for the initial 2024–25 cohort to claims as high as $9.5–12.1 billion for FY 2024–25 — so the true net state General Fund exposure in 2024–2026 depends on federal offsets, timing of enrollments, and policy changes enacted in the 2025–26 budget [1][3][4][5].
1. Expansion, enrollment and the scale of the population covered
California’s 2024 expansion made income‑eligible adults ages 26–49 eligible for full‑scope Medi‑Cal regardless of immigration status, and state projections expected about 764,000 adults to enroll at a cost of $2.9 billion in 2024–25 for that cohort specifically [1]; other reporting indicates nearly 1.7 million undocumented people were enrolled across earlier phases of expansions, illustrating why aggregate fiscal numbers can appear large [6].
2. The Medi‑Cal program’s fiscal footprint and state budget context
Medi‑Cal is a very large program in California’s budget: planning documents cited Medi‑Cal totals of $196.7 billion (with $46.4 billion General Fund) for 2025–26 and $222.4 billion ($48.8 billion General Fund) for 2026–27, figures that include all Medi‑Cal spending, not just services for people with unsatisfactory immigration status (UIS) [2]. The overall state budget framework that folded in these changes was a $321 billion package in 2025 that aimed to close a multibillion‑dollar deficit through a mix of program adjustments and accounting moves [7].
3. Conflicting estimates of direct costs for undocumented coverage in 2024–25
Independent and partisan outlets offer sharply different totals for the cost of providing Medi‑Cal to undocumented residents in 2024–25: the PPIC and state projections highlighted an expected $2.9 billion cost tied to the 26–49 age expansion [1], while some advocacy and conservative outlets reported much larger aggregates — for example, claims of $9.5 billion or $12.1 billion in FY 2024–25 appear in The Center Square and other sites, and a House Republican budget statement used an $8.4 billion headline — each source frames and aggregates differently and sometimes counts broader categories of immigrant‑related care [4][5][8]. Analytic reports caution that early utilization patterns, program phase‑in, and how federal emergency and limited‑scope services are accounted for drive those gaps [9].
4. Budget actions, projected savings and federal match effects through 2026
To slow growth, Governor Newsom and the Legislature enacted a package that freezes new full‑scope enrollment for undocumented adults 19+ starting January 1, 2026, and includes other changes such as eliminated dental coverage and future premiums — actions the administration and some analyses said would yield multibillion‑dollar savings, with one state narrative citing a roughly $5 billion savings target tied to enrollment limits and premiums [10][11]. The Legislative Analyst’s Office identified the largest ongoing savings in its 2026‑27 outlook as $10.6 billion coming from eligibility policy changes for adults with UIS, while also noting about $1.2 billion of multiyear impacts tied to lower federal funding for emergency services for undocumented immigrants [9].
5. Uncertainties, methodological differences and what remains unknown
Significant uncertainty remains: published totals differ depending on whether counts include only state General Fund outlays, net of federal matching, whether they include emergency‑only federal payments, or whether they aggregate multiple fiscal years; several advocacy, academic and partisan outlets make contrasting aggregations and policy judgments, and some details — for example precise monthly caseload and cost trajectories through 2026 — have limited public disclosure beyond summary projections, meaning firm reconciled figures for undocumented‑specific costs across 2024–2026 are not fully documented in the supplied reporting [9][3][6].