Californians Back Health Care Funds For Undocumented Immigrants Despite Budget Strain, Poll Finds

SACRAMENTO, California — A slim majority of California voters support the state’s coverage of undocumented residents’ health care — but not unconditionally — according to a new poll, offering rare insight into public opinion on a program facing fierce scrutiny from Washington and growing calls to cut back amid a budget shortfall.

The first-of-its-kind POLITICO-UC Berkeley Citrin Center survey shows 21 percent of voters believe California should continue to offer Medicaid to undocumented immigrants, even if it means the state is forced to make cuts elsewhere. Another 32 percent said the state should continue the program but prioritize people in the country legally if budget cuts are necessary.

Nearly a third (31 percent) said the state never should have opened up its Medicaid coverage to undocumented immigrants, especially working-age adults, while 17 percent believe the state should partially or fully reverse such coverage. The findings could offer direction for state lawmakers as they grapple with higher-than-expected costs in deciding on the next budget, said Jack Citrin, a longtime UC Berkeley political science professor.

“There's broad support for the state's Medicaid program for undocumented immigrants,” Citrin told POLITICO, adding, though, that there was some “nuance.”

“I think there will be resistance among the state government to cutting Medicaid, but if they have to, presumably they might start changing which undocumented get access, maybe limiting it to children and elderly people, rather than everyone, … tinkering with that.”

California has been offering Medi-Cal, the state’s Medicaid program, to everyone who qualifies in the state — regardless of immigration status — since January 2024, as part of Gov. Gavin Newsom’s pledge to bring the state closer to universal health care coverage. His predecessor, Jerry Brown, began allowing undocumented children onto Medi-Cal in 2016, and Newsom slowly expanded the age range until everyone qualified after he took office in 2019.

But the program has more recently become a political punching bag in conservative media, with MAGA figures arguing it shows the Democratic majority in Sacramento prioritizing immigrants over citizens. That’s been exacerbated by the larger-than-expected price tag for the program, which has greatly contributed to a multibillion-dollar shortfall for Medi-Cal.

It’s also made California a political target for the Trump administration as well as Republicans within the state amid a broader push for government cost-cutting and a crackdown on migration.

Democratic leaders, meanwhile, point to other factors driving the budget hole, such as higher pharmaceutical prices and an aging population.

The survey findings also show major differences between general voters and a separate group of policy influencers that was polled. The influencer group was far more likely to support the undocumented program, with 31 percent saying it should be continued even if it meant cuts elsewhere, and 45 percent supporting the program but wanting to prioritize people in the country legally if budget cuts were needed

Only 11 percent said the state should have never expanded Medicaid to undocumented residents — 20 percentage points less than the general voting population.

Among the voters, there were further divides between different demographic groups. Democrats were the most likely to support the program (77 percent generally favorable, though some with conditions) compared to Republicans — 58 percent of whom said Medicaid should never have covered the undocumented population.

Citrin said independent voters appeared to be caught in between, though they tended to skew more toward the Republican view, and that’s notable because independents are “a large group in California and they're a growing group.”

Yet more differences emerged among ethnic groups, with Hispanic and Asian voters the most supportive of maintaining the program, even if it meant making cuts elsewhere, both at 27 percent, compared to 17 percent for white, 14 percent for Black and 20 percent for other voters.

“Hispanics and Asians are the most: the largest recent immigrant groups,” Citrin said. “[Even if] they themselves are not undocumented, it may be that they know people who are, or they're more sympathetic.”

The survey was conducted on the TrueDot.ai platform from April 1 to 14 among 1,025 California registered voters and 718 influencers.

To generate the influencer sample, the survey was emailed to a list of people, including subscribers to California Playbook, California Climate and POLITICO Pro who work in the state. Respondents in that sample included lawmakers and staffers in the state Legislature and the federal government.

Verasight provided the registered voter sample, which included randomly sampled voters from the California voter file. The modeled error estimate for the voter survey is plus-or-minus five percentage points.

Financial picture

It is a particularly precarious time for the public insurance program. California had to borrow $3.4 billion in March to fix a short-term cash flow problem and appropriate an extra $2.8 billion earlier this month to make ends meet through June. Overall, Medi-Cal this year is running about 7.5 percent higher than it was originally budgeted for last year.

“Providing health care to people is one of the most important and most popular things the government does,” said Amanda McAllister-Wallner, the executive director of the health care consumer advocacy group Health Access. “It’s something that’s worth the investment.”

Those state budget pressures come as Congress lays out a plan to cut potentially hundreds of billions of dollars from the federal Medicaid budget over the next decade, which could lead to a full-scale restructuring of the program.

“The cost of the program is more than anticipated. It is unsustainable,” Erika Li, the state finance department's chief deputy director of budgets, testified at a recent hearing in the state Legislature. “We are looking at ways to curb those costs.”

Li’s comments were the strongest indication yet that the Newsom administration is considering big changes or cuts to the health insurance program, which could be proposed to rein in costs during the governor’s May budget revision.

As state and national pressure squeezes the Medi-Cal budget, the expansion to undocumented residents has drawn extra scrutiny, with Republicans calling to scale the benefits back and asking the federal government to audit the program.

Legislative Democrats, however, strongly oppose any solution that could unwind Medi-Cal for people without legal status and have instead been pushing for ways to tamp down on the cost of health care across the board.

Several things have contributed to the climbing caseload on Medi-Cal over the past few years, in addition to opening up the program to undocumented people.

Extra flexibilities introduced during the Covid pandemic have also made it so that fewer people get kicked out due to paperwork issues. The state also changed a law in 2024 to remove some financial barriers for seniors to qualify, meaning overall, there are more people on Medi-Cal. With the overall cost of care on the rise, that also means bigger bills.

Assemblymember Jasmeet Bains, a family physician, said last week during a budget hearing that she was “outraged” by the way Republicans were talking about undocumented coverage.

“People need to wake up and understand that health care is important, taking care of the vulnerable is important,” Bains said. “The talking point that covering undocumented people leads to increased health care costs is complete B.S.”