Despite being regarded as frontline workers, California farmworkers are significantly less likely to have health insurance coverage than the general population as they’re ineligible for most of the State’s safety-net services.
In one of the nation’s most dangerous occupations, farmworkers toiled in the fields through excessive heat, smoke, and contagion. Following the COVID-19 pandemic, the role as the backbone of California’s $50 billion agricultural industry was magnified for this low-income, predominantly immigrant agricultural workforce.
Because of this, over the past year, researchers with UC Merced, California Rural Legal Assistance Foundation (CRLAF), Insure the Uninsured Project (ITUP), and Diringer and Associates explored options to increase coverage and improve healthcare access for California farmworkers.
On October 3, these organizations held a policy forum on coverage expansion for California’s farmworker communities. During this forum, state and local leaders shared insights, data, and research on healthcare coverage and policy solutions to expand access to healthcare for California farmworkers.
They also explored the impact of AB 4 on the coverage landscape for farmworker communities and highlighted the need to make sure the healthcare coverage and access landscape is inclusive of and works for an important part of California, and the nation’s, agricultural workers.
According to a brief sent out by ITUP, projections developed by UC Merced show that even with the upcoming Medi-Cal expansion to remove immigration restrictions in 2024, an estimated 44 percent of farmworkers will remain uninsured.
“ITUP has heard from local stakeholders that even with the tremendous culture of coverage fostered in California, there’s still extremely important communities — especially our farmworker communities — across the state that either don’t have access to healthcare coverage at all,” stated Doctor Marissa Montano, Director of Policy at ITUP.
In a snapshot of the current landscape of health insurance for California’s farmworker communities, approximately 47 percent of farmworkers are currently uninsured. The snapshot also shows that undocumented farmworkers are much more likely to be uninsured than documented farmworkers, with 62 percent of undocumented workers being uninsured.
Montano described the forum that was held as a years-long policy research project aimed at delineating and uplifting policy solutions to get farmworkers covered, while also addressing the systemic issues and driving a path forward for equity and access in healthcare.
Key stakeholders in this project identified three main options for expanding health coverage for farmworkers:
- Open Covered California to allow for enrollment of undocumented individuals
- Expand Medi-Cal income limits to at least 266% of the Federal Poverty Level (FPL) to cover most farmworkers
- Examine subsidized plans to enhance employment-based coverage
“Currently, most farmworkers cannot access Covered California, the health insurance exchange created under the Affordable Care Act (ACA), due to immigration restrictions,” the brief sent by ITUP stated. “Allowing undocumented residents into Covered California would put them on the same footing as documented residents, assuming subsidies were available to make the coverage affordable.”
The brief goes on to explain that Covered California can enroll immigrants who are not lawfully present with a waiver under section 1332 of ACA to permit their enrollment in the Exchange, or by creating a parallel “mirror” Exchange with State funding to offer the same coverage as Covered California.
“Most stakeholders believe opening Covered California to undocumented residents was the favored policy alternative to expanding Medi-Cal eligibility to cover higher income categories. Stakeholders believe keeping the same coverage structures in place is beneficial because Covered California was designed to cover workers above the Medi-Cal limits with sliding-scale subsidies. It has worked better with employers and has a small business program. Now that immigration restrictions have been removed from the Medi-Cal program beginning in 2024, advocates believe Covered California should do the same,” stated some of the farmworker stakeholders. “Proponents of removing immigration barriers to Covered California agreed that few immigrants would take advantage of the expanded eligibility without premium subsidies and cost-sharing reductions.”
One speaker, Luz Gallegos, shared her experiences and conversations as someone who works closely with farmworker communities. Gallegos is the Executive Director of TODEC, a community advocacy group. Gallegos founded TODEC in order to help fellow recent immigrants learn English, secure citizenship, and create new connections in their chosen community.
She shared that something she continues to see on the ground — not just recently, but throughout the years — is that the majority of farmworkers they have been engaging as part of their outreach are less and less qualified for Medi-Cal due to certain thresholds.
“That, for us, is very, very concerning because of all the advocacy that we have done through the years to really make sure that Medi-Cal expanded. And many of the farmworkers, they’re not gonna get covered because of their income,” Gallegos shared.
She went on to explain that farm workers live paycheck to paycheck and that they have to do what they need to do in order to keep their family and keep them housed.
“Right now we have an opportunity to do more as a state. We have the moral opportunity,” said Gallegos.
Gallegos also shared the story of one of the farm workers in her community, Sida, a 44-year-old woman who fell ill during COVID and was taken to the hospital for the first time. During her hospital stay, Sida was diagnosed with ovarian cancer and when she tried enrolling in different programs, she was told that she was over the threshold.
“This is something that’s hurting our communities, and that’s going to continue hurting our communities. I don’t know what we need to do as a state, but even our community’s not thinking of prevention — they’re thinking of survival,” stated Gallegos. “For us, it’s very personal because we hear these stories on the ground every day.”
Even with the full implementation of Medi-Cal coverage for all undocumented farmworkers coming in 2024, 44 percent of California’s farmworkers will still be left without affordable coverage options.
Opening up Covered California, with subsidies, to undocumented Californians or expanding Medi-Cal income eligibility to at least 266 percent FPL would cover at least 73 percent of farmworkers.
One issue that was pointed out during the forum with the Medi-Cal eligibility threshold being so low is that even people who are still struggling and could never afford healthcare still don’t have access to it.
“We have lost so many lives and for us, it’s personal that we make sure that every farm worker, every undocumented immigrant that has been contributing to our state’s economy, get their fair share because they have not,” Gallegos said.