From the outset of the Republican-led attack on federal Medicaid funding, health care experts and advocacy groups have warned that the worst effects of the projected $1 trillion in cuts would land on those most vulnerable: low-income and immigrant families without another way to see a doctor.
In California, those results are beginning to be seen — and kids are in the crosshairs.
As of June, roughly 460,000 fewer California children are enrolled in Medi-Cal than were enrolled in January of 2025, according to the policy advocacy group Children Now. The group’s researchers analyzed data provided by the state Department of Health Care Services.
There are plenty of contributing factors, experts say. One that’s near the top is the building fear among members of California’s immigrant community of harassment or deportation if they provide identifying information to a doctor. That is especially the case in homes where one person, often a parent, lacks proper documentation.
The result is that even though kids are eligible for full Medi-Cal coverage in California no matter what their parents’ status is, they’re not using it because their families aren’t. The long-term implications are disturbing, said Kelly Hardy, senior managing director for health and research at Children Now.
“It’s shameful when anyone loses health coverage, but particularly so when it’s kids, where we have such an ability to prevent future illness and disease by keeping them healthy now,” Hardy said. “What we’re trying to do is sound the alarm here.”
Medicaid funding is critical for every state, but California’s sheer size magnifies the scope of the issue. Roughly 14 million people, more than a third of the state’s population, rely on Medi-Cal for their health coverage.
In January of 2025, that total included 4.98 million children, defined as those 18 or younger. As of this June, that number had fallen to 4.52 million, Children Now’s analysis found.
“We’re especially concerned because we know that the worst is yet to come,” Hardy said, referring to looming federal rules changes that will make it harder to qualify for Medi-Cal and harder still to remain eligible.
California’s overall Medi-Cal enrollment is already in decline. It peaked in 2023 at 16 million, the result of continued state coverage expansion to undocumented immigrants and of federal pandemic protections that automatically kept others enrolled for years. As those protections wound down, the enrollment numbers began to fall, and the dropoff got steeper when California Gov. Gavin Newsom rolled back coverage for undocumented adults beginning in January of this year.
In January of 2027, the federal government will install work requirements for Medicaid recipients. It will also eliminate full-scope coverage for certain groups of immigrants who are in the U.S. lawfully, such as asylum seekers and refugees, and make everyone requalify with full documentation twice a year rather than once. Faulty paperwork has long been associated with eligible people losing their coverage.
Partly as a result, the UC Berkeley Labor Center and the UCLA Center for Health Policy Research predict that California’s uninsured rate will nearly double by 2030, nearing 15%. The addition of 2.2 million people to the ranks of the uninsured will erode much of the progress the state has made toward universal coverage, the UC researchers wrote in a May report.
The fallout could be toxic. Research has long shown that when adults lose their Medicaid coverage, their kids stop going to see the doctor, too, even though they’re still eligible for care — the so-called “unwelcome mat” effect.
In California, that effect could be profound. And among the more than 2 million undocumented immigrants who call the state home, other factors are at play. (An estimated 1.55 million children lived with an undocumented parent in 2021, according to the California Budget & Policy Center.)
“There’s definitely a chilling effect on immigrant families with all the enforcement activity,” Hardy said. “There are both undocumented and legal immigrants who are choosing to go off of public programs, even though their kids are still eligible.”
In addition to the humanitarian aspect of a kid being able to see a doctor, there are larger-scale concerns. When adults and children alike stop using preventive care, long-term health costs rise.
According to executives at multiple hospitals and health systems, uninsured Californians are most likely to put off health issues until they get severe, then go to hospital emergency departments, where by law they cannot be turned away. That’s one reason why the California Hospital Association loudly opposed federal Medicaid funding cuts. The CHA estimates that uncompensated hospital costs could increase from $2 billion to $4 billion a year as a result of these cuts, costs that are eventually passed on to other Californians in the form of higher fees or reduced services.
Medi-Cal also includes immunizations and screenings, vision and hearing checks, mental health coverage — the building blocks of a healthy life. For the state’s next wave of adults, such basic care at an early age is critical, Hardy said.
Children Now staff members have been working with state legislators primarily to increase awareness of the issue. They’re encouraging representatives to remind their communities that while adults face myriad changes when it comes to Medi-Cal, their children largely remain eligible.
“We know what’s happened already with kids losing Medi-Cal,” Hardy said. “We can only speculate about how much worse it’s going to get — but we want these families to know that their kids are still covered.”
