In the Lead-up to Medi-Cal for Undocumented Children, California’s Community Health Centers Weigh-In

June 7, 2016

California’s community clinics and health centers (CCHCs) highlight early challenges and successes in enrolling eligible children in a recent issue brief by Pacific Health Consulting Group (PHCG) with support from the Blue Shield of California Foundation.


PHCG interviewed CCHC leaders and other stakeholders ahead of the May 16 official implementation date. CCHCs identified the following barriers:

  1. Lack of public awareness of the expansion – Families may not know that children are now eligible. Clinics pointed out that media coverage for the children’s expansion has been significantly less than during the roll-out of the Affordable Care Act coverage expansion.
  2. Families’ fear of deportation – Many undocumented or mixed-status families are worried that Immigration and Customs Enforcement (ICE) will be informed of the immigration status of family members and take deportation actions. Fears are especially heightened since families have witnessed increased ICE raids in communities in the last 6-9 months.
  3. Public charge misconception – Families seeking legal U.S. status worry that enrolling in Medi-Cal will be deemed a “public charge” and have negative consequences on obtaining legal status. Under federal law, individuals meet the definition of a “public charge” if it is determined they are likely to become dependent on government assistance. A public charge determination can lead to denial of legal status or citizenship.
  4. Isolated indigenous communities – Enrolling children of Mexican and Central American indigenous families is especially challenging due to additional language barriers. These indigenous communities only speak Mixteco and clinics have limited capacity for these language needs.


In order to overcome the enrollment challenges undocumented families face, PCHG highlighted strategies employed by CCHCs to educate families about the Medi-Cal expansion, including:

  • Advertising the expansion through local media and public awareness campaigns
  • Intensive grassroots outreach to families, including door-to-door campaigns, migrant camp visits and school partnerships
  • Analysis of clinic patient rosters to identify families that may benefit from the expansion and conducting targeted outreach, including phone calls and text messages from the clinic
  • Education and training of CCHC staff about the expansion and increased enrollment assistance at CCHC sites
  • Partnering with social services agencies for effective application coordination
  • Targeted messaging built around common misconceptions, such as fears of deportation and public charge

Read more about clinic-specific strategies to educate and enroll families on the expansion here.