Editor’s Note: Some sources in this article are left anonymous for safety and privacy reasons.
The digital version of this piece has been edited and lengthened as developments occur. The original version can be found in City on a Hill Press’ 2026 Primer.
Alvarez, a recent UC Santa Cruz alum, is the child of undocumented immigrants reliant on Medi-Cal, a statewide public health insurance program for low-income individuals. Without plans for employment and, therefore, healthcare benefits, Alvarez says that upcoming changes to Medi-Cal will render their family unable to access life-saving care.
“One of the things they are afraid of is being exposed and being deported if they do try to get enrolled for Medi-Cal,” Alvarez said. “We don’t know how ICE has been using people’s information to deport them.”
Just last week, on Oct. 1, federal changes to Medi-Cal reduced eligibility for certain immigrant statuses, limiting their ability to access healthcare and health benefits.
According to the California Health Care Foundation (CHCF), these changes overwhelmingly threaten coverage for the following demographics, regardless of green card status:
“I think the issue is not being deported,” Alvarez continued. “It’s being kidnapped and killed.”
Alvarez’s family came to the United States in 2019 as asylum seekers. Despite having undocumented family members who need required public school vaccinations and regular checkups for type 2 diabetes, they now deem Medi-Cal applications pointless under current circumstances.
“It should be a basic right to be able to get healthcare,” they said. “To be able to do your regular checkups every year. But, in this administration, you have to choose between having a job or healthcare.”
According to CHCF, 3.4 million California residents will lose Medi-Cal coverage by 2030, a direct outcome of the House of Representatives Bill 1 (H.R. 1).
H.R. 1 was signed into law during President Donald Trump’s second term in July 2025. Otherwise known as the “One Big, Beautiful Bill Act,” H.R. 1 significantly reduced federal fiscal support for public programs. With it, Trump gutted Medicaid, coined as “Medi-Cal” in California.
According to CalMatters, a Californian, nonprofit news organization, $30 billion annually will be carved from the essential program, totaling a cumulative reduction of $1 trillion — the largest attack in Medi-Cal’s history.
“People may die. That’s the reality,” Anita Aguirre said, the chief executive officer of Santa Cruz Community Health (SCCH), a nonprofit health organization that has served Santa Cruz County since 1974. “It’s not meant to be hyperbolic. That is the reality when people lose access to basic healthcare needs, no longer qualify for Medi-Cal, miss redeterminations or are afraid to apply — they delay or forgo preventative care.”
Starting Jan. 1, 2027, immigrants over the age of 19 without legal status will not be eligible to apply for Medi-Cal. Throughout the month, patients and health care institutions, from private to nonprofit, will also face additional changes to billing processes, restrictive eligibility requirements, access requirements and more.
For able-bodied adults between 19 and 64 — barring students, people with disabilities and parents with young kids — new changes will include working and earning up to $580 monthly or volunteering at least 80 hours a month. The Department of Health Care Services (DHCS) calls this Medi-Cal eligibility change “work reporting requirements.”
The DHCS states that by June 2027, over 233,000 Medi-Cal members will lose coverage as a result of new work reporting requirements, significantly increasing the uninsured rate and raising costs for hospitals and clinics treating uninsured patients.
Medi-Cal redeterminations, or deadlines to re-enroll and substantiate continued eligibility, have also doubled, from once a year to once every six months.
Other changes vary by state, but the common denominators, fiscally and in terms of mortality rates, are devastating.
“Central California Alliance for Health, which is our local Medi-Cal managed care organization, projects a 27 percent decline in Medi-Cal enrollment across our region,” said Amy Peeler, the chief of health center services at the Santa Cruz County Department of Health Center Services. “That’s 21,000 patients that will lose their coverage.”
DataShare Santa Cruz County, a county-run data hub primarily used by local officials and community leaders, states that as federal support for community health programs is whittled away, data tracking systems will become less accurate. Consequently, vulnerable communities experiencing severe hardship may no longer be captured in traditional federal data systems.
Senior analyst at the Santa Cruz Human Services Department Adam Spickler said in an email to City on a Hill Press that within the last few years, Santa Cruz County households —–including people with non-citizen immigration status — have already been “disenrolling in or falling off Medi-Cal faster than citizen households.”
For “K,” an immigrant unable to enroll in Medi-Cal because of her expired F-2 visa, delaying care is now her only option.
K is the spouse of a UCSC graduate student, when her husband immigrated to the United States a few years ago, she followed.
“America had always been a dream of his,” K said. “Growing up with American media, it’s painted as the place to be, you know?”
K was six weeks pregnant with her first child when they touched down in California. Without health insurance and with limited funds, she scoured for a clinic offering free prenatal care. She found the Pregnancy Resource Center of Santa Cruz County (PRC), a nonprofit that provides extensive zero-to-low-cost reproductive health care services.
The PRC helped K complete Medi-Cal eligibility tests and enrolled her in free pregnancy-related Medi-Cal. After her first child’s birth, the county automatically switched her to full scope Medi-Cal, which covered her and her child’s healthcare for two years.
Come late 2024, everything changed. She received a letter from Santa Cruz County stating her Medi-Cal status was revoked.
Her son was still insured, albeit with copays, and her husband had UC SHIP, a low-fee, premium health benefit plan for UC students. But K lost all coverage.
“They just said it was due to my immigration status,” K said.
For the last two years, she’s paid for all medical costs out of pocket. She hasn’t had a checkup since the letter.
More recently, one of K’s children sustained a serious injury. Her family incurred expenses for an ambulance, an emergency care visit and a medical scan — totaling thousands of dollars. She has yet to receive the bill and is “afraid to find out.”
“No one is guaranteed perfect health until they leave this earth,” K said. “As long as this continues to be the case — not having proper healthcare — we’re going to have to leave and go somewhere else where we can make an actual plan.”
K’s family is actively considering moving to a different country if healthcare access in the United States remains unsustainable.
Some, like K’s spouse, are able to turn to UC SHIP for support, but the plan doesn’t come without its caveats.
“I tried to waive it,” said fourth-year biology student Kassandra Bui in reference to UC SHIP. “I didn’t want to pay for health insurance when I already had Medi-Cal, plus I worried there was going to be an out-of-pocket expense.”
Bui grew up in a low-income, Vietnamese-immigrant household and has been on Medi-Cal all her life. The university enrolled Bui in UC SHIP her first year by default, as all students are, but she couldn’t afford the attached fees.
“It’s pretty pricey when you have to pay at the beginning of each quarter,” Bui said. “I filled out the [waiver] form three times and all three times it was denied.”
Months later, Bui found out that she automatically received the UC Health Care Insurance Grant (UC SHIP Grant) due to her low-income background.
“It covered pretty much the entire cost of UC SHIP,” Bui said. “Now, I’m receiving $400 per quarter for the grant.”
Bui received $3,141 in grant money for the entirety of her freshman year, covering the cost of UC SHIP at the time, around $1,047 quarterly. For the 2026 – 2027 academic year, Bui received a $1,200 grant, but UC SHIP costs $1,403 quarterly. That’s an increase of over $400 in costs per quarter and a drop of nearly $2,000 in yearly aid in the span of three years.
Her father, also a Medi-Cal enrollee, pays her remaining UC SHIP costs out of pocket.
Similar to Bui, 2025 UCSC alumna Lula Etienne grew up on Medi-Cal in a low-income, Caribbean-immigrant household. She recounted feeling “confused” by UC SHIP’s default enrollment process her first year and said that her UC SHIP grant was cut significantly in her fourth year.
“I’m 100 percent sure they [UCSC administrators] didn’t give me any notice whatsoever,” Etienne said. “They cut that at the beginning of my senior year. From what I recall, it was about half.”
Etienne was on both Medi-Cal and UC SHIP for her first three years of college, but defaulted to solely using Medi-Cal her third year because of grant cuts.
During her time on UC SHIP, she met with on and off-campus healthcare professionals for various reasons, including a minor wrist surgery for a ganglion cyst removal. The surgery, including anesthesiology and a hospital stay, totaled to upwards of $8,000.
“I don’t think UC SHIP covered enough of that, but I did get Medi-Cal, too,” said Etienne.
Even with Medi-Cal coverage, her bill totaled almost $5,800 and Etienne said she felt “lucky” to have at least discharged some of the full cost through her dual coverage plan. But at the time, she was in her third year, just before her grant was slashed in half.
Students opting into dual coverage this year now face significant cuts on two fronts — Medi-Cal and UC SHIP.
“It hits close to home because I know how essential these resources are and how much of a difference it truly makes in people’s lives,” said Zaynab Masri, a UCSC third year and the current UCSC Student Union Association vice chair of external affairs.
Masri immigrated from Syria in 2019 and has played a pivotal role in maintaining her family’s Medi-Cal status since she was a child. Just last year, she was blindsided right before her youngest brother’s checkup: She got a call from San Mateo County stating her family’s insurance “didn’t work.”
Between struggling with digital and in-person paperwork submissions, most of Masri’s family missed the subsequent re-enrollment deadline.
“With this new administration, staying on Medi-Cal requires more steps,” Masri said. “We were struggling a lot because the process to get enrolled in Medi-Cal is so annoying, tedious and long.”
Angel J. Martinez, the chief equity and engagement officer at community programs at the Los Angeles County Department of Health Services, said that with increases in redeterminations and other H.R. 1 changes, paperweight barriers will only be more difficult to overcome. While county agencies can provide applicants with the necessary documents to qualify for Medi-Cal, he finds this doesn’t guarantee enrollment.
“That piece of paper still has to get uploaded somewhere. We’re in a space where we’re creating more variability for people to receive basic needs, like healthcare,” Martinez said.
In an attempt to bridge the divide in access to care, organizations in Santa Cruz County have come together to discuss contingency plans. With midterm elections on the horizon, conversations regarding upcoming healthcare-related propositions, like Proposition 44, are vital.
“Proposition 44 is a direct attack on the work we are doing and the work of community health centers throughout California,” said Dena Loijos, chief strategy and impact officer at SCCH. “It would mandate arbitrarily that we cap our overhead at 10 percent and if we don’t meet that threshold, we would be penalized for the difference.”
This would require them to spend 90 percent of revenue on health care service expenditures, prohibiting health centers from using more than 10 percent on administrative expenses, translators and patient navigators. Some critics of Proposition 44 argue that this will lead to healthcare center closures, while others believe it will secure services for patients and workers.
Loijos said that SCCH could be down by about $2.4 million in the first year alone.
Other propositions, such as Proposition 40 (the Billionaire Tax”), aim to alleviate burdens caused by Medi-Cal cuts and eligibility changes by recirculating taxpayer dollars back into community funding for health care and education.
Dr. Carlos Martinez, a UCSC Global and Community Health assistant professor and supporter of the tax, said that although the proposition will mitigate harms caused by H.R. 1, it’s not a one-stop shop solution.
“The odds are stacked against regular people in terms of our tax system. In other words, these kinds of efforts provide some semblance of equality,” Dr. Carlos Martinez said. “But the truth is it’s still very insufficient.”
UCSC administration has yet to release a public statement, but wrote in an email to City on a Hill Press that UCSC and other UC campuses are exploring ways students can bill health insurance plans beyond UC SHIP, potentially helping students access care on campus “with other forms of insurance.”
“Realistically, the state supersedes any sort of county rule we would want in Santa Cruz. But that doesn’t mean the school shouldn’t try,” said Riya Navale, a second-year UCSC Student Doctor Alliance member. “At the end of the day, if one UC suffers, the rest do too.”
Three Upcoming Healthcare-Related Propositions
Medicare for All Act
This act is essentially universal healthcare. A recent study from Yale and Harvard proved it could significantly lessen the fiscal healthcare burdens felt by families. It would provide public health care without a premium, deductible or co-pay, saving over 114,000 lives and over $1 trillion.
The Billionaire Tax – Proposition 40
State – On the Ballot
This revision, also known as Proposition 40, levies a one-time, five percent tax on billionaires in the state of California while simultaneously resurfacing cumulative funds back into communities by way of awarding health care, food security and education programs with fiscal support. Some believe the tax may discourage the top one percent of income earners from residing in the golden state, while others believe it can help mitigate effects of H.R. 1 cuts.
The Half-Cent Sales Tax – Measure E
County – On the Ballot
This tax would be placed on sales items in Santa Cruz County for the next five years, funnelling costs back into general funds for the community, by way of food security initiatives, health services, and more. It’s predicted to accrue about $27 million annually and would begin operations in 2027.