Laura doesn’t know what she’s going to do when her medication runs out. For years, she relied on Medi-Cal, California’s version of Medicaid, to cover the costs of treating her Type 2 diabetes: doctor visits, tests, medication. An undocumented immigrant from Mexico, she benefited from California policies that opened Medi-Cal to all low-income residents, regardless of immigration status.

Last winter, however, she received a notice that her coverage was set to expire and that she would need to renew it. At the time, Laura, who lives in the San Francisco Bay Area, said she rarely left her home, scared of getting caught up in an immigration enforcement operation. For months, she had missed many of her appointments and sent friends to pick up her prescriptions.

But she eventually ventured to the enrollment office. There, the person reviewing her renewal application told her that, since some of her family members were paid under the table, they would all have to make and sign attestations of income. Her husband was hesitant, worried by news of Medicaid’s data-sharing agreement with ICE.

“For me it was more about fear,” she said in Spanish. “I didn’t write the letter and I didn’t take it back…We didn’t know if [the news about data sharing] was true or what they could do.”They decided the risk was too great. The deadline passed.

And now Laura cannot get her coverage back. On January 1, California began denying full Medi-Cal benefits to undocumented adults amid a growing budget deficit federal Medicaid cuts Now, only those enrolled before 2026 can keep their coverage, as long as they don’t roll off; for Laura, it was too late.

Since the start of the second Trump administration, doctors and policy experts across the country have increasingly warned that immigrants are avoiding medical care as deportation fears weigh heavily on their day-to-day lives. During Minnesota’s Operation Metro Surge last winter, for instance, researchers found that the rate of missed appointments increased by more than 80 percent among Spanish-speaking families.

Medicaid doesn’t fund full coverage for undocumented immigrants. In fact, this October, it scaled back coverage for many immigrants with legal status who were previously eligible, as provisions of the GOP’s July 2025 budget bill—better known as the “One Big Beautiful Bill”—kicked in.

But many immigrants are also choosing to drop out of programs that they are still eligible for, including state-funded coverage—even though, as blue states including California, Colorado Washington roll back and cap enrollmen t for these programs due to funding constraints, they might not be able to recover that medical support later on.

“What past research has shown us is that just the chilling effect and the fears and uncertainty around these policies lead many more immigrants to disenroll from coverage than those who are directly impacted,” said Drishti Pillai, director of immigrant health policy at KFF.

As more federal policies are implemented, such as the new eligibility provisions and changes to the federal public charge rule, which now penalizes some green card applicants if they use non-cash public benefits like Medicaid, it’s likely that the share of immigrants avoiding healthcare will keep “increasing as time goes on,” Pillai said. Laura, who is going by a pseudonym in this article, said she was initially reluctant to share her experience for the same reasons she didn’t risk renewing her health insurance benefits. But it was important, she reasoned, to raise awareness of a situation that has also happened to other of her friends and acquaintances.

“I know I’m not the only person who is going through this,” she said. From May 2025 to March 2026, around 244,000 immigrants disenrolled from California-funded expansion programs meant for low-income residents ineligible for Medicaid due to their legal status. It’s a drastic change from years prior, when enrollment in these programs generally increased each month.

Despite the fact that people in expansion programs only made up about one in nine of the state’s Medi-Cal enrollees as of May 2025, based on public enrollment data, they accounted for about a third of disenrollments in the state from that month to March 2026, according to Diana Camacho, a senior program officer at the California Health Care Foundation.

California doesn’t keep track of why its residents disenroll from Medi-Cal. Many people, like Laura, simply roll off when they don’t renew their plan before their deadline.

Conversations Camacho has had, however, suggest that “fear and lack of information” are at work. Her team has heard immigrants voice concerns “about immigration enforcement, data sharing, as well as changing public charge rules” in weighing whether to renew—even when, like Laura, they might not be able to reverse their decision.

“A whole generation of children and immigrant families are falling behind in school because of all of this.” recent analysis by the Latino Policy and Politics Institute at the University of California, Los Angeles, compared data on ICE arrests with Medi-Cal enrollment numbers in state-funded programs. It found that, though enrollment rates in state-funded programs—which are used predominantly by undocumented immigrants—started decreasing after raids began in Los Angeles, the drops went far beyond the number of people arrested during that time. Many factors “suggest that immigration enforcement has led to what is commonly known as the chilling effect,” said Arturo Vargas Bustamante, the institute’s faculty director of research.

About a third of this group’s disenrollments in 2025, his study noted, couldn’t be explained by deportations or by regular enrollment fluctuations. Vargas Bustamante attributes that share of the decline to fear. Though Northern California has been spared raids on the scale of Los Angeles or Chicago, Laura and her family have had much to be scared about: Last October, a planned massive ICE deployment was announced, then cancelled in the Bay Area, followed by news of ICE activity multiple cities across the region and at San Francisco International Airport Laura’s biggest worry, she said, is that her family could be separated.

Her two children, both US citizens, have told her they don’t want to move to a new country and leave their old lives behind. Though her children are young adults—her son just started college, and her daughter works and lives on her own—they still need her help. Her son is not yet financially independent; her daughter is autistic, so Laura wants to be close by.

Last year, when she still had coverage, “I would tell my doctor that I didn’t know why my glucose levels were rising,” Laura said.

“I was working out, I was eating well, but I was stressed. And my stress was because my son was in high school and very worried about me. He would tell me to not go to his school, to not wait for him, and he would get worried. And I was even more worried for him.”According to Vargas Bustamante, families like Laura’s, where undocumented parents are a household’s main providers, are among “the most affected” by these chilling effects: they are those for whom fears of family separation carry the most weight.

Even adults with coverage are underusing the health services they have access to, says Alma Santana of Mujeres Unidas y Activas, a nonprofit that supports Latina and indigenous women in Oakland and San Francisco.

“Our members have stopped going to their appointments, from basic ones to primary care visits,” said Santana, who heads the nonprofit’s immigrant rights program. “They’re worried about being detained if they go.”Two women she worked with, who had diabetes and cancer respectively, she said, decided to self-deport to Mexico, worried about interruptions to their medical care if they were detained.

It’s increasingly difficult for advocates and resource providers to tell immigrants what’s safe Many of the federal administration’s new immigration policies have been challenged in court, though not always successfully. Sometimes, as with Medicaid’s data sharing agreement with ICE, the way the federal government plans to use the data remains unclear. But groups like Santana’s try to make sure immigrants have as much information as possible to weigh their options. “There’s a lot of fear, and then there’s people who, at a moment in time, decided not to renew and then later regretted it,” Santana said.

That impact extends to kids.

Over the years, San Francisco pediatrician Raul Gutierrez has built a lot of trust with his patients, many of whom are from Spanish-speaking immigrant families. But since the start of the second Trump presidency, he’s noticed they’re much more reluctant to seek treatment. “More kids need reminders to come to their visits. Kids are missing their vaccines,” Gutierrez said.

“Kids are missing their specialty appointments for things that they need to be evaluated on.”One mother asked Gutierrez if it was necessary to take her daughter to the gastroenterologist; the specialist was located in a different city that she didn’t know well. ”She really was struggling with that question of, ‘Do we go and just risk the possibility of being detained?’” he said. He has sought workarounds to let those families safely access care, such as phone appointments.

But that’s not always possible. Some families, Gutierrez said, wait too long to access care; one family he knows, whose child had a condition that causes fluid accumulation in the brain, waited until their child needed emergency surgery. Other families, he has noticed, have opted to not renew their children’s Medi-Cal altogether—even though children under 18 in California are still eligible regardless of immigration status.

“There’s so many questions that are being asked and so much uncertainty about how that information is being shared,” he said. Gutierrez worries that these lapses in coverage will leave immigrant children with even more unmet health care needs, including mental health support, which he notes more children now require amid deportation fears.

“I worry that a whole generation of children and immigrant families are afraid to engage in their communities and not take advantage of all the wonderful things that help them thrive and that help them just be children,” he said. “A whole generation of children and immigrant families are falling behind in school because of all of this.”

New state and federal policies could make disenrollments even worse in the coming year, Camacho said, and not just for immigrants. Further restrictions on Medi-Cal will kick in next year that add more eligibility checks and work reporting requirements, creating more barriers for all low-income California residents. The “public charge” rule, implemented in mid-September is among the policies that alarms advocates most: immigration officers now consider whether immigrants or their family members use public benefits like Medicaid and SNAP when reviewing applications for permanent residency. “It’s hard not to live stressed, thinking about what might happen tomorrow if you go to the store and you don’t come back.”

After Trump first tried to implement a similar rule in 2019—when it was contested in the courts and eventually rescinded by the Biden administration—researchers found that, though the rule did not apply to many of the immigrant groups that qualify for benefits, it had broader impacts on those groups’ willingness to seek support.

A 2021 KFF survey, for instance, found that 1 in 4 undocumented Latino adults, and 1 in 10 lawful permanent Latino residents, had decided to opt out of government assistance programs because they worried about its impact on their immigration status or that of a family member. “Perhaps it’s going to go away at the end of the Trump administration,” Vargas Bustamante said. A group of 22 states has already filed a lawsuit challenging the rule.

But for now, he predicts, it will only “generate bigger and more chilling effects in our communities.”The last time Laura saw her doctor, she re-filled Laura’s prescriptions and said that they could figure out a way to continue their visits, even though Laura no longer had coverage. It wasn’t the first time her doctor had expressed concern. Laura said the doctor had called her multiple times last winter, asking her why she wasn’t showing up to her appointments.

Laura would say that she didn’t want to put herself at risk. But what would happen, Laura’s physician asked, if she stopped going to the doctor? When Laura went to pick up her pills with her new prescription, she learned she’d have to pay out of pocket. She can’t cover that cost regularly—the 53-year-old hasn’t been able to find a consistent source of income since last year, when the woman she regularly cooked and cleaned for told her she could no longer afford to pay for her help due to the Bay Area’s rising cost of living.

“It’s a very uncertain future,” Laura said. “I don’t know if I’m going to have the same support.”She is hardly the only one.

“With the messages we’re getting every day, it’s hard to stay calm,” said Santana, of Mujeres Unidas y Activas.

“It’s hard not to live stressed, thinking about what might happen tomorrow if you go to the store and you don’t come back.”