SACRAMENTO, Calif. - Starting tomorrow, all low-income Californians younger than age 26 who meet the income requirements will be able to sign up for health insurance under the Medi-Cal program, regardless of immigration status.

The state estimates 138,000 young people will sign up - a small but significant chunk of the state's uninsured population. Carolina Gamero, senior communications specialist with the California Immigrant Policy Center, said that will make significant progress toward universal coverage.

"The majority of California's uninsured are undocumented folks," Gamero said. "And I believe that's around 1.4 million Californians who aren't able to access health care coverage or Medi-Cal simply because of where they were born."

In 2015, the state voted to extend coverage to all children, regardless of immigration status. Now people who were on Medi-Cal under the Health for All Kids initiative can now stay on it until age 26.

President Donald Trump has called the policy "unfair to our citizens."

But Gamero said the entire state benefits when people are healthy enough to go to school or work, when everyone can afford to get the medical, dental and mental-health care they need.

"It really is about making sure that all families are covered," she said. "It's really about ensuring the holistic health care of the entire family and, in that case, the entire community."

The expansion to undocumented adults up to age 26 is expected to cost the state about $98 million this year. Advocates for truly universal health care say the next step will be to look for ways to secure coverage for undocumented people over age 65.

A coalition of Montana groups will rally at the Capitol Wednesday to advocate for the protection of Medicaid expansion, which legislators will debate this session before the program's scheduled expiration in June.

The state's 10-year-old Medicaid expansion program covers 75,000 low-income Montanans at an annual cost of about $1 billion, according to KFF Health News. The state picks up about 10% of the tab.

Kristen Stewart of Billings is a caregiver for her 90-year-old grandmother, and enrolled in Medicaid herself. As an organizer with the advocacy group Big Sky 55+, she noted many Medicaid enrollees work but the work is often undervalued.

"Medicaid supports a lot of people who are doing unpaid work," Stewart pointed out. "Things that were we to monetize, you would see an economic boost from their production level, often more than the cost of their care."

The Gianforte administration already tightened eligibility for the program, cutting the number of enrollees by nearly 40% between May 2023 and October 2024. The program currently covers nondisabled adults ages 19 to 64 who make less than $21,000 a year.

Jeannie Brown, a bus driver for the Belgrade Public School District and a full-time caregiver and legal guardian for her teenage granddaughter, said if Medicaid expansion does not get reauthorized, she will be on a "slippery slope."

"Because I'm 60 years old and I'm having my own health issues after being a caregiver, it's hard work and it takes a toll on you physically, financially and emotionally," Brown explained. "I'm hoping these legislators really take all of these things into consideration and reauthorize it."

Any laws passed on the issue could also affect the state's behavioral health services, which Gov. Greg Gianforte has made a priority.

Obtaining medical records can be a costly endeavor but there is hope Washington state lawmakers could find a fix this session.

Medical providers look for compensation when producing medical records because of the work involved in the process.

Holly Brauchli, an attorney at Seattle Injury Law, said an outdated process is used to determine the cost. Federal law requires all records to be digitized and Brauchli pointed out providers charge per page as if the records were on paper.

"We download it and we get a bill for thousands of dollars and the justification of that bill is that there's a per page charge," Brauchli explained. "I get these invoices that say copying charge per page. There are no copies."

Brauchli noted there are a variety of reasons why someone would want to obtain their medical records. For instance, the records could be important to an injury lawsuit or someone might want to check if their health insurance was billing them correctly.

Brauchli argued records should no longer be charged as if they are on paper.

"This seems like a really easy fix and certainly one that would help Washington citizens," Brauchli contended. "People have a right to know what's in their medical record and they have a right to be able to see it. So, to me, it's a really simple and elegant fix."

A bill has not been filed yet but is expected from Sen. Tina Orwall, D-Des Moines, soon. The 2025 legislative session starts today.

This Wednesday is the deadline to enroll in Affordable Care Act marketplace health coverage.

Advocates say this year is even more critical for those seeking a plan, because the expanded tax credits that allowed many Kentuckians to enroll in health coverage - at little or no monthly cost - are set to expire at the end of this year.

After Jan. 15, folks will have to qualify for a special enrollment period to take advantage of Advanced Premium Tax Credits while they still exist.

Priscilla Easterling, director of outreach and enrollment with Kentucky Voices for Health, said the state's uninsured rate could potentially increase if families can't afford coverage without the credits.

"I think we should all be very concerned," said Easterling. "Without these enhanced premium tax credits being extended, we're going to see enrollment drop off, because families will no longer be able to afford that monthly premium."

According to research from the Robert Wood Johnson Foundation, the elimination of expanded tax credits would especially impact older adults - who tend to have higher health coverage costs.

In 2024, people over age 50 made up more than one-third of total ACA enrollment.

Easterling said in many cases, for low-income individuals making around $22,000 per year, the credits covered the full cost of their plan, and have saved Kentuckians thousands of dollars a year.

"They have been around for the duration of the ACA," said Easterling, "but the enhanced part that was first expanded in 2021. They have, on average, saved most households over $500 per month."

Easterling said residents can find local experts at kynect.gov to help them take advantage of tax credits and find the best plan for them.

"There are 'kynectors' available in all 120 counties," said Easterling, "who can help and provide free assistance for anyone who needs help navigating Kynect.gov or trying to get enrolled in coverage."

During 2024, more than 71,000 Kentucky residents enrolled in a plan through the marketplace, according to the health advocacy group KFF.

Nationwide, a record 24 million people have signed up for insurance coverage through the Affordable Care Act, according to federal data.