California is rocking the boat with a proposal that would reshape Medicaid eligibility. If signed by Governor Jerry Brown, the legislation would make California the first state to offer full Medicaid coverage for undocumented adults.

California currently provides immigrants with restricted-scope Medi-Cal, the state’s Medicaid program, which only covers emergency-room services and pregnancy-affiliated care. The restricted-scope coverage works by reimbursing hospitals for unpaid ER costs and providing prenatal care, which can help reduce future expenses associated with pregnancy and childbirth. The state’s new proposal would expand Medi-Cal to full-scope, offering complete coverage to all adults. If enacted, the law would continue reducing uncompensated care for hospitals and providers.

The bill has passed both the state Assembly and Senate and awaits approval on the Democratic governor’s desk. Although Governor Brown has not expressed his support for the legislation, the full-scope coverage would build off the elected official’s 2015 legislation that expanded Medi-Cal coverage to all children irrespective of immigration status.

Despite President Donald Trump’s efforts to stifle immigration with items like his proposed border wall, California Democrats who have championed the bill (SB 974) are not waiting for Washington to change its mind on immigration policy. However, the timing might be risky, as President Trump has set his sights on rallying Republican support against California’s sanctuary-state policies.

Additionally, the initiative would be quite costly. California’s Legislative Analyst’s Office estimated the total 2018-2019 net state cost of this coverage expansion is roughly $3 billion. The state would be responsible for covering the entire amount, which represents the change between the cost of offering full-scope Medi-Cal and the cost of providing restricted-scope Medi-Cal to California’s undocumented adult population, for which the state currently doles out $1.7 billion per year. An opinion piece  in The Los Angeles Times highlights that if the GOP and Administration’s repeated efforts to cut Medicaid funding prevail, California might have to bear more of the cost of those currently enrolled in the program or even end up denying coverage.

Experts are also worried the statute would intensify the impending provider shortages. A recent report  from the Healthforce Center at University of California San Francisco forecasted that California will have a shortage of primary care physicians by 2030. The potential health coverage extension might cause an influx of immigrants to California and, consequently, decrease the provider-to-patient ratios.

However, supporters of the bill believe that there is more to take into account when calculating the capacity of the bill. Micah Weinberg, president of the Bay Area Council Economic Institute, argues that the cost debate must consider the regulation’s comprehensive benefits, including enhanced worker productivity and greater community health. “Since most undocumented immigrants are productive members of society, it would, of course, be much better to give them all a path to citizenship and immediately naturalize them to make it easier for them to buy regular health insurance,” Weinberg said.

Californians and the federal government both anxiously await Gov. Brown’s decision, which is due by September 30.