California will become the first state to guarantee free health care for all low-income immigrants living in the country illegally, a move that will provide coverage for an additional 764,000 people at an eventual cost of about $2.7 billion a year.

It’s part of a $307.9 billion operating budget that Gov. Gavin Newsom was expected to sign Thursday. It pledges to make low-income adults eligible for the state’s Medicaid program by 2024, regardless of their immigration status. It’s a long-sought victory for health care and immigration activists, who have been asking for the change for more than a decade.

Nationwide, federal and state governments join together to give free health care to low-income adults and children through Medicaid. But the federal government won’t pay for people who are living in the country illegally. Some states, including California, have used their own tax dollars to cover a portion of health care expenses for some low-income immigrants.

Now, California wants to be the first to do that for everyone.

About 92% of Californians currently have some form of health insurance, putting the state in the middle of the pack nationally. But that will change once this budget is fully implemented, as adults living in the country illegally make up one of the largest group of people without insurance in the state.

“This will represent the biggest expansion of coverage in the nation since the start of the Affordable Care Act in 2014,” said Anthony Wright, executive director of Health Access California, a statewide consumer health care advocacy group. “In California we recognize (that) everybody benefits when everyone is covered.”

People living in the country illegally made up about 7% of the population nationwide in 2020, or about 22.1 million people, according to the Kaiser Family Foundation, a health care nonprofit. They are not eligible for most public benefit programs, even though many have jobs and pay taxes.

Immigrants have slowly been getting access to some health care programs. Eighteen states now provide prenatal care to people regardless of their immigration status, while the District of Columbia and five states — California, Illinois, New York, Oregon and Washington — cover all children from low-income families regardless of their immigration status. California and Illinois have expanded Medicaid to cover older adult immigrants.