Several Democratic lawmakers called Saturday's vote historic.
"We don't know for certain that this will contain the costs; that's certainly the goal. But ... we also make sure that healtcare is not considered a privilege of the fortunate few but as a basic human right," said Sen. Mark Leno, D-San Francisco. "That's what we're implementing today. This is a big deal."
Republicans raised concerns about whether California can afford the expansion over the long run, especially once the federal government drops its commitment from 100 percent to 90 percent.
Democrats included a provision in the legislation that allows for future lawmakers to reconsider the expansion if the federal government's share drops below 70 percent.
Republican Assemblyman Tim Donnelly called the expansion a potentially debilitating move for the state's finances.
"We are shackling future legislators to the decisions we are making here today," he said.
The federal government will pay the full cost of expanding the low-income health program, which is called Medi-Cal in California, for the first three years. It will gradually reduce payments to 90 percent starting in 2020, putting the rest of the cost on the states that adopt the expansion.
Legislative Analyst Mac Taylor has estimated that by taking on new enrollees, the state could be responsible for between $300 million and $1.3 billion a year starting in 2020.
"I worry about expectations that we set out for individuals with ACA in California and having the rug pulled out from underneath us without a funding mechanism. Can we as a state handle that financial burden? I'm very concerned about this," said Sen. Ted Gaines, R-Rocklin.
Democrats said the expansion would help save lives, keep workers healthy and attract billions of dollars from the federal government into the state. Senate President Pro Tem Darrell Steinberg, D-Sacramento, noted that taxpayers and those who have health insurance already are paying for the medical care of those who currently go without insurance. The Medicaid expansion will cover many of those people who now receive uncompensated care, he said.
While the Affordable Care Act has led to deep partisan divisions across the country, the bills that passed Saturday had a sliver of bipartisan support. Katcho Achadjian of San Luis Obispo was the lone Republican to support the expansion when it passed the Assembly on a 55-24 vote, while two Republicans, Joel Anderson of San Diego and Anthony J. Cannella of Ceres, joined Democrats in passing the legislation 28-8 in the Senate.
Anderson, vice chairman of the Senate Health Committee, said he felt obligated to make the healthcare reforms work in California but also had pressed for a provision that would allow the state to back out of the Medicaid expansion if the federal government reduces support in the future.
"I spent the last two years fighting it, but the Supreme Court has ruled, the president is still the president, it's the law of the land. So it's incumbent upon me to implement it in the best interest of all Californians," he told The Associated Press in an interview after the vote.
Anderson acknowledged that politics can sometimes make strange bedfellows.
"I opposed it for two years," he said. "Now I'm a champion trying to ensure that it has a fighting chance for survival."
The Medi-Cal vote came a day after the Legislature passed the main bill to enact California's $96.3 billion spending plan for the fiscal year that starts July 1. Lawmakers were approving so-called trailer bills that implement certain parts of the budget on Saturday, their deadline to send a balanced budget to the governor.
Buoyed by supermajorities in both chambers and better-than-anticipated tax revenue, Democratic lawmakers have been able to restore some of the money that was slashed during the recession for mental health treatment, healthcare for the poor and higher education.
Those partial restorations were possible even as they stuck to Democratic Gov. Jerry Brown's more-conservative revenue projections.
Republicans were largely excluded from the budget negotiations and blasted the Democratic agreement as too costly given California's debts, including tens of billions of dollars in unfunded public employee pension and retiree healthcare liabilities.
"It's a compromise between the people who want to spend a little more and the people who want to spend a lot more," said Assemblyman Brian Jones, R-Santee.
Under the spending plan, K-12 school districts will receive more money, particularly those with high levels of students who come from low-income families, who are not proficient in English or who are foster children. Districts also will have more control over how they spend state aid.
Among the pending bills is a measure to distribute $1.2 billion in one-time money to help districts implement a set of new academic standards intended to better prepare students for college.
Another measure would set aside $305 million annually for college scholarships for students whose families make less than $150,000 a year. The so-called middle class scholarships would be available starting in the 2014 academic year.