California is preparing for its final expansion to Medi-Cal in January 2024, which will include all low-income Californians regardless of immigration status. In a recent presentation, Shalini Mustala, research associate at PPIC, presented the results of a new PPIC report about the services that undocumented patients tend to use at community clinics, information that can help the state prepare for a new influx of patients. PPIC researcher Paulette Cha moderated a panel discussion on lessons learned from the recent round of Medi-Cal expansions.
While undocumented patients in all age groups are less likely than current Medi-Cal patients to visit clinics specifically for preventive health services, Mustala reported that undocumented patients benefit from some screenings age-appropriate services, such as mammograms and colonoscopies, at similar rates. Additionally, undocumented patients in Los Angeles County, studied among its large immigrant population, were more likely to receive a stool colon test or shingles vaccination, screenings that do not require referral.
“Common chronic illnesses begin to appear in patients in their 30s and 40s,” noted John Heintzman, associate professor of family medicine at the Oregon Health and Science University School of Medicine. When patients have Medi-Cal coverage, providers can diagnose, begin treatment, educate and intervene before conditions develop complications. “Medical coverage opens up routine treatment options. (A health problem then becomes) a problem of a few months instead of turning into a longer and debilitating problem.
Mustala found that being undocumented increases the likelihood that a visit will be behavioral health-related, a connection that is particularly strong among young adults (ages 19 to 25) in Los Angeles County. Demand for mental health services like counseling is high, despite long wait times to see a provider and facing a shortage of mental health providers.
“When one member of a household has a behavioral health issue, it impacts the health and mental health of other members of the household,” said Richard Pan, former state senator and current council member of the Health Care Affordability Board. Previous gaps in care, where one household member was covered and another was not, made treatment difficult; the January expansion closes this gap.
Cha wondered how the state could meet patients’ language needs: While California is linguistically diverse, it can be difficult to recruit providers who are fluent in Spanish; finding providers who work in less widely spoken languages, such as Asian or Pacific Island languages, can be more difficult.
“Not speaking the language can affect care, especially mental health, which is all about communication,” Pan said. “(Patients) cannot communicate their symptoms and (and providers) cannot communicate the treatment plan. It ends up costing more because we’re doing more testing because we can’t communicate. Access to languages remains a policy area that needs to be addressed.
However, to receive Medi-Cal coverage, communities must be aware of their eligibility. Roshena Duree, deputy director of self-sufficiency at the California Association of County Welfare Directors, noted that relying on trusted messengers from community organizations to provide accurate information has helped counties in their transitions during previous Medi-Cal expansions.
Duree also highlighted news that counties are working to automate registrations. Some people will not need to visit an office or call; counties will automatically switch them to Medi-Cal in the January expansion, a step toward streamlining access for all eligible Californians.
