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, PPIC research associate Shalini Mustala outlined findings from a new PPIC report on the services undocumented patients tend to use at community clinics, information that can help the state prepare for a new influx of patients. PPIC research fellow Paulette Cha moderated a panel discussion on the lessons learned from the recent series of Medi-Cal expansions.

While undocumented patients of all age groups are less likely than current Medi-Cal patients to visit clinics specifically for preventive health services, Mustala reported that undocumented patients receive certain age-appropriate screenings—such as mammograms and colonoscopies—at similar rates. Furthermore, undocumented patients in Los Angeles County, studied for its large immigrant population, were more likely to have a stool colon test or vaccination for shingles on record—screenings that don’t require a referral.

“Common chronic conditions start to rear their heads in patients’ 30s and 40s,” John Heintzman, associate professor of family medicine, School of Medicine, Oregon Health and Science University, noted. When patients have Medi-Cal coverage, providers can diagnose, start treatment, educate, and intervene before conditions develop complications. “Medi-Cal coverage opens up routine treatment options. [A health concern then becomes] a few-month problem versus turning into a longer, disabling issue.”

Mustala revealed that being undocumented increases the likelihood that a visit is for behavioral health, a connection that is especially strong among young adults (age 19­–25) in LA County. Demand for mental health services like counseling is high, despite long wait times to see a provider and in the face of a shortage of mental health providers.

“When someone in a household has a behavioral health issue, it has an impact on the health and mental health of other people in the household,” said Richard Pan, former state senator and current board member of the Health Care Affordability Board. Prior gaps in care, where one household member was covered and another was not, made treatment challenging; the January expansion closes this gap.

Cha questioned how the state can meet patient needs around language—while California is linguistically diverse, recruiting providers who are fully fluent in Spanish can be difficult; finding providers who work in less widely spoken languages, such as Asian or Pacific Islander languages, can be a greater challenge.

“Not having language can affect care, especially mental health—which is about communication,” Pan said. “[Patients] can’t communicate symptoms, [and providers] can’t communicate the treatment plan. It ends up being more expensive because we do more tests because we can’t communicate.” Language access is still a policy area that needs to be addressed.

To benefit from Medi-Cal coverage at all, however, communities must be aware of their eligibility. Roshena Duree, deputy director of self-sufficiency, County Welfare Directors Association of California, emphasized that relying on trusted messengers from community-based organizations to provide accurate information has helped counties with transitions during prior Medi-Cal expansions.

Duree also highlighted news that counties are working to automate enrollment. Certain individuals won’t need to come into an office or call; counties will automatically transition them to Medi-Cal when the January expansion happens—a step toward streamlining access for all eligible Californians.