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Report · January 2021

Assessing Teen Well-Being and Mental Health after the Medi-Cal Expansion

Paulette Cha

Supported with funding from the Californian Health Care Foundation


The 2014 Medi-Cal expansion under the Affordable Care Act has increased health insurance coverage among low-income adults in California. Along with reducing uninsured rates and providing access to care, Medi-Cal also improves financial stability and mental health-changes that can make children’s home lives better. Adolescents, who are at a key developmental stage, stand to benefit from the stronger finances and positive parenting the expansion may provide.

Medi-Cal’s reach has been uneven, with coverage disparities related to race/ethnicity, citizenship, and nativity. This report analyzes whether disparities in mental health and child maltreatment for California’s adolescents improved after the Medi-Cal expansion. Moreover, concerns about teen mental health and maltreatment have escalated during COVID-19, a crisis characterized by high uncertainty, economic difficulties, and more time at home for teens due to school closures and social distancing.

This report examines teen well-being before and after the Medi-Cal expansion and presents the following key findings:

  • There were no racial disparities in serious mental health issues for teens. The odds of severe psychological distress and suicidal thoughts were similar across Asian, Black, Latino, and white adolescents.
  • Noncitizen and foreign-born teens had better mental health than US citizens and US-born teens. Though there is much overlap between Latinos and immigrants in California, being an immigrant is what matters for teen mental health disparities.
  • Over time, adolescent mental health has been worsening. Mental health disparities did not change after the Medi-Cal expansion. Either the policy change did not help teens in underserved communities, or perhaps disparities would have worsened without a Medi-Cal expansion.
  • Racial/ethnic disparities in substantiated abuse and neglect were notable both before and after Medi-Cal expansion. There are higher substantiated rates of teen maltreatment among Asian, Black, and Native American adolescents relative to white adolescents, while Latinos are similar to white teens. Though these rates of maltreatment are troubling, the overwhelming majority of teens are not maltreated, and maltreatment statewide has fallen in recent years.
  • Despite positive changes within low-income households, large disparities remain. There was little change to racial/ethnic, citizenship, or nativity differences in teen mental health or maltreatment after Medi-Cal expansion.

Adolescent mental health in California has worsened in recent years, which raises concerns about how the current crisis is affecting mental health for teens in households hit hard by COVID-19. Moreover, racial disparities persist in the rates of maltreatment among teens, and during economic downturns the risk of maltreatment tends to rise. Analyzing patterns of teen mental health and maltreatment since the Medi-Cal expansion can help us better understand the need for additional resources-and targeting of resources-to pull through this crisis, a crisis that marks the first test of the Medi-Cal expansion as a safety net program in an economic downturn.


COVID-19 Health & Safety Net Population