Title: Assessing Barriers to Medi-Cal Enrollment among Immigrant Communities in the Era of Medi-Cal Expansion in Los Angeles County

Author: Jacqueline Cabral (1)(2), Alejandro Quiñones Baltazar (1)(2), Alejandra Rivas Deras (1)(2), Melissa Venegas (1)(2), Daniela Barcenas, M.Ed. (3), Ilan Shapiro, MD, MBA (3), Gerardo Moreno, MD, MSHS (1), Annie M. Hernandez, MD, MPH (1)

Affiliations: (1) Department of Family Medicine at UCLA; (2) David Geffen School of Medicine at UCLA; (3) AltaMed Health Services

Area of Concentration (Petal): PRIME

Specialty (if any): Family Medicine

Keywords: Health care access, systemically excluded communities

Background: Medi-Cal expansion efforts aim to improve access to health care for all adults, regardless of immigration status. While the goal of Medi-Cal expansion is to increase enrollment among immigrant communities, research shows historical barriers, such as language discordance and mistrust in health care, still persist. Due to recent policy changes, new barriers may include policy misinformation and reduced health resource utilization. A review of the literature demonstrates limited research focused on understanding these barriers from the perspective of those on the frontlines: community stakeholders and health care providers.

Objective: Identify barriers to enrollment among immigrant communities in Los Angeles county in the era of Medi-Cal expansion and changes to the federal administration.

Methods: Through a community-based participatory research approach, we partnered with AltaMed, a federally qualified health center, to explore barriers to Medi-Cal enrollment. Together, we identified key stakeholders such as community health workers, enrollment specialists, clinicians, and legal experts. Insights from iterative stakeholder meetings informed the development of an interview guide, which is currently being used to conduct 20 semi-structured interviews. Interviews are transcribed verbatim. A thematic analysis of the data will be performed to explore barriers to enrollment.

Results: We anticipate themes around knowledge, trust, resource utilization, and efficacy of community outreach efforts will emerge. Limited awareness of Medi-Cal eligibility, misinformation on public charge, and state-level budget cuts to local community organizations are expected to be identified as key barriers to Medi-Cal enrollment. We also expect the need for increased training among key stakeholders on the policy implications of Medi-Cal enrollment among undocumented residents to emerge.

Conclusions: Misinformation about public charge and Medi-Cal eligibility, as well as budget cuts to health insurance navigator programs may impede Medi-Cal enrollment among eligible individuals. We anticipate these findings will highlight the need for community-wide education on public charge, advocacy to financially sustain community outreach efforts, and stronger partnerships between providers and community organizations.