Abstract
BACKGROUND: In May 2022, California became the first state to extend full-scope Medi-Cal coverage to low-income residents aged 50 and older, regardless of immigration status. This study explored the older adult Medi-Cal expansion among newly enrolled undocumented patients in Southern California, focusing on barriers and facilitators to enrollment, continuity of care, healthcare utilization, and changes in health status. METHODS: We examined patient perspectives on the Medi-Cal transition using both focus groups and interviews collected between April and December 2023. We collected data from 12 undocumented participants from two Southern California Federally Qualified Health Centers (FQHCs) who became eligible for Medi-Cal with the older adult expansion. We conducted a thematic analysis combining deductive and inductive techniques and developed a coding scheme around medical care before Medi-Cal expansion, participants' experiences with enrollment process, and their health care experiences after the policy change. RESULTS: We found that most patients were able to enroll in Medi-Cal successfully, but nearly all relied on social workers or health clinic staff to assist them. Some participants who were enrolled in a local health coverage program that pre-dated Medi-Cal expansion had continuity in their primary health care experiences. Others with more episodic care experienced improvement in health care costs. All patients shared increased feelings of security and were more willing to seek out health care with full-scope Medi-Cal. CONCLUSIONS: Our exploratory findings highlight the relative success in Medi-Cal enrollment while also calling attention to potential differences in the policy's impact based on pre-expansion health care availability, as well the vital importance of professional enrollment support.