178 - Sí se puede: Did “Medi-Cal for all Children” in California improve Latino immigrant children’s healthcare access, utilization, and health?

Poster Number: 178
Publication Number: 178.412

Valerie Peicher, Stanford University School of Medicine, Stanford, CA, United States; Lee Sanders, Stanford University, Stanford, CA, United States; Victoria Ding, Stanford University School of Medicine, Palo Alto, CA, United States; Fernando S. Mendoza, Stanford University School of Medicine, Stanford, CA, United States

Background: In 2016, California enacted Senate Bill 75 (SB75), expanding Medicaid to cover undocumented children, but no study has examined the impact of this policy on healthcare access, utilization, and health outcomes for them or those with at least 1 undocumented parent (UP).

Objective: To examine changes in health insurance coverage, healthcare access, and health outcomes of Latino children pre- and post-SB75.

Design/Methods: Logistic regression analyses with sample weights were performed on the California Health Interview Survey data to compare changes in child health outcomes pre- and post-SB75 for Latino children based on family documentation status. Primary outcomes were parent report of: insurance coverage, usual source of care, doctor visits in the past year, unmet healthcare needs, and parent-perceived child health. Documentation status was categorized as: 1) US-born child with US-born parents; 2) US-born child with naturalized immigrant parents; 3) US-born child with green card-holding parents; 4) US-born child with at least one UP; and 5) undocumented children. Groups 1-3 were considered “all with legal status”. Logistic regression models were adjusted for family poverty level, family size, adult’s English proficiency, and geographic region.

Results: The weighted sample size represented Latino children: 6,414,190 pre-SB75 and 6,299,472 post-SB75. The documentation status relative prevalence was: children with legal status parents 77.2% pre-SB75 & 75.6% post-SB75; children with UP 20.6% pre-SB75 & 21.7% post-SB75; undocumented children 2.2% pre-SB75 & 2.7% post-SB75. From 2013-14 to 2017-18 among undocumented children, health insurance coverage increased (aOR 13.6, 95% CI 2.5-73.2, p=0.002), unmet health needs decreased (nonsig), and parent-perceived child health improved (nonsig). In adjusted analyses, children with UP showed a significant decrease in usual source of care (aOR 0.15, 95% CI 0.06-0.38, p=0.001) and doctor visits in the last year (aOR 0.36, 95% CI 0.18-0.71, p=0.003). Conclusion(s): Health insurance coverage for undocumented Latino children increased after the implementation of SB75. However, significant disparities remained among Latino children, based on parent documentation status. Future research is necessary to understand public policy’s impact on child healthcare access and health status.
APA Valerie Peicher, MD CV 2022.pdf
Table 2: Adjusted* change from 2013-14 to 2017-18 in 5 child health outcomes, based on family documentation status.* Adjusted for poverty level, family size, English proficiency, and geographic region.
** Having seen a doctor in the last year was dichotomized as yes or no.
*** Parent-reported child health status was dichotomized as good (excellent, very good, or good) versus poor (fair or poor).