Health care use gaps by citizenship status among Latino adults aged 26–49 in California under a new federal immigration environment

Since 2016, California has expanded Medi-Cal, the state’s Medicaid program, to include all income-eligible residents, regardless of immigration status. The most recent 2024 expansion extended coverage to adults aged 26–49. However, anti-immigration federal policies and a proposed state-level freeze on Medi-Cal enrollment for undocumented adults undermine these expansions. This study examines the association between citizenship/documentation status and health care use among adults ages 26–49 with incomes below 138% of the Federal Poverty Level, the eligibility threshold for Medi-Cal. It also explores differences in health care use between Latinos and non-Latinos. Using data from 2,384,944 adults in the 2018–2021 California Health Interview Survey, the analyses employed multivariate logistic regression models with an interaction term between citizenship/documentation status and Medi-Cal enrollment to estimate utilization gaps. Non-Green Card holders (non-GCH) with Medi-Cal had significantly higher odds of a doctor visit in the past year compared to citizens without Medi-Cal (aOR = 5.23; 95% CI: 2.36–11.57). Among Latinos, the interaction between Medi-Cal enrollment and non-GCH status was also statistically significant (aOR = 6.53; 95% CI: 2.57–16.59). These findings indicate that Medi-Cal may help undocumented individuals overcome barriers to accessing care, but federal and state policies undermine these advances.