Policy Brief: Health Conditions and Health Care Among California’s Undocumented Immigrants

California has invested in its immigrant population by expanding Medi-Cal eligibility to low-income undocumented residents by age. By January 2024, the program will be available to all ages, regardless of immigration status, and the state can expect an influx of new Medi-Cal applicants. Information about the health of undocumented immigrants and the health services they use can help California plan for health care needs and the costs this latest expansion could bring.

What can community health center visits tell us about undocumented patients?

We can better understand health care needs by comparing clinic visits among low-income undocumented immigrants who would be eligible for Medi-Cal without their immigration status, to Medi-Cal patients at the same clinics . We studied 369,891 people who made more than 5.4 million visits to 350 community health centers (CHCs) between January 2018 and November 2022. We use electronic health records to study several outcomes, including types of visits that patients perform for health care; additional information helps us determine if patients are undocumented.

CHC records list patients’ chronic illnesses, such as heart disease, diabetes and obesity. Statewide, undocumented patients and Medi-Cal patients have similar rates of chronic diseases and undocumented young adults are healthier than their Medi-Cal peers. Chronic illnesses are more common among middle-aged and older adults.

What health services are undocumented patients likely to benefit from?

While most clinic visits are coded for preventive health services (55.9% statewide, 66.8% LA County), undocumented patient visits are 20% less likely than Medi-Cal patient visits from being coded for preventative reasons such as an annual exam. A range of issues may explain this difference, from fears about immigration to lack of insurance.

However, undocumented patients are just as likely to benefit from numerous age-appropriate cancer screening tests and vaccinations, important parts of preventative care. Statewide, undocumented patients and Medi-Cal patients have similar rates on their records for having performed mammograms and colonoscopies. In Los Angeles County, however, PAP smears and laboratory tests for colon cancer are more common among undocumented patients. Both groups are getting vaccinated against shingles, flu and COVID-19 at similar rates statewide, while Los Angeles’ undocumented immigrants are outpacing their medical industry peers.

Do undocumented immigrants use behavioral health and telehealth?

Many undocumented immigrants deal with trauma, including trauma related to migration, domestic violence or war in their home countries, according to interviews with Los Angeles experts. These respondents highlight high demand for behavioral health, even as patients face long wait times for appointments and clinics struggle to find fully bilingual providers who can offer advice in Spanish.
or other languages.

Among undocumented patients, visits are much more likely (36%) to be behavioral health-related than among California Medi-Cal patients, particularly among those ages 26 to 49 and older. In Los Angeles County, the increased likelihood is even greater (46%), with an even greater difference (70% more likely) among young adults.

Telehealth can alleviate logistical challenges for low-income patients, such as scheduling jobs and arranging transportation. Statewide and in Los Angeles County, about a quarter of visits were telehealth visits, which is striking since it was negligible before the pandemic. In Los Angeles, telehealth visits are more likely among undocumented patients than Medi-Cal patients, even among adults 50 and older.