Changes in Type 2 Diabetes Medications Among Primary Care Patients After California's 2022 Medicaid Expansion

In May 2022, California expanded full-scope Medicaid (Medi-Cal) to low-income undocumented immigrants aged 50 years or older, which provided access to newer type 2 diabetes (T2D) medications. This study examined whether the expansion led to more prescriptions of newer therapies like glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors among older undocumented immigrants.

We used patient records between January 2019 to June 2023 from two Federally Qualified Health Centers (FQHCs) in Los Angeles County. We compared prescriptions among 1) older undocumented immigrants newly eligible for Medi-Cal, 2) younger undocumented immigrants not eligible for Medi-Cal, and 3) documented patients (n = 20,420 encounters and 4,601 patients). We used generalized linear mixed models with patient-level random intercepts to examine whether the patient groups differed in their likelihood of being prescribed newer medications and if there were changes over time.

The odds of being prescribed newer classes of drugs was significantly lower for both the older and younger undocumented patients than documented patients at baseline. Prescriptions for newer T2D medications increased over time for all patients, but the monthly rate of increase in the odds was 6% higher for the older undocumented group compared with the documented patient group.

Medi-Cal expansion was effective in changing prescription patterns for older undocumented immigrants with T2D. Although the older undocumented immigrants were prescribed newer drugs at a much lower level than were documented immigrants, they ended at a similar level as the documented patients by the end of the study period.