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Restricted Medi-Cal Expansion and Healthcare Usage Among Undocumented Farmworkers.

Katherine Lacy1, Sankar Mukhopadhyay2

  • 1U.S. Department of Agriculture, Economic Research Service, Kansas City, Missouri, USA.

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Summary

California's restricted-scope Medi-Cal program significantly improved healthcare access for undocumented farmworkers. The expansion led to increased use of institutional providers and greater restricted Medi-Cal coverage, enhancing care utilization.

Keywords:
Medicaidemergency carefarmworkersrestricted Medi‐Calundocumented

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Area of Science:

  • Public Health
  • Health Services Research
  • Health Policy

Background:

  • Undocumented farmworkers face significant barriers to health insurance and healthcare access.
  • California's restricted-scope Medi-Cal program aimed to expand coverage for this vulnerable population.
  • Understanding the program's impact is crucial for informing future health policy.

Purpose of the Study:

  • To evaluate the impact of California's restricted-scope Medi-Cal program on health insurance coverage.
  • To assess changes in healthcare utilization among undocumented farmworkers post-program expansion.
  • To determine the causal effect of the Medi-Cal expansion on access to care.

Main Methods:

  • A difference-in-differences approach was employed, comparing California farmworkers to those in other states.
  • Data from the National Agricultural Workers Survey (NAWS) from 2001-2020 was utilized.
  • Analysis included assessing parallel trends using a decade of pre-treatment data.

Main Results:

  • Restricted-scope Medi-Cal expansion correlated with an 11.6% increase in coverage for undocumented farmworkers.
  • Use of institutional healthcare providers (clinics, hospitals, ERs) rose by 8.0%.
  • A decrease in private clinic utilization was observed, alongside evidence supporting the parallel trend assumption.

Conclusions:

  • The expansion of restricted-scope Medi-Cal demonstrably increased healthcare access for undocumented farmworkers.
  • Policy interventions can effectively improve health insurance coverage and utilization in underserved populations.
  • Findings support the expansion of similar programs to enhance care access for vulnerable groups.