Consistent Enrollment in a Health Care Coverage Program Is Associated With Fewer Type 2 Diabetes-Related Emergency...

Area of Science:

• Public Health
• Health Services Research
• Chronic Disease Management

Background:

• Undocumented immigrants face significant healthcare access barriers, leading to increased emergency department (ED) use for chronic conditions like type 2 diabetes (T2D).
• Local health coverage programs, such as MyHealthLA (MHLA) in Los Angeles County, aim to improve chronic disease management through regular healthcare access.

Purpose of the Study:

• To examine the association between enrollment patterns in MHLA and ED utilization for T2D-related conditions.
• To determine how the duration of MHLA enrollment influences the likelihood of T2D-related ED visits.

Main Methods:

• Analysis of 115,690 ED encounters from 44,333 MHLA patients (2016-2020) within the Los Angeles Department of Health Service.
• Categorization of patients based on MHLA enrollment status in the 12 months preceding an ED encounter: continuously enrolled (≥6 months), newly enrolled (<6 months), consistently unenrolled (≥6 months), newly unenrolled (<6 months), and never enrolled.

Main Results:

• Continuous MHLA enrollment (≥6 months) was associated with a lower likelihood of ED visits for short-term T2D complications.
• Patients with enrollment lapses (newly enrolled or unenrolled) exhibited higher odds of T2D-related ED visits, suggesting that inconsistent care exacerbates disease management challenges.

Conclusions:

• Continuous access to primary care is crucial for effective chronic disease management and reducing avoidable ED utilization among underserved populations.
• Findings support the potential benefits of Medicaid expansion for undocumented adults in California and emphasize the need for healthcare systems to prioritize continuity of care.