Expanded Medi-Cal Coverage and Persisting Access Barriers for Latino Immigrants in California

In California, health and community-based organizations serve as vital intermediaries, helping Latino immigrants navigate Medi-Cal (the state's Medicaid program) enrollment and access to care. The 2024 Medi-Cal expansion extended eligibility to undocumented immigrants who meet income criteria. Despite this policy shift, persistent barriers to care remain at the individual, insurance system, and organizational levels. This study examines Latino immigrants' navigation of health insurance and access to care in California. As part of the MIRA Latino study, we interviewed leaders from 32 California health and community-based organizations between May 2024 to April 2025. Two researchers independently coded transcripts in Dedoose. Themes were organized using our Insurance Navigation and Healthcare Access Framework, developed from emergent themes and adapted from Andersen's Behavioral Model, examining predisposing and enabling factors at individual, organizational, and insurance system levels. The framework effectively organized themes despite substantial cross-level overlap. Key multilevel barriers included immigration status and institutional mistrust at the individual level; restrictive Medi-Cal income thresholds and complex application processes at the insurance system level, which generated burdens for both clients and staff; and caseworker delays and funding constraints at the insurance and organizational levels. Navigation support provided by organizations included education, application assistance and follow-up, appeals, and linkage to health services. Community organizations play a critical role in bridging gaps in government systems amid California's 2024 Medi-Cal expansion to income-eligible undocumented immigrants. However, limited and unstable funding constrains their capacity. Sustained state investment and stronger agency partnerships are essential to support outreach and ensure equitable access to care as health and immigration policies continue to evolve.