Health Policy Brief August 2019 Still Left Behind: Health Insurance Coverage and Access to Care Among Latinos in California Tara L. Becker, PhD; Susan H. Babey, PhD; and Shana A. Charles, PhD, MPP SUMMARY: Data from the 2015-2016 Cal), an individual’s citizenship or permanent California Health Interview Survey show that residency status remains a barrier to obtaining Latinos remain less likely to have health public coverage. This lack of coverage has insurance coverage than other Californians, as important implications for the well-being of they are less likely to have insurance through these Californian Latinos, because not only are an employer. Though 22% of uninsured Latinos uninsured Latinos in poorer health than those are eligible for health insurance coverage who are insured, but they also have less access through California’s Medicaid program (Medi- to health care services. ‘‘ Latinos are more than two times more likely than other nonelderly racial/ethnic M illions of Californians gained health insurance coverage under the Patient Protection and Affordable Care Act (ACA), and California’s uninsured rate has reached a historic low. Implementation of the ACA led to significant increases in health insurance coverage for all racial/ethnic Latinos Continue to Have the Highest Rate of Uninsurance In California, Latinos are more than two times more likely than other nonelderly racial/ethnic groups to be uninsured, even with full implementation of the ACA (13.7%, compared to 6.4% for African groups to be groups across California.1 However, despite a ’’ Americans and 5.3% for non-Latino whites; uninsured. significant increase in insurance rates, Latinos Exhibit 1). However, Latinos also have one of continue to have lower access to coverage the highest rates of enrollment in Medicaid than other Californians.1 Using data from (called Medi-Cal in California) (44.9%). the 2015-2016 California Health Interview Job-based coverage rates among Latinos are Survey (CHIS), this policy brief examines the lowest of all racial/ethnic groups, with differences within the Latino population in one-third of Latinos reporting being insured access to health insurance. The brief focuses through an employer (34.1%). on differential access by citizenship and language proficiency in order to assess how One-Fifth of Uninsured Latinos Eligible for restrictions on Medicaid and health insurance Medi-Cal exchange subsidies affect eligibility and Under the provisions of the ACA, any citizen access to insurance among this important or legal permanent resident with a household segment of the California population. In income less than 138% of the federal poverty addition, the brief describes how disparities level (FPL)2 is eligible to be enrolled in in insurance coverage affect access to care. Medi-Cal, but individuals must take action to enroll themselves. Some of those who Support for this policy brief was provided by a grant from remain uninsured are eligible for coverage The California Endowment. through Medi-Cal. In California, uninsured 2 UCLA CENTER FOR HEALTH POLICY RESEARCH Exhibit 1 Insurance Status by Racial/Ethnic Group, California, Ages 0-64 1.7% 1.4% 1.9% *** 2.7% 1.6% 100% 4.1% 3.1% 7.2% 6.9% 10.6% 8.1% 90% 80% 34.1% 39.4% 70% 48.5% 50.7% 60% 62.4% 61.5% 50% 40% 44.9% 30% 44.3% 32.0% 29.8% 20% 18.6% 22.4% 1.5% 10% 4.9% 2.0% 13.7% 2.5% *** 2.6% 5.3% 6.4% 6.1% 6.1% 9.0% 0% Latino White African American Asian American, Other or Total Native Hawaiian, Multiple Race or other Pacific Islander Uninsured Medicare Medi-Cal ‘‘ Employer-Based Insurance Privately Purchased Other Public Source: 2015-2016 California Health Interview Survey Note: *** = Estimate is unstable due to a coefficient of variation Three in four over 30% and cannot be reported. uninsured people can access Medi-Cal enrollment Despite available options, 21.6% of Latino children through California’s private health insurance uninsured nonelderly Latinos (a total of are eligible for exchange, Covered CA, either online or with 410,000 people) are eligible for but not in-person assistance. Additionally, both currently enrolled in Medi-Cal (Exhibit 2). Medi-Cal but ’’ county-level and hospital eligibility workers Three out of every four uninsured Latino are not enrolled. can help eligible people enroll in Medi-Cal. children (0-18 years) are eligible for Medi- Cal enrollment (76.0%, or 139,000) but are Exhibit 2 Percent Currently Eligible for Medi-Cal Among Uninsured Latinos by Age Group, California, Ages 0-64 Ages 19-64 15.8% Ages 0-18 76.0% Ages 0-64 21.6% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% Source: 2015-2016 California Health Interview Survey UCLA CENTER FOR HEALTH POLICY RESEARCH 3 Uninsured Rates by Demographic and Health Characteristics, Latino Adults, California, Exhibit 3A Ages 19-64 Male 22.2% Sex Female 15.9% 19-25 Years 17.0% 26-34 Years Age Group 20.3% 35-44 Years 21.0% 45-54 Years 21.5% 55-64 Years 13.2% Puerto Rican 7.8%* Mexican 19.1% Guatemalan 35.9% Latino Ethnicity Salvadoran 23.6% Other Central American 16.6% South American 13.7% Latino European 21.4%* Other Latino 9.4% Two or More 8.1% Good or Better Health 16.9% Health Fair or Poor Health 24.5% 0% 5% 10% 15% 20% 25% 30% 35% 40% Percent of Latinos Who Are Uninsured Source: 2015-2016 California Health Interview Survey Note: Latino ethnicity is self-reported. A small percentage of *Estimates for Puerto Rican and Latino European are statistically respondents who report being Latino identify as European unstable and should be interpreted with caution. (generally, Spanish or Portuguese). not enrolled. Children (ages 0-18) have fewer 860,000 Latino adults who are currently restrictions on eligibility than adults, due to ineligible because they are not citizens or a higher income cutoff for eligibility (266% permanent residents would gain the ability FPL), and in 2016 eligibility was expanded to enroll in Medi-Cal.3 Children are already to include undocumented children. An eligible, regardless of citizenship status. additional 271,000 uninsured Latino adults (15.8%) are also eligible for Medi-Cal but are Demographic and Health Characteristics of not enrolled. Uninsured Latinos Though Latinos as a group are more likely Of the uninsured Latinos ages 0-64 who to be uninsured than other Californians, are not currently eligible for Medi-Cal, there are considerable differences within nearly half (46.3%) are not U.S. citizens or the Latino population (Exhibit 3A). Like permanent residents and therefore do not other California women, Latina women are meet Medi-Cal eligibility criteria (data not significantly less likely to be uninsured than shown). At present, California has legislation Latino men (15.9% vs. 22.2%). In general, allowing the state to fund health care uninsured rates increase with age (although through Medi-Cal for residents regardless differences across age groups do not reach of their citizenship status, but the state statistical significance), increasing from needs to obtain a federal waiver in order to 17.0% among those ages 19-25 to 21.5% implement the program. If the program were among those ages 45-54, although those ages implemented and fully funded, many of the 55 and older have the lowest uninsured rate 4 UCLA CENTER FOR HEALTH POLICY RESEARCH Exhibit 3B Uninsured Rates by Immigration-Related Characteristics, Latino Adults, California, Ages 19-64 U.S.-Born Citizen 10.5% Citizenship Naturalized Citizen 11.6% Status Permanent Resident 16.5% No Green Card 44.7% U.S. Born 10.5% Years Lived in U.S. Under 5 Years 41.3% 5-9 Years 44.6% 10-14 Years 35.4% 15+ Years 21.2% Speaks Only English 9.9% Proficiency English Very Well/Well 13.0% Not Well/Not at All 31.0% 0% 10% 20% 30% 40% 50% Percent of Latinos Who Are Uninsured ‘‘ Source: 2015-2016 California Health Interview Survey Latinos who are among nonelderly adults. These trends are among those who report that their health is consistent with those seen for all Californians. good or better. This means that Latinos who are noncitizens and more in need of health care are less likely to be not permanent The uninsured rate differs significantly across able to access that care. Over time, this lack of residents are Latino groups. Guatemalans are the most likely to be uninsured, with more than one-third access could lead to worsening overall health. more than four lacking health insurance coverage, followed The important role that citizenship status plays times more likely by Salvadorans, among whom nearly a quarter in access to health insurance coverage is shown are uninsured. Puerto Ricans have the lowest in Exhibit 3B. Latinos who are noncitizens and to be uninsured uninsured rate, at 7.8%.4 This disparity likely not permanent residents are more than four than U.S.-born reflects the fact that a higher proportion of times more likely to be uninsured than U.S.- Latinos. ’’ those of Guatemalan and Salvadoran descent are not U.S. citizens and are therefore more likely to be ineligible for programs such as born Latinos (44.7% vs. 10.5%), and more than 2.5 times more likely to be uninsured than Latino noncitizens who are permanent full-scope Medi-Cal or federal subsidies to residents (44.7% vs. 16.5%). There is no purchase health insurance coverage through difference between U.S.-born Latinos and Covered California. In contrast, Puerto Ricans those who are naturalized citizens. Latinos who are U.S. citizens by birth, and those who report immigrated to the U.S. less than 10 years ago more than one Latino ethnicity or who fall into are significantly more likely to be uninsured the “Other Latino” category are more likely to than those who immigrated 15 or more years have been born in the U.S. Thus, the variations ago; more than 40% of those who recently across those of different Latino ethnicities likely immigrated were uninsured, compared to reflect the citizenship status and length of time 21.2% of those who have lived in the U.S. for members of these populations have resided in 15 or more years. Latinos with low English the United States. proficiency are more than three times more likely to be uninsured than those who speak Uninsured rates are significantly higher among only English (31.0% vs. 9.9%). This could Latinos who are in fair or poor health than indicate that those who do not speak English UCLA CENTER FOR HEALTH POLICY RESEARCH 5 Uninsured Rates by Socioeconomic Characteristics Among Latino Adults, California, Exhibit 4 Ages 19-64 White 17.1% African American 17.9% Race Asian/Pacific Islander 13.5% Other/Multiracial 21.0% Less than High School 27.8% Education High School 17.1% Some College 13.2% College Degree 10.7% Under 139% FPL 24.1% Income as % of FPL† 139-250% FPL 22.3% 251-400% FPL 13.7% 401%+ FPL 7.4% Employed: Working 21+ Hr/Wk 19.8% Employment Status Employed: Other 19.1% Unemployed 28.2% Not in Labor Force 13.8% Ownership Owns Home 13.1% Home Rents/ Other Arrangement 23.1% 0% 5% 10% 15% 20% 25% 30% Percent of Latinos Who Are Uninsured Source: 2015-2016 California Health Interview Survey Note: Latino ethnicity is reported separately from racial information. †The federal poverty level (FPL) is an economic guideline Thus, people of Latino or Hispanic ancestry may also report being that accounts for household size and is used to determine a member of one or more of these racial groups: American Indian/ income eligibility for public programs such as food stamps and Alaska Native, Native Hawaiian, or other Pacific Islander, Black or Medicaid. In 2016, 138% FPL was $16,394 for a single-person African American, Asian, white, or other. household, $22,108 for a two-person household, and $27,821 ‘‘ for a three-person household. or who have spent less time in the U.S. face a high school degree, most likely because Income-based significant barriers to insurance enrollment. noncitizens who are not permanent residents are more heavily represented among those disparities Socioeconomic Characteristics of without a high school degree. in insurance Uninsured Latinos remained large ’’ Uninsured rates did not differ significantly by Among all Californians, implementation of race within the California Latino population the ACA reduced income-based disparities in among Latinos. (Exhibit 4).5 Among Latinos, uninsured health insurance coverage by making health rates varied significantly with educational insurance available to those with incomes attainment. The proportion of uninsured below 400% FPL.6 In contrast, among decreased with higher levels of education, California Latinos, income-based disparities such that the uninsured rate among Latinos in 2015-2016 remained large and were who had less than a high school degree statistically significant. Nearly one-quarter was about 2.5 times higher than among (24.1%) of Latinos with incomes below those who had a college degree (27.8% vs. 139% FPL and more than one-fifth (22.3%) 10.7%). The biggest decrease in uninsured of Latinos with incomes between 139% and rates was between those with and without 150% FPL were uninsured, compared to 7.4% 6 UCLA CENTER FOR HEALTH POLICY RESEARCH Exhibit 5 Logistic Regression Results Predicting Uninsured Status Among Latino Adults, California, Ages 19-64 AOR 95% Conf Int Female 0.72 (0.50, 1.03) + Age Group (Reference = 55-64 years) 19-25 years 1.67 (0.78, 3.57) 26-34 years 1.10 (0.62, 1.95) 35-44 years 1.00 (0.57, 1.77) 45-54 years 1.26 (0.73, 2.17) Latino Ethnicity (Reference = Mexican) Puerto Rican 0.92 (0.20, 4.23) Guatemalan 1.40 (0.78, 2.51) Salvadoran 1.05 (0.50, 2.20) Other Central American 0.79 (0.29, 2.14) South American 1.04 (0.46, 2.33) Latino European 3.30 (0.18, 61.91) Other Latino 0.87 (0.20, 3.70) Two or More 0.71 (0.38, 1.32) Citizenship Status (Reference = U.S.-Born Citizen) Naturalized Citizen 0.94 (0.57, 1.57) Permanent Resident 1.09 (0.61, 1.94) No Green Card 4.12 (2.35, 7.23) *** Years Lived in the U.S. (Among Non-U.S. Born. Reference = 15+ Years) Less than 5 years 1.92 (0.98, 3.75) + 5-9 years 1.77 (0.97, 3.23) + 10-14 years 1.23 (0.76, 1.97) English Proficiency (Reference = English Only) Very Well/Well 1.01 (0.64, 1.58) Not Well/Not at All 1.51 (0.87, 2.63) Self-Reported Race (Reference = White) African American 0.87 (0.39, 1.96) Asian/Pacific Islander 0.67 (0.27, 1.63) Other/Multiple 1.25 (0.95, 1.65) Education (Reference = Less than High School) High School Degree 0.90 (0.63, 1.27) Attended College 0.95 (0.60, 1.49) College Degree 0.75 (0.45, 1.24) Income as Percent of Federal Poverty Level (Reference = Above 400% FPL) Under 139% FPL 1.66 (0.91, 3.02) + 139-250% FPL 2.08 (1.20, 3.62) ** 251-400% FPL 1.57 (0.77, 3.21) Employment Status (Reference = Employed, Working 21+ Hr/Wk) Employed: Other 0.90 (0.54, 1.49) Unemployed 1.48 (0.85, 2.60) Not in Labor Force 0.58 (0.38, 0.87) ** Does Not Own Home 1.00 (0.71, 1.40) In Fair or Poor Health 1.36 (0.98, 1.89) + Source: 2015-2016 California Health Interview Survey Note: Latino ethnicity is self-reported. A small percentage of AOR = Adjusted Odds Ratio respondents who report being Latino identify as European (generally, Spanish or Portuguese). *** p<0.001; ** p<0.01; * p<0.05; + p<0.10 UCLA CENTER FOR HEALTH POLICY RESEARCH 7 of those with incomes above 400% FPL. This difference reflects the fact that Latinos were disproportionately less likely to be eligible for the expansion in Medicaid eligibility and subsidies to purchase health insurance mandated by the ACA. These Californians have been left out of the expansion in coverage In the bivariate comparisons, the uninsured rate increased with age. However, after adjusting for other demographic, immigration, socioeconomic, and health characteristics, age is not a predictor of being uninsured among California Latinos. Women are less likely to be uninsured than men, but this difference ‘‘ Latinos were less likely to be eligible for the expansion in Medicaid that was available to others. is only marginally significant. Differences eligibility and across Latino ethnic groups no longer reach subsidies to Latinos who are not in the labor force are less statistical significance after adjusting for purchase health ’’ likely to be uninsured than Latinos who are differences in immigration and socioeconomic unemployed (13.8% vs. 28.2%) or Latinos characteristics. After adjusting for other insurance. who are employed and working half-time or characteristics, we found that only Latinos more (13.8% vs. 19.8%). Uninsured rates who are noncitizens and not permanent are significantly lower among those who own residents are more likely to be uninsured. their home than among those who rent or Their uninsured rates decline with time spent have another living arrangement (13.1% vs. in the U.S. 23.1%). These findings likely reflect the higher economic security of the former group. Those The relationship between uninsured rates who remain out of the labor force are more and education shown in Exhibit 4 is no likely to be those who have financial support longer present once other socioeconomic and/or health insurance from another source characteristics are adjusted for in the model. (e.g., a spouse or SSDI). They are less likely Latino college graduates are no less likely to need to work to obtain health insurance to be uninsured than Latinos with less coverage. Similarly, those who own their own education. Latinos with household incomes home are generally more economically stable above 400% FPL are less likely to be and have a higher income than those who rent uninsured than those with lower household or have another living arrangement. incomes; however, the uninsured rate does not differ by income among those with Citizenship Status and Income Explain incomes below 400% FPL. Latinos who Differences in Insurance Access for Latinos are not in the labor force are less likely to Up to this point, we have examined each be uninsured. This is most likely because of these demographic and socioeconomic those who are out of the labor force are characteristics separately. Exhibit 5 shows more likely to be disabled and eligible for the results of a logistic regression model Medicare, or to be students or spouses who predicting being uninsured among nonelderly have parents or partners who are affluent adult Latinos. This model adjusts for age, enough to afford coverage or who work for Latino ethnicity, immigration characteristics, an employer offering dependent coverage socioeconomic status, and overall health. The and are thus able to extend health insurance results are presented as adjusted odds ratios to other household members. Even after (AOR), or the adjusted ratio of the odds of adjusting for demographic, immigration, being uninsured among Latinos in each group and socioeconomic characteristics, Latinos listed in the table compared to Latinos in the who are in fair or poor health are more likely respective reference group. Reference groups to be uninsured than those with good or are listed in the table. A value below 1.0 better health, though this difference is only indicates that the group is less likely to be marginally significant. uninsured than the reference group. A value above 1.0 indicates that the group is more likely to be uninsured than the reference group. 8 UCLA CENTER FOR HEALTH POLICY RESEARCH Exhibit 6 Indicators of Poor Access to Health Care by Insurance Status Among Latino Adults, California, Ages 19-64 Does Not Have a 51.4%* Usual Source of Care 20.2% No Routine Check-Up 55%.2* in Past Year 26.3% No Doctor Visit 47.4%* in Past Year 20.2% 17.0%* ED Visit in Past Year 23.5% Delayed Getting 12.4% Needed Medical Care 11.7% Delayed Filling 10.7% Prescription 10.1% Delayed Medical Care 10.1%* Due to Cost 5.6% Delayed Filling 8.7% Prescription Due to Cost 6.0% 0% 10% 20% 30% 40% 50% 60% Uninsured Insured Source: 2015-16 California Health Interview Survey ‘‘ * Statistically different from “Insured,” p<0.05 These findings Uninsured Latinos Less Likely to Have are typically higher among uninsured than Usual Source of Health Care, More Likely show the to Delay Medical Care Due to Cost insured populations, uninsured Latino adults (17.0%) had lower rates of ED visits in the limitations Previous research has documented lower past year than insured Latino adults (23.5%). of public access to care among Latinos compared to Discussion and Conclusions health policies non-Latino whites in California.7 These disparities in access are especially acute for Following the full implementation of the that exclude the uninsured Latino population, for whom ACA, uninsured rates have remained much noncitizens. ’’ lack of insurance coverage is a significant barrier to receiving health care (Exhibit 6). More than half of uninsured Latino adults higher among nonelderly Latinos than among other nonelderly Californians. The results shown in this brief suggest that although (51.4%) lacked a usual source of health a large number of uninsured Latinos are care, compared to just 20.2% of those with eligible for coverage, an important part of insurance. In addition, 55.2% of uninsured the story is the policy decision to exclude Latino adults had not had a routine check-up noncitizens who are not permanent residents in the past year, and 47.4% had not had any from receiving the benefits of the Medicaid doctor visit at all in the past year, compared expansion and subsidies for purchasing health to 26.3% and 20.2%, respectively, of those insurance through Covered California. with insurance. The proportion of Latino adults who delayed needed medical care or Though uninsured rates differ across Latino delayed filling a prescription did not differ by groups and are particularly high among insurance status. However, uninsured Latinos Guatemalans, these differences are nearly were more likely than insured Latinos to entirely explained by differences across these delay needed medical care due to cost (10.1% populations in citizenship status and time and 5.6%, respectively). Although rates spent living in the United States. Beyond of emergency department (ED) utilization these immigration-related differences, low- UCLA CENTER FOR HEALTH POLICY RESEARCH 9 income and unemployed Latinos experience adults in California who are currently greater barriers to obtaining health insurance ineligible because they are not citizens or coverage. This difference reflects the permanent residents would gain the ability to fact that Latinos are less likely to receive enroll in Medi-Cal. coverage through an employer and were disproportionately less likely to be eligible Methodology for the expansion in Medicaid eligibility This policy brief presents data from the 2015-2016 cycle of the California Health Interview Survey (CHIS), and subsidies to purchase health insurance conducted by the UCLA Center for Health Policy mandated by the ACA. These Californians Research (CHPR). Health insurance coverage was have been left out of the expansion in measured at a point in time (at the time of responding coverage that was available to others. The to the survey). As a result, estimates presented here importance of these barriers is clear: Rather may differ from other sources that report coverage over than the expected negative selection into the past year. CHIS is a telephone survey that uses a dual-frame, random-digit-dial (RDD) technique. health insurance coverage, Latinos who are Through the use of traditional landline RDD and in fair or poor health are less likely to have cell-phone RDD sampling frames, the survey is health insurance coverage than those in good representative of the state’s population. Survey items or better health. for the adult modules are self-reported, with data collected by trained interviewers. CHIS data are These findings have important ramifications collected continuously throughout the year, and each for access to care and for public health more full cycle is comprised of two years. Each year, CHIS generally. Though they report being in worse completes interviews with adults, adolescents, and parents of children in more than 20,000 households, health, Latinos who are uninsured have fewer drawn from every county in the state. Interviews contacts with the health care system. They are are conducted in English, Spanish, Chinese (both less likely to have a usual source of care, to Mandarin and Cantonese), Vietnamese, Tagalog, and have seen a doctor, or to have had a routine Korean. Interviews cover a diverse array of health- check-up. Despite this, they are also less likely related topics, including health insurance coverage, to visit the emergency room. This discrepancy health status and behaviors, and access to health care. CHIS employs a complex survey design that requires could be due to familiarity with access to analysts to use complex survey weights to provide emergency room coverage or fear of the high accurate variance estimates and statistical testing. This publication contains costs of emergency room care. Although All analyses presented in this policy brief incorporate data from the California uninsured Latinos are not more likely to have replicate weights to provide corrected confidence Health Interview Survey delayed getting needed medical care or filling interval estimates and statistical tests. (CHIS), the nation’s largest a prescription, they are more likely to report state health survey. Author Information cost as a reason for these kinds of delayed care. Conducted by the UCLA Tara Becker, PhD, is a senior public administration Center for Health Policy analyst at the UCLA Center for Health Policy The findings presented in this policy brief Research, CHIS data give Research. Susan Babey, PhD, is a senior research a detailed picture of the show the limitations of public health policies scientist at the UCLA Center for Health Policy health and health care that exclude noncitizens. Bringing down Research. Shana Charles, MPP, PhD, is an assistant needs of California’s large the uninsured rate among Latinos will professor in the Department of Health Sciences at and diverse population. require expanding eligibility to noncitizens California State University, Fullerton. for public health coverage programs and/ CHIS is a collaboration or subsidies to purchase private coverage. of the UCLA Center for Otherwise, Latinos will continue to be left Health Policy Research, California Department of behind. For example, California currently Public Health, California has legislation allowing the state to fund Department of Health health care through Medi-Cal for residents Care Services, and the regardless of citizenship status, but the Public Health Institute. state needs to obtain a federal waiver to Learn more at: be able to implement the program. If it is www.chis.ucla.edu implemented, many of the 860,000 Latino UCLA CENTER FOR HEALTH POLICY RESEARCH 10960 Wilshire Blvd., Suite 1550 Los Angeles, California 90024 Acknowledgments Endnotes The authors would like to thank Jennifer Cabe, 1 Becker T. 2018. ACA Reduces Racial/Ethnic Disparities in Health Coverage. Los Angeles, CA: UCLA Center Venetia Lai, and Celeste Maglan Peralta for for Health Policy Research. The UCLA Center for Health Policy Research their assistance. The authors are grateful to the 2 The federal poverty level (FPL) is an economic is part of the following reviewers for their helpful feedback: guideline that accounts for household size and is used UCLA Fielding School of Public Health. Michael A. Rodriguez, MD, MPH, professor and to determine income eligibility for public programs such as food stamps and Medicaid. In 2016, 138% vice chair in the Department of Family Medicine FPL was $16,394 for a single-person household, at the David Geffen School of Medicine at UCLA, $22,108 for a two-person household, $27,821 for a professor in the Department of Community three-person household, etc. 3 As of June 11, 2019, the California Legislature Health Sciences at the UCLA Fielding School of and Governor Newsom had reached a budgetary Public Health, and director of the UCLA Blum agreement to approve state funding for Medi-Cal Center on Poverty and Health in Latin America; coverage for uninsured undocumented persons ages 19-25. Whether this provision will be implemented Joseph Viana, PhD, Evaluation Lead, Division of will be seen after this year’s state budget process is The analyses, interpretations, conclusions, and views expressed in this policy brief are Chronic Disease & Injury Prevention, Los Angeles complete. those of the authors and do not necessarily County Department of Public Health; and Maria- 4 Estimate is unstable due to small sample size. represent the UCLA Center for Health Policy Elena Young, PhD, MPH, research scientist, 5 In accordance with federal guidelines about the Research, the Regents of the University collection of race and ethnicity information, of California, or collaborating UCLA Center for Health Policy Research. Latino ethnicity is reported separately from racial organizations or funders. information. Thus, people of Latino or Hispanic PB2019-4 Suggested Citation ancestry may also report being a member of one or more of these race groups: American Indian/Alaska Copyright © 2019 by the Regents of the Becker TL, Babey SH, Charles SA. 2019. Still Native, Native Hawaiian or other Pacific Islander, University of California. All Rights Reserved. Left Behind: Health Insurance Coverage and Access Black or African American, Asian, white, or other. Editor-in-Chief: Ninez Ponce, PhD to Care Among Latinos in California. Los Angeles, 6 Becker T. 2017. Number of Uninsured in California Calif.: UCLA Center for Health Policy Research. Remained at Record Low in 2016. Los Angeles, CA: UCLA Center for Health Policy Research. 7 Ortega AN, McKenna RM, Kemmick Pintor Phone: 310-794-0909 J, Langellier BA, Roby DH, Pourat N, Vargas Fax: 310-794-2686 Bustamante A, Wallace SP. 2018. Health Care Email: chpr@ucla.edu Access and Physical and Behavioral Health Among healthpolicy.ucla.edu Undocumented Latinos in California. Medical Care 56 (11): 919-926.