Arturo Vargas Bustamante

Authors aim to qualitatively assess the experiences that English and Spanish-speaking patients with Medicaid managed care encounter when scheduling a first-time primary care appointment, with a preference for telehealth, in the Los Angeles (LA), Houston and New York (NY) Metropolitan Statistical Areas (MSAs). Primary care offices were randomly selected to participate in this qualitative mystery shopper study. Two researchers listened and transcribed real-time calls between the mystery shopper patients and the receptionists at the primary care offices. Data collection occurred between April 8, 2024, and April 26, 2024.

Findings: Spanish-speaking patients who call to schedule a first-time primary care appointment are more likely to experience call transfers, be told to call back later, and encounter more telephone hang-ups, compared to English-speaking patients. Telehealth for first-time appointments is uncommon and typically available only under special circumstances, including COVID-19, medication refills, test result reviews, and for chronically ill populations.

This study shows disparities in access to care between English and Spanish-speaking patients at the time of scheduling a first-time appointment, highlighting an important point for future intervention.

Using enrollment data from California’s Department of Health Care Services, demographic data from the Census Bureau’s American Community Survey, and health outcome data from the 2019–2023 California Health Interview Survey (CHIS), this data brief provides key facts on Medi-Cal beneficiaries and underscores the broader community and economic implications of reductions to Medicaid funding.

Findings:

• Disproportionate Impact on Latinos: Latinos make up 52% of Medi-Cal enrollees,  compared to their 40% share of the state’s population.
• Labor Force Participation: Latino Medi-Cal beneficiaries participate in the labor force at higher rates (63%) than other groups, yet work requirements could lead to 2.3 million enrollees losing coverage, over half of whom are Latino.
• Essential Workers: Over 1.4 million Latino Medi-Cal enrollees work in critical industries like hospitality, health care, and construction, often in low-wage jobs without employer-sponsored insurance.
• Youth and Seniors: Latino children account for 38% of Latino enrollees, while Latino seniors account for 35% of senior enrollees. Both groups rely heavily on Medi-Cal for regular health care coverage and long-term care.
• Chronic Conditions: Latino and Black enrollees face higher rates of diabetes (18%) compared to the general population (11%), with Medi-Cal providing vital care for managing chronic conditions.
• Geographic Impact: Counties like Los Angeles, Riverside, and Fresno, and congressional districts such as CA-22, CA-34, and CA-35, with large Latino populations, would face significant economic and health challenges from cuts.
   

Authors studied patterns in health care access between Latino and non-Latino white adults according to citizenship status before and after the American Rescue Plan Act (ARPA) of 2021 was enacted to determine whether inequities changed. This study used 2019–2022 National Health Survey Interview data. Differences in predicted probabilities from logistic regression models were used to estimate changes in health care access outcomes (any insurance coverage, private insurance coverage, delaying care due to cost, and having a usual source of care) among Latino citizens, Latino noncitizens, and non-Latino white citizens in periods before and after ARPA's enactment (2019–2020 vs. 2021–2022).

Findings: Adjusted models observed that inequities in health care access did not change between Latino and non-Latino white citizens from the 2019–2020 period to the 2021–2022 period. Moreover, the health insurance gap widened by 5.8 percentage points between Latino noncitizens and non-Latino white citizens and by 5.2 percentage points between Latino noncitizens and Latino citizens from the 2019–2020 period to the 2021–2022 period. The private insurance coverage gap widened by 6.8 percentage points between Latino noncitizens and non-Latino white citizens and by 6.9 percentage points between Latino noncitizens and Latino citizens from the 2019–2020 period to the 2021–2022 period.

ARPA may have helped increase white citizens' insurance coverage, but this benefit did not extend to Latinos, regardless of citizenship status. Developing more inclusive health policies that do not have restrictions based on citizenship and legal authorization status is an important step toward reducing health care inequities.
 

This study examined racial and ethnic disparities in mental health service use, social support, and telemedicine access among U.S. adolescents between 2019 and 2022. Authors analyzed nationally representative data from the 2019-2022 National Health Interview Survey (NHIS) Sample Child Interview, focusing on adolescents aged 12 to 17. Multivariate logistic regression models with survey weights were used to assess disparities in outcomes by race and ethnicity. 

Findings: From 2019 to 2022, despite rising mental health needs, Black, Hispanic, and Asian adolescents were significantly less likely than white peers to take prescription medications, receive therapy, or receive both treatments. Hispanic and Asian adolescents were also 9 and 15 percentage points less likely, respectively, to report receiving community support, while Black and Asian adolescents were 8 and 6 percentage points less likely, respectively, to have had a virtual health care appointment. 

Access to mental health services, virtual care, and community support remains disproportionately limited for racial and ethnic minority adolescents, even as overall mental health needs have worsened across all groups during the COVID-19 pandemic. The underuse of virtual care and community support among Hispanic and Asian adolescents underscores the urgent need for culturally responsive strategies to promote accessible and personalized mental health care for all adolescents.