Underlying challenges of public health insurance enrollment and use among Latino adults: insights from the largest safety-net institution in Los Angeles

Public Health. 2017 Nov;152:47-50. doi: 10.1016/j.puhe.2017.06.006. Epub 2017 Aug 8.


Objectives: We examined challenges to enrollment in and use of California’s Medicaid program among Latino residents in Los Angeles County.

Study Design: This is a cross-sectional, mixed-methods study.

Methods: We collected survey data from 156 adult Latino clients seeking urgent care at one of the largest public hospitals in California. We also analyzed data from 78 semistructured interviews with randomly selected participants using Dedoose version 6.0.24, a web-based qualitative software program. Transcripts were analyzed using a constant comparison analytic approach based in grounded theory.

Results: Eighty percent of survey respondents had health insurance; Medi-Cal was most common. Survey and interview data revealed three main areas in which respondents experienced challenges enrolling and participating in the Medi-Cal program: gaining awareness of benefits, completing the enrollment process, and understanding and using benefits. Surveys showed Latino participants had limited knowledge of Medi-Cal benefits and eligibility criteria and faced challenges with enrollment related to language and fear of authorities. Understanding and effectively using benefits was challenging, and respondents reported a lack of provider support.

Conclusions: Our findings highlight potential challenges to effective implementation of Medicaid expansion among Latinos in the United States. Proposed solutions include community outreach and education, effective use of media in Spanish, and provider guidance and follow-up.