Access to health care is a critical need for millions of individuals in the United States. Yet, for foreign-born individuals, many with Limited English Proficiency (LEP), navigating Medicaid Managed Care presents significant barriers. These barriers are shaped by complex factors, including state-level immigration policies, the geographic distribution of bilingual providers, and the availability of linguistically appropriate resources. A new LPPI report sheds light on the challenges encountered by immigrant and LEP adults and offers actionable recommendations for addressing the disparities.

To delve deeper into the findings, we spoke with Dr. Lucía Félix Beltrán, co-author of the report, to understand their research and the implications for LEP populations across the country. 

Q: What were your key findings about the challenges immigrant and LEP individuals face in accessing Medicaid Managed Care?

Dr. Félix: State-level immigration policies significantly shape Medicaid access for LEP -who are often foreign-born individuals- populations as they generate “favorable” or “adverse” climates for immigrant integration. For example, California’s inclusive policies grant access to all low-income adults and children, regardless of immigration status, resulting in better outcomes for all people in the state, including LEP individuals. By contrast, Texas imposes restrictive eligibility criteria, such as stringent income thresholds, that severely limit access for the entire Texas population. Additionally, Spanish- and Chinese-speaking providers are not evenly distributed; instead, they cluster in specific geographic areas, leaving several portions of LEP and foreign-born populations underserved. This issue is compounded in medically underserved areas (MUAs), which frequently overlap with census tracts containing higher-than-average numbers of foreign-born Latinos. Moreover, access to Medicaid navigation resources varies widely across states, creating further barriers for LEP and immigrant individuals attempting to enroll or maintain coverage.

Q: How does the geographic clustering of bilingual providers impact LEP communities?

Dr. Félix: The clustering of bilingual providers directly impacts the accessibility of care for LEP communities. In the Los Angeles metropolitan area, Chinese-speaking providers are sparse, while Spanish-speaking providers are more concentrated but still leave gaps in MUAs. Similarly, in Houston, most bilingual providers are clustered in Harris County, leaving neighboring counties like Montgomery and Fort Bend underserved. In the New York metropolitan area, bilingual providers are concentrated in boroughs such as Brooklyn and Queens, but areas in New Jersey and other outlying regions face significant shortages. These geographic disparities mean that many LEP individuals struggle to access care in their preferred language, often compounding existing health disparities.

Q: How do state-level immigration policies affect Medicaid eligibility for LEP and foreign-born populations?

Dr. Félix: State-level policies act as the first barrier to Medicaid access for LEP and immigrant populations. In California, policies create a more inclusive environment by extending Medicaid to all low-income individuals, regardless of immigration status. In stark contrast, Texas—one of the few states that has not expanded Medicaid under the Affordable Care Act—limits eligibility to caretakers of CHIP beneficiaries who meet extremely low-income criteria. States like New York and New Jersey offer nuanced exceptions for foreign-born individuals, but these often involve complex administrative processes that can deter eligible LEP individuals from enrolling.

Q: What are the implications of the overlap between medically underserved areas and high concentrations of foreign-born Latinos?

Dr. Félix: The overlap between medically underserved areas and high concentrations of foreign-born Latinos underscores a critical shortage of primary care services in these communities. This shortage exacerbates health disparities, making it even harder for foreign-born LEP populations to access necessary care. Improving access in these regions is crucial to addressing inequities and ensuring that all individuals can receive high-quality health care.

Q: Based on your findings, what policy actions do you recommend to improve Medicaid access for LEP and immigrant populations?

Dr. Félix: Expanding Medicaid eligibility under the Affordable Care Act or through state-specific initiatives is essential to bridging the access gap. States must also extend Medicaid coverage to immigrant communities and enhance linguistically appropriate care by providing translation services that extend beyond clinical interactions to include Medicaid navigation and enrollment. Collecting comprehensive demographic data on primary language and LEP status is critical for identifying and addressing disparities. Finally, recruiting and retaining bilingual healthcare professionals must be prioritized to ensure LEP and immigrant communities have access to culturally and linguistically competent care.

Q: How might federal changes under the Trump Administration, including public charge rules, impact Medicaid access for LEP populations?

In 2018, the Trump administration made a change to the public charge determination that expanded the list of publicly funded programs that could disqualify immigrants from getting a green card, including the Supplemental Nutrition Assistance Program (SNAP) and Medicaid. This action deterred immigrants from using these public benefits, even if they were eligible to do so. Despite its reversal in 2020, confusion about this policy and a generalized fear of immigration authorities generated what is known as the “chilling effect.” For instance, estimations show that in 2020, more than 150,000 Latino adults likely avoided Medi-Cal enrollment due to fears about their immigration status, in addition to  ~130,000 citizen children in California could have potentially lost access to a usual source of care if their family members refrained from enrolling in public benefits. The current administration’s anti-immigrant agenda is even more aggressive than in 2018, we can expect changes to the public charge determination, elimination of DACA, expanded interior enforcement actions (mass deportations), among others. State-level policies are critical to counteract these federal restrictions. 

Read the full report here.