Realizing the Dream for Californians Eligible for Deferred Action for Childhood Arrivals (DACA): Health Needs and Access to Health Care
UC Berkeley Center for Labor Research and Education
UCLA Center for Health Policy Research
UCSF Philip R. Lee Institute for Health Policy Studies
This report describes the health needs, common sources of care, and major barriers to health care access for teens and young adults in California who are eligible for the Deferred Action for Childhood Arrivals (DACA) program, which provides temporary work authorization and relief from deportation for qualified undocumented immigrants. It is the second of two reports that collectively describe the findings from the California Health Interview Survey (CHIS) data and key informant interviews. This second report also describes findings from focus groups with DACA-eligible young adults in California.
The majority of DACA-eligible Californians are low-income and are more likely to lack private health insurance than their U.S.-born counterparts, as shown in the CHIS data from the companion report in this series. These teens and young adults constitute a subset of the approximately one million undocumented immigrants who are not eligible for federal coverage options under the Affordable Care Act (ACA), though low-income Californians granted DACA are eligible for Medi-Cal (California’s Medicaid program) under state policy.
Further analysis of CHIS data shows that DACA-eligible Californians are more likely to report poor health than their U.S.-born counterparts. They have similar rates of being overweight and obese, but are less likely to report having asthma than their U.S.-born counterparts. DACA-eligible individuals are also less likely to have a usual source of medical care, or to have had a doctor or emergency room visit in the past year.
To provide further context to the CHIS data, focus groups conducted with DACA-eligible young adults in urban areas of Los Angeles and the Bay Area revealed that they tend to either avoid care completely or seek care outside of the mainstream medical system, except in instances of serious health need. Focus group participants and key informants identified the following key barriers to accessing care: cost, lack of health care literacy, difficulty navigating the health care system, and fear and mistrust of the health care system and its providers. Key informant interviews were also conducted to validate and expand upon focus group results.
The focus groups indicated that mental health issues are highly prevalent within the DACA-eligible community due to trauma and stress related to participants’ undocumented status. In addition, participants noted that given the financial stressors, competing demands for their time, and general mistrust of health care providers, it has become culturally normative for DACA-eligible individuals to delay seeking care for physical and mental health issues.
Many DACA-eligible young adults are currently unaware of their eligibility for state, county, and private health care and health insurance programs. This lack of information reflects the complexity of the network of programs through which they can seek care, in addition to the limited transfer of information about how to access and utilize the health care system from their parents, families, and other community members, many of whom lack health care access and insurance.
This report highlights the health needs and gaps in access to health care for a significant number of young Californians who are not eligible for the benefits of the Affordable Care Act due to their immigration status. Focus group participants, as well as key informants interviewed in this study, made a number of recommendations for ways to improve health and health care access for DACA-eligible Californians. Some of the top priorities included:
- Supporting efforts to educate Californians with DACA about their health coverage options, enroll them in available programs, and assist them in navigating the health care system;
- Disseminating information about health care options and coverage programs through trusted sources, including peer networks, families, advocacy organizations, Spanish-language media, and social media; and
- Improving the way that health care services are delivered so that they are more culturally and linguistically accessible to diverse immigrant populations.
Removing barriers to timely preventive and primary care would improve overall population health and potentially reduce avoidable hospitalizations. Movement toward achieving these two central goals of the ACA would be bolstered by healthy DACA-eligible Californians, who are and will continue to be important contributors to the state and its economy.
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