Diabetes CareType 2 DiabetesCohortJanuary 1, 2026

Changes in Type 2 Diabetes Medications Among Primary Care Patients After California's 2022 Medicaid Expansion.

Ro AE, Morales C, Jiang L, Choi JM, Tavares Kuhn N, Wu C

Key Finding

After California expanded Medicaid to older undocumented immigrants in 2022, their access to newer diabetes drugs like GLP-1s increased 6% faster per month than documented patients, eventually reaching similar prescription levels by study's end.

What This Study Found

Think of this study like tracking who gets the newest smartphones in different neighborhoods after a policy change. California's 2022 Medicaid expansion was like suddenly giving older undocumented immigrants (50+) access to the premium phone plan, while younger undocumented immigrants still had to use the basic plan. Researchers followed 4,601 diabetes patients across two community health centers from 2019 to 2023 to see if this policy change translated into more prescriptions for the 'premium' diabetes drugs - GLP-1 receptor agonists and SGLT-2 inhibitors - compared to older medications like metformin and insulin. Before the expansion, both older and younger undocumented patients were much less likely to get these newer, more effective medications compared to documented patients - imagine having to settle for flip phones while everyone else got iPhones. But after Medicaid expansion, something remarkable happened: the older undocumented group started catching up fast, with their prescription rates for newer drugs increasing 6% more each month compared to documented patients, like getting on an express elevator while others took the regular one.

Statistics Decoded

The '6% higher monthly rate of increase' means that each month after the policy change, older undocumented immigrants were 6% more likely than the previous month to get prescribed newer diabetes drugs, and this rate was 6% faster than the improvement seen in documented patients - think of it like compound interest working in their favor. The study tracked 20,420 patient encounters across 4,601 people, giving researchers a robust dataset. 'Significantly lower odds at baseline' means the undocumented patients started way behind - like being at the back of a very long line. The phrase 'ended at a similar level' means that by June 2023, the prescription rates for newer diabetes drugs among older undocumented immigrants had essentially caught up to documented patients - they went from the back of the line to the same position.

Why This Matters

This proves that insurance coverage barriers, not clinical need, were keeping undocumented immigrants from accessing better diabetes treatments - and that policy changes can rapidly close these health equity gaps. For doctors, it shows how quickly prescription patterns can shift when financial barriers are removed, suggesting similar expansions could help other vulnerable populations get optimal diabetes care.

Original Abstract

In May 2022, California expanded full-scope Medicaid (Medi-Cal) to low-income undocumented immigrants aged 50 years or older, which provided access to newer type 2 diabetes (T2D) medications. This study examined whether the expansion led to more prescriptions of newer therapies like glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors among older undocumented immigrants. We used patient records between January 2019 to June 2023 from two Federally Qualified Health Centers (FQHCs) in Los Angeles County. We compared prescriptions among 1) older undocumented immigrants newly eligible for Medi-Cal, 2) younger undocumented immigrants not eligible for Medi-Cal, and 3) documented patients (n = 20,420 encounters and 4,601 patients). We used generalized linear mixed models with patient-level random intercepts to examine whether the patient groups differed in their likelihood of being prescribed newer medications and if there were changes over time. The odds of being prescribed newer classes of drugs was significantly lower for both the older and younger undocumented patients than documented patients at baseline. Prescriptions for newer T2D medications increased over time for all patients, but the monthly rate of increase in the odds was 6% higher for the older undocumented group compared with the documented patient group. Medi-Cal expansion was effective in changing prescription patterns for older undocumented immigrants with T2D. Although the older undocumented immigrants were prescribed newer drugs at a much lower level than were documented immigrants, they ended at a similar level as the documented patients by the end of the study period.