The differential effects of psychotherapeutic and pharmacologic intervention on symptom severity and functioning in children and adolescents with internalizing problems: a systematic review protocol.

In May 2022, California expanded full‐scope Medicaid (Medi‐Cal) to all low‐income Californians 50 years of age or over, irrespective of immigration status. This was a significant policy change; over 349 000 older undocumented immigrants enrolled in the program, nearly 100 000 more than initial projections []. ‘Undocumented’ refers to immigrants who are not citizens, nor do they have a current valid visa, green card, or other legal immigration status to reside in the United States long‐term. Prior to expansion, nearly two‐thirds of California undocumented immigrants under 65 years were uninsured []. Other states, such as Illinois, Colorado, and New York, have similarly expanded their Medicaid programs to certain segments of the undocumented population []. Expanding access is a promising step towards addressing the medical needs of the rapidly aging undocumented immigrant population []. These policies remain heavily debated; however, empirical evidence is needed to understand their possible health impacts. While increased health care access has improved specific kinds of utilization among some undocumented populations (e.g., pregnant women and prenatal care) [], it remains to be seen whether large‐scale expansions in access can improve outcomes for cardiometabolic conditions that are highly prevalent among Latinos. One such condition is Type 2 diabetes mellitus (T2D); estimates of T2D prevalence among undocumented immigrants range between 13%–15% [, ]. In contrast, 7.4% of non‐Hispanic Whites have T2D []. T2D is a major driver of undocumented immigrants' health care utilization and they seem to fare poorer in controlling their T2D than documented patients. Undocumented immigrant patients in the Los Angeles County health system had 9% higher odds of having an emergency visit related to uncontrolled T2D than documented patients []. The little research on expanding access to care among undocumented immigrants has shown mixed results related to T2D. On the one hand, Latino patients in the Los Angeles County safety net system who were insured had lower Haemoglobin A1c (HbA1c) than those who were uninsured []. However, research on MyHealth LA (MHLA), a local health care coverage plan in Los Angeles County for undocumented residents that pre‐dated Medi‐Cal expansion, has shown mixed effects of the program on T2D management. Compared to documented patients, undocumented patients enrolled in the program had higher odds of visiting the ED for short‐term T2D‐related conditions (i.e., T2D with hypoglycemia) but not for long‐term related complications (i.e., T2D with diabetic chronic kidney disease) []. Any changes in T2D management among older undocumented adults after Medi‐Cal expansion remains therefore hard to anticipate. This present study compares measures of T2D management among undocumented patients before and after the older adult Medi‐Cal expansion. We examine HbA1c, a reliable indicator of long‐term diabetes control, and body mass index (BMI), as obesity is a major risk factor for T2D and weight loss is a common byproduct of newer T2D therapeutics. We focus on patients in two Los Angeles County Federally Qualified Health Centers (FQHCs) in the year before and after the May 2022 Medi‐Cal expansion. This is a unique patient population study to any potential changes, as they were enrolled in the MHLA program prior to expansion, which offered a primary care home at FQHCs and specialty, inpatient, and ED care through the county health system []. As this population already had a primary care home prior to Medi‐Cal expansion, we expect our estimates for the pre/post differences in T2D control to be conservative.