Doubly Disadvantaged: A Documentation of How Limited English Proficiency and Citizenship Status Compound Health Disparities in California

Ann D. Bagchi, Mathematica Policy Research, Inc.

Despite legal provisions intended to ensure equal access to health care among persons with Limited English Proficiency (LEP) mounting evidence documents poorer health among LEP individuals compared with non-LEP groups. After passage of the welfare reform act of 1996, citizenship status became a central factor influencing access to health services. Given that the majority of LEP individuals are immigrants, this study examines how citizenship status and English ability interact to influence variations in health status and outcomes. The analyses demonstrate that citizenship status significantly compounds disparities in health care utilization and outcomes by English proficiency level. The study also documents a small but important segment of the LEP population; namely native-born individuals who report poor English speaking ability. Despite greater legal access to health care services, this socioeconomically vulnerable population experiences many of the same health disparities as non-citizen LEP individuals.