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Thesis advisor: Thomas M. Crea / The United States is home to over 44 million immigrants, giving it the largest foreign-born population in the world, a number which is projected to roughly double by 2065. Among foreign-born individuals, significant disparities have been uncovered in health care utilization compared to their U.S.-born peers. A growing body of research has recognized the need to assess the institutional and systemic barriers to health care access contributing to this disparity, and how those barriers may be effectively mitigated. My investigation of this topic was based in California and consisted of two analytic components. The first was a quantitative assessment of barriers to health care access and how those barriers were uniquely experienced by subgroups of participants. Utilizing data from the 2015-2019 California Health Interview Survey data collection cycles, latent class analysis was used to investigate unique patterns of barrier endorsement based on participant immigration status, race or ethnicity, and the interaction between the two. Three distinct classes were identified with a low-, moderate-, and high-risk of endorsing multiple barriers to health care access. The hypotheses that legal status, race or ethnicity, and the interaction between the two were partially supported. The second component of this study was a critical policy analysis of California’s SB 54, a package of legislation which aimed to foster trust in public institutions and increase use of health care by limiting the ability of local law enforcement to act on behalf of federal immigration authorities. This analysis determined that county-level implementation was inconsistent, and those differences were associated with mixed success in decreasing immigration contact and increasing service utilization. These findings are leveraged to identify policy and programmatic recommendations that may improve delivery and facilitate increased ability to safely seek high-quality care for medically underserved populations. / Thesis (PhD) — Boston College, 2024. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

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