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Evaluating the impact of Medicaid Coverage on Diabetic Foot Care in Safety-Net Populations

Award Number: R01MD020665
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 07/28/2026
PERIOD OF PERFORMANCE END DATE: 12/31/2030

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Evaluating the impact of Medicaid Coverage on Diabetic Foot Care in Safety-Net Populations - Diabetic foot ulcers (DFUs) affect over 1.6 million people annually in the United States (US) and are responsible for 80% of all lower limb amputations. Safety-net populations with DFUs, particularly low-income and Latino patients, face a significantly higher risk of amputation due to non-clinical factors including lack of health insurance, financial instability, and limited English proficiency. Latino patients have the highest uninsured rates, a 30-65% higher risk of amputation than non-Latino patients, and they comprise of 50% of the safety-net population in California. Recent expansions of California’s Medicaid program offer a unique opportunity to study how insurance coverage changes where patients seek DFU care and affects limb outcomes in safety-net populations. These coverage changes include the reinstatement of routine podiatry care coverage for full-scope Medicaid beneficiaries (January 2020) and the provision of full-scope Medicaid coverage for all income-eligible individuals (ages 50+ as of May 1, 2022, and ages 24-49 as of January 1, 2024). Our study will use electronic health records from the Los Angeles (LA) County Department of Health Services (DHS), Medicaid claims, and survey/interview data to examine how insurance coverage and covered podiatry affects outpatient foot care utilization, emergency department (ED) visits, and DFU outcomes among safety-net populations with diabetes. In Aim 1, we will examine how insurance status and other non-clinical factors integrate to influence outpatient foot care and ED use. We will also compare primary and foot care utilization among patients enrolled in the MyHealth LA (MHLA) program and matched non-enrollees with diabetes. MHLA was a local DHS program that provided primary, specialty, ED, and inpatient care through Federally Qualified Health Centers (FQHCs) and DHS facilities for low-income individuals without insurance coverage. It ended in 2024 with the expansion of Medicaid to all income-eligible individuals in California. Aim 2 will assess whether covered podiatry changes outpatient foot care utilization and DFU management by comparing full-scope Medicaid beneficiaries before and after coverage restoration using a difference-in-differences analysis against Arizona Medicaid beneficiaries. Aim 3 will use a mixed-methods approach to examine the experiences of adults receiving DFU care in DHS and FQHC settings following California’s Medicaid expansion and to identify factors that disrupt outpatient diabetic foot care. We hypothesize that continuous insurance coverage and covered outpatient podiatry will increase the use of preventive foot care, reduce reliance on ED services, and lower the rate of amputations among safetynet patients with diabetes. Our findings will shift DFU research upstream from limb loss to measurable gaps in outpatient care, identify the coverage factors that help patients receive timely DFU care, and define targets for health systems working to reduce avoidable ED use and prevent limb loss.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $860,472 )
2026	2026	UNIVERSITY OF SOUTHERN CALIFORNIA	3720 S FLOWER ST FL 3	LOS ANGELES	CA	90033	LOS ANGELES	USA	Minority Health and Health Disparities Research	000	1	7/30/2026	NEW	$860,472
														Subtotal = $860,472

Grand Total All Awards = $860,472

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Evaluating the impact of Medicaid Coverage on Diabetic Foot Care in Safety-Net Populations

Award Number: R01MD020665

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 07/28/2026

PERIOD OF PERFORMANCE END DATE: 12/31/2030

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