Background: Atherosclerotic cardiovascular disease, a major contributor to healthcare expenditures, is the leading complication in adults with diabetes mellitus. Composite risk factor control, defined as hemoglobin A1c < 7%, blood pressure < 130/80 mmHg, low density lipoprotein cholesterol < 55 mg/dL, improves atherosclerotic cardiovascular disease outcomes in this population but disparities persist. Methods: Cross-sectional study from 7/1/2023-6/30/2024 utilizing the University of California Health Data Warehouse of 6 health systems. Results: 29,671 patients (mean age 71.0 ± 11.6 years; 37.7% female) were included: 11.4% of patients achieved composite risk factor control, more likely for those on Medicaid (OR 1.13 [1.01-1.26]). Composite risk factor controlwas less likely among Non-Hispanic Black adults (OR 0.62 [0.52-0.74]) and in moderate (OR 0.88 [0.81-0.96]) and most (OR 0.86 [0.78-0.95]) disadvantaged area deprivation index tertiles. Conclusions: Decreased composite risk factor control disproportionately affects disadvantaged groups and racial/ethnic minorities, predisposing to major adverse cardiovascular events. Medicaid offers protective effects and enables crucial preventive care. These findings support policies advocating for sustained Medicaid access to promote health equity, which will decrease health system costs by reducing catastrophic health expenditures related to cardiovascular disease.