The Access Partnership: Expanding Outpatient Health Care Access for Uninsured Patients at One Academic Medical Center

In the United States, immigrants who lack legal immigration status are at risk of being uninsured because they are not eligible for federally subsidized health insurance. Although affordable primary care is available to this population at federally qualified health centers, outpatient specialty care remains unaffordable.

The Access Partnership (TAP) began in 2009 at the Johns Hopkins Health System to provide outpatient care access to individuals with financial need who are ineligible for subsidized health insurance. Spanish-English bilingual navigators, located at community-based clinics, help patients with TAP applications and scheduling appointments. Specialty referrals are reviewed for medical necessity. When the Johns Hopkins Health System financial assistance policy was revised in 2020 to remove noncitizen exclusions, TAP eligibility was revised (TAP-FA).

From January 1, 2020, to March 31, 2024, 6,053 patients enrolled in TAP-FA. The majority were at least 18 years old (5,209; 86.1%), of Latino ethnicity (5,133; 84.8%), and Spanish speaking (5,422; 89.6%). TAP-FA facilitated 39,061 outpatient appointments: 7,612 (19.5%) for hospital-based primary care, 18,752 (48.0%) for specialty care, and 12,697 (32.5%) for radiology. The most common adult specialty appointments were ophthalmology (n = 4,833), orthopedic surgery (n = 1,520), and cardiology (n = 1,472). Among children and adolescents, the most common specialty appointments were ophthalmology (n = 250), otorhinolaryngology (n = 84), and plastic surgery (n = 68).

TAP-FA is an innovative charity care model operationalizing a financial assistance policy for individuals with financial need who are ineligible for subsidized insurance. In the absence of federal policies to expand access to care for immigrants in this population, academic medical centers have an opportunity to address this gap. The TAP-FA model provides a blueprint for the provision of inclusive and equitable care for patients without access to insurance and could be implemented at other academic medical centers.