Self-Pay Emergency Department Visits by Undocumented Patients After 2018 Public Charge Announcement

Area of Science:

• Public Health
• Health Services Research
• Immigration Policy

Background:

• The 2018 public charge announcement caused concern among undocumented immigrants regarding public program usage.
• The impact on Emergency Medicaid and emergency department (ED) self-pay visits remained unclear.

Purpose of the Study:

• To determine if self-pay ED visits increased among likely undocumented patients versus US-born patients post-public charge announcement.
• To analyze the differential changes in ED visit payment status.

Main Methods:

• Retrospective cohort study of ED encounters in Los Angeles County safety-net hospitals (May 2017 - Dec 2019).
• Classified adult patients as likely undocumented or US-born.
• Utilized difference-in-differences and event study models to assess changes in self-pay ED visits after the September 2018 announcement.

Main Results:

• Analyzed 375,258 ED encounters (174,406 likely undocumented, 200,852 US-born).
• Self-pay ED visits increased by 2.10 percentage points among likely undocumented patients compared to US-born patients post-announcement.
• Event study models showed this increase persisted from Nov 2018 to Aug 2019, peaking at 17.8%.

Conclusions:

• Likely undocumented patients experienced a significant increase in self-pay ED visits following the 2018 public charge announcement.
• Anti-immigrant policies can alter healthcare payment patterns, affecting patient financial burden and hospital finances.