Changes in Outpatient and Telehealth Visits Among Undocumented Patients

Area of Science:

• Health Services Research
• Public Health Policy
• Immigration Studies

Background:

• Federal immigration policy changes in 2025 may impact healthcare access for immigrant communities.
• Understanding shifts in outpatient and telehealth utilization is crucial for health systems.
• Preventive care and timely access remain vital for vulnerable populations.

Purpose of the Study:

• To compare outpatient in-person and telehealth visit completion rates.
• To analyze changes in visit patterns before and after 2025 federal immigration policy implementation.
• To assess differences between patients likely undocumented and those likely with legal status.

Main Methods:

• Cross-sectional analysis of electronic health record data from a public safety-net system.
• Proxy classification for documentation status: non-English primary language without SSN (likely undocumented) vs. English primary language with SSN (likely legal status).
• Comparison of outpatient visits from January-June 2024 and January-June 2025 using mixed Poisson regression.

Main Results:

• Patients likely undocumented had higher in-person visit completion rates (15% higher) than those likely with legal status.
• In-person visit completion decreased in 2025 among likely undocumented patients (5-12% decrease), with significant drops in March and June.
• Telehealth visit proportion increased by 12% for likely undocumented patients and decreased for likely legal status patients between 2024 and 2025.

Conclusions:

• While initially showing higher in-person visit completion, likely undocumented patients experienced declines potentially linked to immigration enforcement.
• Increased telehealth utilization by this group emphasizes its critical role as an access pathway.
• Health systems must prepare for evolving care use patterns and expand telehealth services to support immigrant communities.