While providing care to undocumented immigrants, particularly those who remain uninsured, aligns with the healthcare sector's ethical duty to treat all patients equitably, it also presents financial, operational, and strategic challenges for hospitals and health systems. The question often becomes, How do we treat these patients without bearing additional burden?
The good news is an affordable outcomes-based solution may be closer than you think! In this article we will review Medi-Cal’s expansion, present 5 challenges it brings hospitals and healthcare systems, and a possible solution.
Undocumented immigrants in California have long faced obstacles in accessing healthcare due to their immigration status. With a strong belief that care should be equitable for all residents, California expanded their Medi-Cal coverage on May 1, 2022, making it accessible to individuals, regardless of immigration status. Previously, coverage was limited to undocumented children and young adults up to age 26, marking this change as a significant stride in addressing longstanding disparities in care.
While these expansions bring hope and relief to many individuals, particularly those in essential industries like agriculture, enrollment challenges persist. Approximately 1.16 million undocumented immigrants remain uninsured. Efforts to increase awareness and streamline enrollment processes have been essential to maximizing the impact of these initiatives; however, many undocumented residents worry that seeking medical care or enrolling in Medi-Cal could expose them or their families to immigration authorities, thus preventing them from getting routine care and/or enrolling in Medi-Cal altogether. With the economy and housing market tightening, many are also faced with significant Social Determinant of Health (SDoH) barriers like lack of access to safe and consistent housing, nutritious food, transportation, and assistance from community resources, making it challenging to prioritize their healthcare needs.
Faced By Hospitals & Healthcare Systems
1. Emergency Department Overuse:
Without access to preventive and primary care, undocumented immigrants may rely on emergency departments for healthcare needs. This can lead to overcrowding, increased wait times, and strain on emergency services.
2. Uncompensated Care Costs:
Hospitals often provide care to undocumented immigrants without the expectation of reimbursement, especially in emergency situations where hospitals are mandated to provide care regardless of immigration status or ability to pay. This results in higher uncompensated care costs, which can impact the financial stability of hospitals and health systems.
3. Public Health Implications:
When undocumented immigrants avoid seeking care due to fear of deportation or transportation barriers, conditions that are preventable or manageable may go untreated. This can lead to outbreaks of communicable diseases, higher rates of chronic disease complications, and overall poorer community health outcomes.
4. Resource Allocation:
The need to address the complex medical and social needs of undocumented immigrants can require significant resources, including language services, cultural competency training for staff, and legal
resources to navigate immigration-related issues. Allocating resources to these areas can strain hospital budgets and impact resource availability for other services.
5. Policy and Funding Challenges:
Navigating state and federal policies around healthcare provision to undocumented immigrants presents ongoing challenges. Hospitals and health systems must stay informed about legal requirements and funding opportunities, such as state funds or specific grants that may offset some of the costs of care provided to undocumented populations.
One support solution lies in the innovative approaches offered by Caret Health, a growing health tech company founded by long-time California residents, Kevin Zhao and Dr. Riya Pulicharam. Collectively, they have over 30 years of experience developing programs to lower the cost of care and improve quality performance within risk-bearing organizations.
Caret’s solution creates end-to-end intervention programs designed to drive outcomes and ROI through a hands-on prospective intervention approach that targets highly weighted measures. These programs utilize a variety of administrative support tools alongside proprietary remote care intervention and predictive analytics to deliver tailored intervention programs for high-risk high-cost patient populations, including those on Medicaid. By offering a centralized care team Caret’s execution-focused approach differentiates itself from other platforms which may only act as passive, retrospective reporting systems. This also means little to no physician or operational burden.
Ultimately, Caret aligns quality measures and the principles of value-based care models to improve holistic outcomes. The results?
One of the most special things about Caret is that patients don’t have to worry about repercussions of seeking care because monitoring is made digitally accessible. It has also been designed to meet the needs of underserved populations. The program uses Ai and a highly trained care team to assess each patient’s technology literacy, language, and education needs so outreach and implementation can be customized to truly meet patients where they need to be met.
In similar programs, Caret has seen stupendous Medicaid patient engagement results with monthly engagement as high as 70-80% among enrolled participants.
Caret Health's commitment to transforming healthcare delivery underscores its role as a catalyst for change in addressing the complex healthcare needs of underserved communities. By partnering with organizations like Caret Health, policymakers and healthcare leaders can continue advancing initiatives that promote health equity and improve outcomes for all individuals, irrespective of immigration status.
Looking to discuss partnerships, pilots, or just learn more? Caret's Sales Leadership team would be happy to assist you.
