Connecting the uninsured to care: Engaging new primary care patients at a new York City safety net system

Objective: Cost and ineligibility are major barriers to accessing United States health care, particularly for undocumented immigrants. NYC Care is a healthcare benefit program covering care at NYC Health+Hospitals, the nation's largest safety net system located in New York City. In this evaluation, we describe care received by new primary care patients recently enrolled in NYC Care. Methods: We reviewed demographics and diagnoses for 14,953 NYC Care adults who first visited primary care between November 1, 2020 and October 31, 2021, along with their total primary care visits, referrals, specialty visits, and acute visits one year following care initiation. Characteristics and utilization were compared to new Medicaid patients (n = 19,701). A generalized estimating equation calculated odds of returning to primary care and visiting specialty care among new NYC Care versus Medicaid patients. Results: NYC Care patients had a median of 3 (Interquartile Range: 2,4) primary care visits, 2 (1,4) referrals, and 2 (1,6) specialty visits in the first year. NYC Care patients had an aOR of 1.9 (95 % CI, 1.7, 2.1) for a second primary care visit in the year and 2.0 (95 % CI, 1.9, 2.2) for a specialty visit, compared to Medicaid patients. Conclusions: NYC Care patients demonstrated high utilization of outpatient services. Previously deferred healthcare may contribute to pent-up demand among uninsured individuals. In lieu of state or federal action, city-sponsored healthcare access programs may offer a pathway to care for uninsured patients, including undocumented immigrants. Future evaluations should utilize longer observation windows and external data to expand generalizability.