Undocumented Patients with Access to Primary Care and Avoidable Emergency Department Visits: Evidence from a Safety-Net System

We examined whether undocumented patients enrolled in a health care coverage program in Los Angeles have fewer avoidable emergency department (ED) visits than other foreign-born patients. We analyzed 2016-2020 ED encounters from all safety-net hospitals in Los Angeles County. We estimated the odds that an ED encounter was for an ambulatory care sensitive condition from mixed effects models among 1) undocumented patients in the program, My Health LA (MHLA), 2) non-MHLA undocumented patients, and 3) foreign-born documented patients (n=567,671). My Health LA patients had a lower likelihood of avoidable visits from acute conditions and non-diabetes chronic diseases than the foreign-born documented patients and non-MHLA patients. However, they had greater likelihood of visits related to type 2 diabetes (T2D). Having access to regular primary care improves some acute and chronic disease-related utilization but undocumented patients with T2D may select into the program and face ongoing challenges managing the disease.