Changes in Outpatient and Telehealth Visits Among Undocumented Patients

Importance: Anti-immigration policies in 2025 may influence outpatient care and telehealth among immigrant communities. Understanding visit patterns is essential for health systems leaders to prepare for shifts in health care use and ensure preventive care. Objective: To compare outpatient in-person and telehealth visit completion rates among patients classified as likely undocumented and those likely with legal status, before and after 2025 federal immigration policy changes. Design, Setting, and Participants: This cross-sectional study analyzed electronic health record data from outpatient encounters in a public safety-net system. Documentation status was approximated using non-English primary language without a Social Security number (SSN) to classify patients with likely undocumented status and using English primary language with SSN for patients likely with legal status. Analyses compared visits from January to June 2024 and January to June 2025. Main Outcomes and Measures: Outcomes included the number of in-person visits, in-person visit completion (show) rate, and telehealth visit proportion as a percentage of total outpatient visits. Mixed Poisson regression was used to estimate incidence rate ratios (IRRs) for completed outpatient visits and telehealth visit counts by month, comparing both proxy groups. Results: This study analyzed 184 541 outpatient visits in 2024 (48.7% females, 51% males, 0.2% other sex) and 182 573 outpatient visits in 2025 (49.8% females, 49.9% males, 0.3% other sex). During both 6-month periods, patients classified as likely undocumented had 15% higher in-person visit completion rates compared with patients likely with legal status (IRR, 1.15; 95% CI, 1.13-1.16). However, month-specific analyses found that in-person visit completion rates decreased in 2025 among likely undocumented patients, with decreases ranging from 5% to 12%, and significant decreases in March 2025 (IRR, 0.88; 95% CI, 0.83-0.93) and June 2025 (IRR, 0.93; 95% CI, 0.87-0.99) compared with 2024. The relative proportion of telehealth visits increased by 12% among likely undocumented patients between 2024 and 2025 (IRR, 1.12; 95% CI, 1.04-1.20) and decreased among patients likely with legal status (IRR, 0.95; 95% CI, 0.93-0.98). Among more than 367 000 visits, there was no clinically significant change in total visits for either group between 2024 and 2025 (IRR, 1.00; 95% CI, 0.99-1.02). Conclusions and Relevance: This study found that patients classified as likely undocumented had higher in-person visit completion rates than patients likely with legal status, but experienced month-specific decreases, which may correspond to increased immigration enforcement activities. Their increased telehealth use underscores its importance as a critical access pathway. Health systems leaders should anticipate shifts in care use and safeguard outpatient access by expanding telehealth supports for immigrant communities.