P3.K206: Increasing Access to Primary Care for Newly Arrived Immigrant Children with Acute or Complex Medical Needs in the D.C., Maryland, and Virginia Region

Background: The District of Columbia (D.C.), Maryland, and Virginia (DMV) region has longstanding communities of immigrant families. Between April 2022 and October 2023, D.C. received over 12,500 immigrants via bussing from the southern border. Immigrant families face unique challenges accessing the U.S. healthcare system including physical, language, and insurance barriers. In the DMV region, access to health coverage depends on place of residence, immigration status, length of time in the country, and other factors. We used philanthropic funding as a payor of last resort for medical care costs while awaiting longer-term health coverage (Judy and Peter Blum Kovler Foundation Medical Care for Migrant Children Fund). We sought to develop a system to meet the primary care needs of recently arrived immigrant children who initially presented with acute or complex medical conditions.

Project Description: Newly arrived immigrant children with acute or complex medical conditions were identified during mobile health unit, emergency room, or inpatient encounters and referred to our immigrant health team for primary care follow-up. A designated primary care clinic held two appointment slots for this program per week. The clinic is a multi-disciplinary medical home offering psychology, social work, an immigrant health care coordinator, early intervention specialists, and legal support. As an academic primary care center, we refer to all pediatric subspecialties within our institution. We seek to welcome patients into the healthcare system and to provide trauma-informed, well-rounded care. Our team of immigrant health focused social workers, care coordinators, and physicians meets weekly to review patients’ needs.

We began offering appointments in September 2023. In the first six months, 10 patients were referred for primary care. Seven patients were seen in clinic within one month of referral. Three patients were lost to follow-up or obtained care elsewhere. Patient age, referral source/reason, and payor status are outlined in table 1. As of March 2024, five patients continue to receive primary care in our clinic. Two patients have been connected with FQHCs for primary care based on location of residence and payor status.

Discussion: Newly arrived immigrant children may have difficulty accessing the healthcare system leading to poor health outcomes, unnecessary ED visits, or prolonged hospital stays especially for children with acute or complex medical needs. There are often financial barriers to accessing care. We sought to provide timely connection to primary care for immigrant children with high-risk medical issues. Further work is needed to quantify how many children would qualify for initiatives such as this and to assess long-term health outcomes and impact.

Conclusion: A dedicated primary care clinic can provide timely access to primary care services, as well as connection to the larger healthcare system, for immigrant children with a variety of acute and complex medical needs.