Barriers and Opportunities to Improve Healthcare Access for Uninsured Patients at a Student-Run Free Clinic in New Haven, Connecticut

Abstract

Introduction

Uninsured patients have limited options to pay for necessary medical services. Most United States hospitals offer financial assistance programs (FAPs) to help patients pay for care, but the challenges of accessing these programs demonstrate a need for more solutions.

Methods

This study was a retrospective review of 200 randomly sampled HAVEN Free Clinic patients from September 2022 to September 2023. Patients were eligible to be seen at HAVEN if 18–65 years old, without health insurance, and living in New Haven County, Connecticut. Application histories to Medicaid and hospital FAP at a non-profit tertiary care center in Connecticut were assessed.

Results

In the 200-patient sample, average age was 43.4 ± 11.2 years old, 61.0% were female, and 86.5% were Hispanic or Latino. 68% were employed with a median household yearly income of $18,200 [$7,293-$26,741]. 80% had applied for a hospital FAP—71.1% were currently approved for Free Care or Discounted Care. 6% were approved for Medicaid; 2.5% were approved for Emergency Medicaid. Of those who applied for a hospital FAP, 28.3% received ≥ 1 application denial. Most common hospital FAP denial reasons were missing, wrong, or outdated proof of income (93.9%), and incomplete application (6.1%).

Conclusion

Hospital FAPs and Medicaid provide important access to care for uninsured patients, but are not without barriers and should not be viewed as the only solution. Improving hospital FAP access involves assessing eligibility at presentation, extending approval duration, and advocating for more funding. Addressing these barriers can advance equitable care for all.