Background: Undocumented residents in California face persistent barriers to healthcare access. To address gaps in healthcare coverage for undocumented persons prior to the 2024 Medi-Cal expansion, the County Medical Services Program launched Path to Health (PTH), a pilot program that delivered primary care to more than 19,000 residents across 35 primarily rural counties from 2019-2023.

Objectives: This evaluation examines the program’s impact on healthcare access and explores the perceptions, demographic patterns, and clinical characteristics associated with telemedicine use among participants.

Methods: UCLA DGSOM analyzed responses from a randomized cross-sectional telephone survey conducted between 2019 and 2023. Twenty clinic organizations across 100 sites participated. Telemedicine use was assessed among 210 participants, comparing users and non-users across demographic and clinical characteristics. A follow-up survey of participants who exclusively used telemedicine (N=80) captured perceptions of telemedicine services.

Results: Most participants were Spanish-speaking Latino/a adults aged 21-64. Telemedicine users were older (16% age 60+ vs. 3% among non-users) and more likely to have diabetes (27.7% vs. 9.2%, p=0.001). Despite high rates of limited English proficiency, over 75% of telemedicine users reported that visits were easy to use, convenient, and acceptable. Notably, 20.9% reported delaying or avoiding care due to fears it might affect their or a family member’s immigration status. Additionally, 24.8% screened positive for high depression risk, and 17% reported feeling unsafe leaving home due to immigration fears.

Conclusions: ​​Telemedicine improved access for older adults and those with chronic conditions. PTH demonstrated that telemedicine can expand equitable care access for undocumented populations in underserved areas. With one in five participants avoiding care due to immigration fears and public charge, telehealth may serve as a more acceptable alternative to in-person care. These findings support continued investment in care models tailored to uninsured and undocumented communities.