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Introduction: Recent federal Medicaid policy changes under H.R.1, also referred to as the One Big Beautiful Bill, may reduce safety-net financing and disproportionately affect low-income, uninsured, and undocumented populations. Prior Medicaid funding reductions have been linked to decreased access, reduced services, and strained clinic capacity. Simultaneously, heightened immigration enforcement may further deter healthcare utilization. This mixed-methods study examines stakeholder understanding and patient experiences while assessing early shifts in care access and outcomes at Los Angeles safety-net clinics.

Methods: The current study uses a mixed-methods study that includes patients and clinic stakeholders from Los Angeles County safety-net clinics. Semi-structured interviews with patients, clinicians, administrators, and care coordinators explore understanding of H.R.1-related policy changes, immigration enforcement, and experiences accessing or delivering care. This qualitative data will be analyzed using thematic analysis. Quantitative analysis will use electronic health record data to compare trends across the time frame of July 2025 to July 2026. Measures will include healthcare utilization, clinic capacity, chronic disease indicators, and mental health-related outcomes.

Results: Data collection is ongoing; preliminary qualitative themes will be presented at the time of Scholarship Day.

Conclusion: As safety-net clinics navigate pressures from Medicaid restructuring and immigration enforcement, understanding their intersecting effects on vulnerable populations is urgent. This study's mixed-methods approach will capture both system-level trends and the lived experiences often absent from policy discussions. Findings intend to inform clinic-level adaptations and provide evidence to advocate for policy safeguards that protect equitable access for underserved communities in Los Angeles and beyond.