Objectives. This research aims to understand undocumented immigrant partici-pants’ experiences, program participation levels, and desired improvements in the Options program, a sliding-scale fee-for-service model for un/under-insured patients operated by New York City (NYC) Health and Hospitals (H&H). Methods. Community-engaged, mixed-methods included: focus groups (FG) (n=144), post-FG surveys, and key informant interviews (KII) (n=15) across all five NYC boroughs. All FG and KII transcripts were analyzed following grounded theory methodology. Results. Key findings include low awareness of Options; a need for greater community-based outreach efforts; prioritization of access, quality, and affordability of services; and need for activities that address concerns regarding immigrant status and fear of high bills and long-term debt. Program utilization depends on access, affordability, and patient experience factors, with particular emphasis on stigma associated with being poor and un/underinsured. Discussion. Cultural humility training, diverse staff, and language services access may be the key to increased program success. © Meharry Medical College.

Safety-net providers immigrants Grounded theory focus groups Undocumented immigrants Uninsured Key informant interviews

Safety-net Providers information processing medically uninsured medical fee human middle aged Aged language Fee-for-Service Plans qualitative research Undocumented Immigrants interview Young Adult Humans undocumented immigrant psychology New York male staff female Aged, 80 and over very elderly stigma safety net hospital Article genetic transcription program evaluation adult grounded theory major clinical study awareness New York City Fear Focus Groups