Bridging Gaps in Cancer Care: A Mixed-Methods Approach to Investigating the Cancer Care Barriers, Facilitators, and Outcomes for Patients with Emergency Medicaid

PIs Dr. Larry Au (CCNY) and Dr. Joshua Budhu (MSK)

This research is funded by the CCNY-MSK Partnership for Cancer Research, Education, and Community Outreach (https://ccnymsk-partnership.ccny.cuny.edu/). The research has been reviewed by CUNY IRB (#2025-0429-CCNY). The project period spans from March 2025 to February 2026.

Medicaid for the Treatment of an Emergency Medical Condition (“Emergency Medicaid”) provides critical healthcare coverage to recent immigrants and immigrants to the United States without authorized immigration status (IWAIS). Although Federal mandate requires that individual states cover these emergency services, they have significant agency in what services are covered, resulting in a wide range of variation nationally, as well as inequitable differencesand uncertainty in coverage for patients. There are over 11 million people, with 500,000 people in New York City, without authorized immigration status, and $3.8 billion was spent on Emergency Medicaid nationally in 2023. However, little is known about the facilitators of and barriers to care, overall healthcare utilization, and experiences of cancer patients on Emergency Medicaid. We will use a mixed methods approach to collect and understand how clinicians and key community stakeholders provide care to patients with cancer on Emergency Medicaid, and leverage databases and proxy indicators for this population.

Aims of the Study

Aim 1: To conduct in-depth interviews with 20 stakeholders who work in clinical contexts from varied institutions that provide care to IWAIS patients to assess facilitators of and barriers to cancer care. Our purposive sample will also vary relevant organizational factors that may impact the care received by immigrants without authorized immigration status patients, such as the size and type of the hospital, geographic region, demographic profile of patients served, etc. Probes will address: (1) interpersonal challenges that clinicians face when working with immigrants without authorized immigration status patients, such as linguistic barriers and cultural responsiveness; (2) organizational difficulties in providing care for immigrants without authorized immigration status patients with cancer, such as limitations on services and treatment options; and (3) attitudes and opinions about the adequacy of current state and federal policies.

Aim 2: To interview 20 leaders of organizations that support immigrants without authorized immigration status to assess facilitators of and barriers to cancer care. Aim 2 will explore the experiences of immigrants without authorized immigration status patients and complement the views of providers interviewed in Aim 1. These organizations will include those that primarily serve immigrant patients in the New York City area. Questions will include probes similar to those in Aim 1, but with an emphasis on patient experiences. Additionally, we will include questions related to (1) the role of community organizations in helping patients who are immigrants without authorized immigration status access cancer care, and (2) informal sources of support upon which these patients rely.

Interested in participating in this study? Please reach out to Larry Au ([email protected]).