By Linda Nwoke
There are several reasons people leave their home country for another, and one of such is for medical reasons. Sometimes, it can be for a short or long-term basis, depending on individual circumstances. In the United States, three central components aid accessibility to medical care for immigrants: first, the foreign national needs to provide treatment documents for medical procedures that align with what was given from their home country, secondly the treatment must be a necessity and cannot be found in the home country (sometimes), and lastly, there must be evidence of ability to pay for the medical services.
Ms. Jackson has been diagnosed with a rare type of cancer that can be treated effectively in the United States. As part of the required documentation, Ms. Jackson will need a valid and current B-2 visa to travel into the country. To qualify, she will need a verifiable healthcare document from her home country doctor, a U.S.-based doctor’s letter, and an immigration plan. She will also need to show evidence of her permanent residence, a valid passport to return home, a treatment plan, and finance to pay for the healthcare services. For the B-2 visa, she may need a lawyer to assist with any technical and administrative problems that may arise through temporary stays in the United States or any issues that could happen later.
However, suppose Ms. Jackson overstays the approved time on her visa, even after an extension, and finds herself unable to regularize her stay. In that case, she will end up staying illegally in the country and be classified as undocumented. Suddenly, she discovers that the earlier signs and symptoms of the cancer are back. What are her options?
Medical Care for Undocumented Immigrants
The undocumented remains a vulnerable population in many advanced countries, especially the United States, affecting all aspects of their lives, including health. Undocumented immigrants are individuals born outside the United States, who have entered the country without documents or authorization, or those who were legally authorized to enter but remained after their visa had expired. Ms. Jackson is an example of one whose application for immigrant status has not been resolved.
According to data from Kaiser Family Foundation, as of 2017, over 10 million undocumented immigrants in the United States regularly face barriers to accessing health care because of a lack of insurance, resulting in a delay or living without needed healthcare. Spontaneously, when they need medical care, they are unlikely to seek help, but when they do, it is on their own, often at a critical stage. As they confront factors like language barrier, prohibiting policies, fear of deportation, and a lingering psychological impact left from the dark shadow cast by the Trump regime among the undocumented population.
Medicaid and the Undocumented Immigrant
According to Federal law, all hospitals are mandated to render medical treatment such as screening and stabilizing any patient that seeks emergency care. Some states also cover some aspects of medical care through a partnership under Medicaid; however, this is predominantly for Americans and documented immigrants. Medicaid is the nation’s public health insurance program for people with low income. It also provides comprehensive coverage and financial protection for the majority of working families.
The insurance covers long-term care for millions of seniors, children, and people of all ages with disabilities in nursing homes and the community. Due to the COVID-19 pandemic, the loss of jobs and income have increased the impact of previously non-existent healthcare coverage of undocumented immigrants. Their ineligibility to apply or purchase from the Affordable Care Act (ACA) Marketplace because of prohibitions in the legislation makes the case worse.
Though Undocumented, Yet They Remain ‘Essential’
Sometimes people think that undocumented immigrants are parasites in the system, yet, evidence from 2017 tax revenue records show that they paid over $25 billion in taxes. Furthermore, the COVID-19 pandemic substantiated the role that over 70 percent of undocumented adults contribute to the country’s labor force. The Center for American Progress report shows that over 4 million undocumented immigrants perform essential work in multiple sectors.
Sectors like agriculture, construction (building maintenance), essential services – grocery stores, restaurants, laundromats, domestic work; and healthcare serving as care workers in hospitals, nursing facilities, and private homes. Yet, most of them cannot access proper health care for themselves, even though they are most at risk of contracting the virus. These workers were evidenced by the large population of such essential workers who got sick during the pandemic.
The crisis within the meat processing sector, when over 40,000 workers got exposed during the height of the pandemic, comes readily to mind. Many undocumented immigrants may have undiagnosed conditions and diseases that go untreated, causing premature death. Moreover, due to their often physically demanding jobs, they are exposed to an increased risk of workplace injury and chronic conditions from intense manual work. And continuously deal with critical social, financial, and health problems with no help because of their immigration status.
Critical Facts about Medical Insurance for Undocumented Immigrants
Data shows that over forty million people within the United States are uninsured or underinsured. Most undocumented immigrants are more likely than other U.S. residents to be uninsured, which creates barriers to healthcare. They are also unable to pay for the health care they need because of the concern about the financial implications of the care they seek or might receive. Without insurance, undocumented immigrants are constrained to limited and specified health facilities. Some of these locations charge on a sliding scale. However, they may qualify for emergency Medicaid, which covers access to healthcare during an emergency medical situation.
Undocumented immigrants cannot enroll in Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP). They cannot buy insurance through the Affordable Care Act (ACA) marketplace, making affordable healthcare more difficult. Many may not have access to employer-sponsored health plans because they work in industries that usually don’t provide insurance or the coverage offered is unaffordable. Hence the healthcare system appears bewildering for people and wildly expensive for those without insurance—or those whose insurance doesn’t cover enough.
However, it is not all gloomy and depressing. A few options are available, including safety-net institutions where patients can receive heavily subsidized or free medical services. Although, they vary by a couple of factors, including where you live, the kind of treatment required, and other peculiar circumstances.
Health Care Options Available to Undocumented Immigrants
There are three main options for undocumented immigrants to have access to health care coverage:
1.Through a spouse: They can buy private insurance or receive coverage through a spouse; however, the fear of declaring their immigration status or high premiums serves as a deterrent.
2. Employment: Through their employer or union, however, most work in low-wage jobs that don’t provide these benefits. For those who form a union to access these benefits, the fear of employer retaliation prevents them.
3.Government-assisted health care: Care is obtained through government-funded hospitals running under specific programs.
The National Association of Free and Charitable Clinics (NAFC) has over 1,300 free clinics in the United States. They are considered a safety-net hospital that provides uninsured people with low incomes and undocumented immigrants regardless of ability to pay.
They are also called county hospitals, public hospitals, or essential hospitals. You can find a safety-net hospital on this state-by-state list or by searching online for a safety-net hospital, county hospital, general hospital, or critical hospital in your area for the list of qualifying organizations.
Undocumented immigrants can also receive medical care at Federally Qualified Health Centers (FQHCs), urgent care clinics, public hospitals, and emergency rooms — regardless of immigration status.
Specifically, FQHCs, or Community Health Centers as popularly known, provide primary care services and specialty care to undocumented immigrants. This is the most viable means for most undocumented immigrants to receive medical services.
Another category is Charity-run free clinics or health centers that receive funding from programs to provide free or low-cost health care services. However, they charge patients on a sliding fee scale based on their ability to pay. They also have limited access to specialized care if needed. And of course, undocumented immigrants are allowed to seek emergency care under the Emergency Medical Treatment. Since federal law, Labor Act (EMTALA) requires hospital emergency rooms that accept Medicare to treat patients—including the undocumented— with life-threatening emergencies.
However, patients, including the undocumented, can be served an enormous bill beyond their affordability, as hospitals are allowed to charge for providing emergency services. Thus, making them forego specialized care and treatment and limit themselves to primary care services only.
In New York, one notable, though limited in scope program called the HillBurton program, provides funding to health care facilities and hospitals that provide a specified amount of reduced or free cost health care to low-income people.
To apply, individuals must go to the business office at a Hill-Burton facility or check the directory of Hill-Burton facilities (HRSA) to confirm eligibility before going to the health facility. Some organizations that run on the program include:
1. Bronx-Lebanon IDC, 1276 Fulton Avenue, Bronx 10456, 718-299-6910. (Outpatient Facility)
2. Bronx-Lebanon SP CC, 1265 Fulton Avenue, Bronx 10456, 718-590-1800 (Nursing Home)
3. Morris Heights HLTH CTR, 85 West Burnside Avenue, Bronx 10453 (Outpatient Facility)
4. Bushwick Clinic, 22 Chapel Street, Brooklyn 11210, 718-260-2968 (Outpatient Facility)
5. Kings County Hospital CTR, 451 Clarkson Avenue, Brooklyn 11203, 718- 245-3131 (Outpatient Facility)
6. Sunset Park Family H C, Lutheran Family Health Centers, 150 55th Street, Room 2062
7. Orange Co Home & Infirm, BOX 59 Quarry Rd, Goshen 10924, 845-291- 4740 (Nursing Home)
8. Coler Memorial Hospital, Franklin D. Roosevelt Island, NEW YORK 10044, 212-848-6027 (General Hospital)
9. Harlem Hospital Ctr, 506 Lenox Avenue, New York 10037, 212-939-1000 (General Hospital)
10. Open Door Family Medical Center, 165 Main Street, Ossining10562, 914- 941-1263, (Outpatient Facility)
11. Morris Heights Health Ctr,85 West Burnside Avenue, Bronx 10453 (Outpatient Facility)
Private Institutions and Medical Care for the Undocumented
Although some non-profit institutions and organizations provide free medical services to the uninsured or low-income individuals, they are few, and awareness is low, especially in New York. Thus far, the Institute for Family Health, funded by Robin Hood, provides free health care services in their Saturday-only clinics at Bronx and Manhattan. They also have four other locations of operation:
•Amsterdam Health Center: 690 Amsterdam Avenue at 94th St., 212-865- 4104
•East 13th St. Family Practice: 113 East 13th St., 212-253-1830
•Phillips Family Practice: 16 East 16th St., 1st Floor, 212-206-5200
•Sidney Hillman Family Practice: 16 East 16 Street, 3rd Floor, 212-924-7744 Interestingly, New York City, under its NYC Care program, offers more comprehensive coverage for undocumented immigrants.
NYC Care for the Undocumented Immigrant
Launched in 2019, under Mayor Bill de Blasio’s administration, NYC Care partnered with the NYC Health + Hospitals publicly funded system (HHC). NYC Care provides no and low-cost health care services to New Yorkers, especially unqualified or unable to pay undocumented immigrants, health insurance— regardless of their immigration status. The program operates similarly to health insurance by enrolling members and providing them a membership card, making them eligible to receive care from a primary care physician by visiting an NYC Health + Hospital or one of its off-site clinics.
This card makes them eligible to receive prescription medications and various services, including preventive care and routine screenings, including mammograms. Service fees, if any, are based on household income and size.
Although, there are a few challenges with the program ranging from the limited number of facilities, competing categories of patients for the same services (undocumented vs. low-income Americans), long appointment duration to access specialized care, limited translation services, and no option tele healthcare treatment.
Yet, the emphasis is that the program protects the undocumented – as there is no need to reveal immigration status to receive NYC Care health care services in any of the HHC facilities.
To access these services, there are four significant steps to enroll:
•Meet with an NYC Health + Hospitals Financial Counselor
•Meet with or call a representative
•Go to one of the approved community-based partners and access care
•For more information, call 1-646-692- 2273.