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While the United States is home to a rich culture of diverse communities, resources and opportunities are not equitably accessible to all. Immigrant Communities face a complex history with acculturation challenges, immigration status, experience with racism, communication barriers, and resettlement journeys. While these factors all affect a person’s well-being, immigrant communities also face significant challenges in a vital area: accessing health care. Many immigrants are hesitant to seek out preventative medical care – especially if they have understandable fears surrounding their immigration status – until it may be too late, which ultimately may lead to costly emergency room charges. There are multiple factors that contribute to delay of medical treatment; patients may have had previous negative encounters in the hospital, they may be fearful of medical bills and unaware of financial assistance options, or they may have serious mistrust of the government due to critical remarks and the harsh anti-immigrant policies that were hallmarks of the Trump administration.
Health Access Options for Immigrant Communities
While immigrants contribute a sizeable share to the economic growth of the country through consumerism and taxes paid, they are not all provided equitable opportunities to federally funded public health coverage options. For instance, only immigrants who meet certain qualifications such as holding a qualified status for five year or longer are able to get access to Medicaid or CHIP. Private health insurance options are available to all regardless of immigration status, but immigrant communities often work in low-wage industries and many are unable to afford private insurance premiums. This leaves immigrant communities without health insurance coverage options and vulnerable to economic hardship and results in poor health outcomes. Undocumented immigrants are eligible to apply for emergency Medicaid in certain contexts, but it also requires burdensome application documents which may deter some patients due to fear about their immigration status. Additionally, some states have used state-only funds to expand coverage for certain undocumented groups either at county/city levels or through Medicaid-like programs and/or CHIP.
Many immigrant communities seek out medical care from safety-net facilities such as free community clinics and Federally Qualified Health Centers (FQHCs). These facilities are able to offer services on a sliding scale based on ability to pay and provide basic health services to all regardless of immigration status. However, some patients may get referred to external facilities to receive care that is beyond the scope of the clinic. In these situations, patients may be reluctant to follow up with their appointment and/or encounter issues receiving financial assistance at the new facility. However, the financial assistance and charity care hospitals are obligated to provide are also an important part of the safety net to ensure all low-income communities are able to afford medical care.
Community Education and Empowerment
While hospitals are obligated to comply with financial assistance policies, health care facilities across the country vary in eligibility standards and required documentation. Some states have enacted medical debt protections to help those in need but policy language may be interpreted incorrectly or hospital staff may be improperly trained. For instance, in Illinois, non-profit hospitals require uninsured patients to provide proof of Illinois residency through a variety of acceptable documents such as a driver’s license to qualify for financial assistance or charity care. However, many community advocates in the state witnessed denials to undocumented immigrants who could not furnish specific documentation. Although community advocates were able to successfully lead legislation to provide undocumented immigrants access to a temporary driver’s license in 2012, hospitals were not required to accept the document in their financial assistance applications and many facilities did not accept it as a valid form of state residency. To tackle this issue, advocates were able to successfully enact SB 1840 in 2021, which added temporary driver’s licenses to their list of acceptable documents to prove residency and included additional provisions to ensure immigrant-friendly practices in health care. The new law also allows patients to pre-apply for a hospital’s financial assistance when referred from a clinic/FQHC. While protections for the law began on January 1, 2022, community advocates will need to work with health systems across the state to ensure staff are properly educated and community members are aware of their rights.
Unfortunately, health care facilities may not readily offer education (particularly in languages other than English) to patients about medical debt protections, health insurance options, and/or financial assistance. In an effort to empower the immigrant community, our partners in Illinois launched a first-of-its-kind Immigrant Health Academy to educate the community about their rights in seeking equitable access to affordable health care. Initiatives such as this help pave the way for immigrant communities to shift the dynamic to ensure their voices are included in conversations about health equity policies.