Proposals And Recent Actions To Increase Access To Health Coverage For Immigrants
Recent federal and state activity has focused on expanding access to health coverage for immigrants. Moreover, other recent activity may help increase enrollment among immigrants who are eligible for coverage options. However, beyond these actions, broad sustained community-led efforts will likely be key for reducing fears and rebuilding trust among immigrant families.
In December 2020, Congress restored Medicaid eligibility for citizens of Compact of Free Association communities. Compacts of Free Association are agreements between the U.S. government and the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau. Certain citizens of these nations can lawfully work, study, and reside in the U.S., but they had been excluded from federally-funded Medicaid since 1996, under the Personal Responsibility and Work Opportunity Reconciliation Act . As part of a COVID-relief package, Congress restored Medicaid eligibility for COFA citizens who meet other eligibility requirements for the program effective December 27, 2020.
What Is Emergency Medicaid And How Do You Qualify
Undocumented immigrants are eligible to apply for emergency Medicaid, which is used when an individual is experiencing acute symptoms that could cause a body part or organ to not function properly or in a way that would directly affect life or health. This includes emergency labor and delivery. Those who qualify would be able to use emergency Medicaid to cover medical expenses.
As part of the application, you will be asked to provide certain documents including:
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Bank statements
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Utility bill to prove residency
Undocumented Immigrants In California
- California is home to more than two million undocumented immigrants.Undocumented immigrants are not directly identified in any representative national or state surveys. But the best estimates suggest that in 2014, the year of the most recent data available, California was home to between 2.35 and 2.6 million undocumented immigrants. Nearly a quarter of the nations undocumented immigrants reside in California, where they constitute more than 6% of the states population. Nationally, the undocumented population has stabilized at approximately 11 million, following a slight decline after 2007. A combination of increased enforcement, voluntary returns, and fewer new migrants has increased the average length of residence in the United States, with 66% of undocumented immigrants having lived here for 10 or more years.
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How Can Undocumented Immigrants Access Healthcare
Unfortunately, most undocumented immigrants wont be able to acquire health insurance, which means that theyll need to rely on community health centers for care.
Health clinics such as Planned Parenthood provide affordable family planning and basic reproductive health services. Some health clinics including Planned Parenthood offer services on a sliding scale system, which determines how much you pay according to your income level.
Additionally, federal law mandates that emergency rooms stabilize and treat patients with essential care, whether they have no insurance or are undocumented.
Its not the same as having health insurance, but its better than possessing no healthcare at all.
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Best Healthcare Options For Undocumented Immigrants
Undocumented immigrants are a particularly vulnerable group of people who experience limited access to healthcare coverage. While you may not be eligible for employer-sponsored health insurance or government plans, community health centers, private insurance, and membership-based plans are other options for undocumented immigrants.
No one should have to delay or forego the healthcare they need. Mira is here to provide all people access to affordable health services regardless of insurance eligibility. For only $45 per month, Mira can connect you with the appropriate provider and schedule your appointment with full cost transparency. .
Health Programs And Unauthorized Immigrants
In 2011, only 29% of unauthorized immigrants had either employer-sponsored or private health insurance, whereas 71% reported no health insurance coverage 18. In the same year, 47% of unauthorized immigrant children were uninsured 18. Although some health care services are available to uninsured immigrants, the complexity and fear of accessing care in the face of ever-changing and complicated laws may inhibit many legal and unauthorized immigrants from seeking care.
Unauthorized immigrants and temporary immigrants in the United States generally are ineligible for Medicaid 19. The 1996 Welfare Reform Act made unauthorized immigrants ineligible for benefits previously provided by state and local governments unless new state legislation was enacted 20. A number of states have passed legislation to continue use of state funds to provide care, especially prenatal care, to unauthorized immigrants based on residence and financial need 921.
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What Immigration Documents Are Needed To Enroll In Health Insurance
To qualify for Marketplace health insurance as a non-citizen, you must be lawfully present. That means you must have qualified non-citizen status with no waiting period, humanitarian status or circumstances, a valid non-immigrant visa or legal status conferred by other laws.
Other non-citizens who may qualify for Marketplace health insurance include those who are:
- Paroled into the U.S. for at least one year
- Conditional entrants granted before 1980
- Battered non-citizens or their spouses, children or parents
- Victims of human trafficking
Private Health Insurance For Immigrants
There may be several ways to obtain private health insurance for immigrants. These are accessible through a combination of employers, agents/brokers and health insurance marketplaces.
HMO Programs
A health maintenance organization program is a health insurance plan that limits coverage to care from doctors who work for a specific HMO. These programs typically do not cover out-of-network care.
PPO Programs
A preferred provider organization plan is a health insurance plan that covers costs for medical providers in the plans network such as doctors, hospitals and clinics. Providers outside of that network may also be covered, but for an additional cost.
Health Savings Account
Health savings accounts are savings accounts that enable an individual to set aside money for qualified medical expenses. These accounts are untaxed, which can lower the overall costs of health care when these funds are used to pay for copayments, coinsurance, deductibles and other medical expenses.
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Which Health Care Services Are Used Most Frequently By Undocumented Immigrants
Most of the health care services used by undocumented immigrants are for childbirth. A study of emergency Medicaid expenditures for undocumented and recent immigrants in North Carolina between 2001 and 2004 found that between 82.2% and 86.4% of health care spending was related to childbirth. These findings reflect the fact that almost half of undocumented immigrants live in households comprised of couples with children.} Of the remaining health care expenditures in North Carolina, about one third was spent on the treatment of injuries and poisoning . These uses of health care services reflect not only the relatively young age of most undocumented immigrants but also the type of work that they do .
If Youre Undocumented Can You Go To An Urgent Care Clinic Or Emergency Room
Undocumented immigrants can receive care at an urgent care clinic or emergency room but will usually have responsibility for the bills. If thats the case, you have options if you receive a medical bill you cant afford.
Disclosing your immigration status is not required to receive care, but you may be asked about your status if you apply for insurance. You can say you do not wish to apply for insurance and decline to respond about your immigration status. Regardless of status, patients have a right to an interpreter when receiving medical treatment.
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Can Undocumented Immigrants Purchase Private Health Insurance
There is no law barring an undocumented immigrant from purchasing private health insurance, and U.S. citizenship or a lawfully present status is not a requirement of eligibility. The only catch is that the insurance must be purchased outside of the federal marketplace.
The cost of purchasing health insurance directly from a provider with no tax cuts or subsidies is high, and often unaffordable for undocumented immigrants.
Under A Democratic Administration Would Health Insurance Assistance For Immigrants Expand
The Medicare for All bills introduced and would expand coverage to virtually everyone in the U.S., including undocumented immigrants. Some members of Democratic leadership prefer a more measured approach, similar to Hillary Clintons 2016 healthcare reform proposal, which included a provision similar to Californias subsequently withdrawn 1332 waiver proposal.
Joe Bidens campaign health care plan included a similar proposal, which would allow undocumented immigrants to buy into a new public option program, albeit without any government subsidies.
But over the first eight years of exchange operation, roughly 85% of exchange enrollees have been eligible for subsidies, and only 15% have paid full price for their coverage . So although public option plans could be expected to be a little less expensive than private plans, its unclear how many undocumented immigrants would or could actually enroll in public option coverage without financial assistance.
Harold Pollack has noted that our current policy of entirely excluding undocumented immigrants from the exchanges is morally unacceptable. As Pollack explains, Clintons plan to extend coverage to undocumented immigrants by allowing them to buy unsubsidized coverage in the exchange is a good first step, but it must be followed with comprehensive immigration reform to bring de facto Americans out of the shadows into full citizenship.
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So What Would A Health Care Program For Undocumented Immigrants Look Like
The devil is in the details, and the details seem to be in short supply: No candidate has yet offered a blueprint.
As good-hearted as anyone is, its very challenging, Dr. Blumberg said.
Instead, she said, a more pragmatic approach would be to identify providers, hospitals and community centers that disproportionately serve these populations: Giving them additional funds to make that care more accessible seems to me an important place to start.
Requirements For Marketplace Health Insurance
To get health insurance on the Marketplace, as established by the Affordable Care Act of 2020, there are immigration status requirements. According to the Department of Health and Human Services, you must âbe a U.S. citizen or be lawfully present in the United States.â
âLawfully presentâ individuals have:
- Qualified non-citizen status without a waiting period
- Humanitarian statuses or circumstances
- Valid non-immigrant visa
- Legal Status conferred by other laws
Other people who qualify for health insurance from the Marketplace but are considered ânon-citizensâ include:
- Lawful Permanent Residents
- Paroled into the U.S. for at least one year
- Conditional entrant granted before 1980
- Battered non-citizens, spouses, children, or parents
- Victims of trafficking
- Member of a federally recognized Indian tribe or American Indian born in Canada
Additionally, some special cases determine eligibility:
- Mixed status families : Only lawfully present individuals are eligible
- Pregnant women and children: Lawfully residing immigrant children under age 21 and pregnant women are eligible in some states
- Compact of Free Association migrants: Eligible for Marketplace plans, not eligible for Medicaid or CHIP
- Deferred Action of Childhood Arrivals eligible individuals: Not eligible for Marketplace, Medicaid, or CHIP
- Undocumented immigrants: individuals Not eligible for Marketplace, Medicaid, or CHIP
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Health Insurance For Green Card Applicants
Obtaining a green card takes an average of 7 to 33 months in the U.S., and it can take much longer. Thus, it can be a good idea to get some form of coverage or health insurance for green card applicants .
Also, keeping up to date with current health insurance requirements can make the difference between getting a green card application approved and not. While proof of health care coverage is not currently required, it can weigh favorably on a pending permanent resident application.
Who Is Eligible To Apply For Husky Health
Most individuals who fall into one of the above categories will also need to meet a five-year residency requirement. You are excluded from this requirement if you are a child, pregnant, refugee/asylee, Cuban/Haitian entrant, or a victim of trafficking. Amerasians, Iraqi, and Afghan special immigrants, and aliens whose deportations are being withheld, are also excluded from meeting the five-year residency requirement.
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Can Recent Immigrants 65 And Older Buy Exchange Health Plans
Yes. Most Americans become eligible for Medicare when they turn 65, and no longer need individual-market coverage. But recent immigrants are not eligible to buy into the Medicare program until theyve been lawfully present in the U.S. for five years.
Prior to 2014, this presented a conundrum for elderly immigrants, since individual market health insurance generally wasnt available to anyone over the age of 64. But now that the ACA has been implemented, policies in the individual market are available on a guaranteed-issue basis, regardless of age. And if the plan is purchased in the exchange, subsidies are available based on income, just as they are for younger enrollees. .
The ACA also limits premiums for older enrollees to three times the premiums charged for younger enrollees. So there are essentially caps on the premiums that apply to elderly recent immigrants who are using the individual market in place of Medicare, even if their income is too high to qualify for subsidies.
Barriers To Care For Undocumented Immigrants
In the U.S., people experience disparate access to healthcare services based on documentation status. Almost 45% of undocumented immigrants are uninsured compared to 8% of citizens. One report from the Public Policy Institute of California determined âchildren in families with at least one undocumented member are almost 11 percent less likely to have a usual source of care compared to children in other immigrant familiesâ.
One of the main barriers to healthcare services for undocumented immigrants is limited access to employer-sponsored health insurance. Most people in the U.S. enroll in this type of plan, but undocumented immigrants are often employed in industries that are less likely to offer employer-sponsored coverage. As shown in the graph below, undocumented immigrants also experience higher rates of poverty which can make employer-sponsored covered unaffordable even when offered.
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Immigrants And Medicaid & Chip
- Lawful Permanent Residents
- Paroled into the U.S. for at least one year
- Conditional entrant granted before 1980
- Battered non-citizens, spouses, children, or parents
- Victims of trafficking and his or her spouse, child, sibling, or parent or individuals with a pending application for a victim of trafficking visa
- Granted withholding of deportation
- Member of a federally recognized Indian tribe or American Indian born in Canada
- Citizens of the Marshall Islands, Micronesia, and Palau who are living in one of the U.S. states or territories
Questions With Dr Adrienne Sabety On Health Care Access For Undocumented Immigrants
Dr. Adrienne Sabety is an economist and Assistant Professor in the Department of Health Policy at Stanford University. She studies healthcare and the social determinants of health. Her work includes a large, 14-month study in collaboration with the Department of Health and Mental Hygiene in New York City targeting barriers to accessing health care for uninsured, undocumented immigrants. We spoke with her about this work, and how undocumented immigrantsand society more broadlybenefit when access to primary, preventive care is expanded.
What are the particular challenges that undocumented immigrants face accessing health care, and what prompted your collaboration with the New York Citys health and mental hygiene department to investigate this problem?
Undocumented immigrants are a hugely vulnerable group, and we know very little about their health needs and how they utilize healthcare. The opportunity to work with the Department of Health and Mental Hygiene in New York was an awesome way to start digging into undocumented immigrants healthcare needs and utilization patterns.
Now, several years after our study, expanding access to undocumented immigrants is even more relevant in the context of the COVID-19 pandemic, which has disproportionately impacted low-income and immigrant populations, exacerbating longstanding healthcare disparities.
How did the partnership with the NYC mayors office and DOHMH come about?
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Why Immigrants Need Health Insurance
Why have health insurance as an immigrant? The enormous costs of health care in the U.S., coupled with the coverage insurance offers, are strong reasons in favor of getting health insurance as an immigrant.
Health Care Is Expensive
Health spending increased by 9.7% in 2020 in the U.S. according to the American Medical Association . When it comes time to pay the $4.1 trillion bill, the AMA found that 27.9% of health care spending came from private health insurance companies, 20.1% came from Medicare, 16.3% came from Medicaid and 3.8% came from other health insurance programs in 2020. Additionally, 9.4% was paid out-of-pocket, amounting to $388.6 billion.
Insurance Covers Essential Health Benefits
- Individuals who lack health insurance often have poorer health care outcomes.