Healthcare for undocumented immigrants

elkpark · Nov 17, 2015

I'm not aware of any healthcare facility that makes any sort of determination of the immigration status of individuals presenting for care. Everyone has been treated the same and no one has asked about immigration status, in my experience.

anon456, BSN, RN · Nov 17, 2015

I just wrote a paper on this topic and may be able to help you find information. :-)

The best way to find out information is to research your area for the number of illegal immigrants. The US Census website is helpful. You can find out what percentage of Hispanic/Latino people in your area are undocumented immigrants. (And by the way, the different websites and sources use Hispanic and Latino interchangeably and I know there is a difference, but that's another topic.)

You can also find your county's health status report and that may have information about Hispanic people in your area, their rates of chronic diseases, rate of death, etc. Research the local schools and find out their demographics. You might even call up a couple of schools and ask the nurse about issues related to the health of undocumented children. Call some of the free or low cost clinics in you area to find out what some of the main issues are with this population.

Also ask what are the out of pocket fees for the clinics to see a general doc and a specialist, or if the specialists will even see people without proof of insurance (many will not). Some clinics have different charges for uninsured vs insured patients. Also *very important* some clinics like Planned Parenthood require a photo ID to be seen, which makes many undocumented people hesitant to go there.

In my experience, the main issue is not emergency care, but lack of access to regular healthcare for routine health screenings, and to manage chronic diseases. This is where your calls to local free/sliding-scale clinics will be useful for your paper.

Patients are not able to get that care managed so they go to the ER when things get really bad (such as DKA or a foot rotting off) and they will get treated. Then they will be discharged with no real hope for follow-up care or health education. And then they will find themselves back in an emergency situation. Children also cannot get their chronic conditions paid for if they are here illegally. Think about things like asthma, Type 1 Diabetes, and congenital conditions and syndromes.

PinayUSA · Nov 17, 2015

Challenges are getting them illegal aliens to pay the bills. In my area we have two public hospitals that are funded by property tax, Parkland and JPS they have taken full advantage of free medical.

They go to the emergency room for colds and take full advantage of having a baby in these hospitals...

klone, MSN, RN · Nov 17, 2015

I'm writing a paper on provision of healthcare to undocumented immigrants. I inquired if my hospital has any policy covering this population but aside from giving them emergency care as required by EMTALA, we have nothing else. Does anyone have had any experience with providing care to this population? If so, what challenges were presented? Do you know of any hospital/state policies in place for providing care to undocumented immigrants? Any information would be much appreciated.

We have a lot of undocumented immigrants in our city. The facility where I work is the largest safety net facility in Colorado, and the vast majority of our patients are Medicaid/Medicare and uninsured. For patients who are not US citizens and do not qualify for Medicaid, our facility does offer a very low-cost payment plan (typically, copays are $4-5). And because the facility has numerous public health clinics, that means these people can also receive primary care under the payment plan, not just hospital visits. And for those undocumented patients who are pregnant, they are eligible for "Emergency Medicaid" which covers their prenatal care and hospital visit for delivery.

klone, MSN, RN · Nov 17, 2015

Also *very important* some clinics like Planned Parenthood require a photo ID to be seen, which makes many undocumented people hesitant to go there.

That totally depends on the clinic. If the Planned Parenthood is a recipient of Title X, then they are not allowed, per Title X guidelines, to require ID. Whether a PP is under Title X is dependent upon state, I believe.

coast2coast · Nov 18, 2015

I'm not aware of any healthcare facility that makes any sort of determination of the immigration status of individuals presenting for care. Everyone has been treated the same and no one has asked about immigration status, in my experience.

interestingly enough, this is not actually true. Having worked for multiple FQHCs,I can tell you that determination of eligibility for medi-caid/obamacare takes place on site and is an integral part of the workflow of community clinics. Specifically, you need a social security number to apply/ enroll.

If I see an uninsured patient who needs specialty care, I need to know if that patient will EVER be eligible for insurance - it impacts course of treatment. Patients in DKA, with potential DVTs, or even with plain old chronic abdominal pain - I need to know if you have a (valid) social security number to decide how much I'm willing to try to treat in-house. It's not about denying care, but you have to frank and realistic about what you can offer them. The outcome of this is typically 1 of 2 extremes: cowboy medicine, where you treat patients w serious disease despite incomplete testing/eval, or no treatment at all for chronic but non-life-threatening conditions. So we will try to treat your lupus, even though we aren't rheumatologists and have very few treatment choices, but you are SOL when it comes to chronic back pain, frozen shoulder, or most mental health issues.

OP, both LA county and the state of California have expanded pieces of medi-caid to cover individuals without legal status. LAC as late as spring 2015 was talking about opening up medi-caid enrollment regardless of status. The reality is the county pays for that healthcare whether or not you grant people eligibility to enroll. So eligibility/enrollment is at least a way of trying to count and characterize that shadow population. I would look for resources out of Cali, possibly also Kaiser which coincidentally is trying to take over the medi-cal market.

pm me if you would like to know more about the impact of legal status on individual healthcare ... I have war stories í ½í¸œ

elkpark · Nov 18, 2015

interestingly enough, this is not actually true.

I'm curious about how you decided my statement is "not actually true." I make no claim to have a comprehensive understanding of how every healthcare setting in the US handles immigration status, and stated not once, but twice, that I was referring only to my own personal experience.

The original question was about "providing care," not getting that care paid for later, and the OP did specifically refer to "hospitals." In the acute care inpatient settings in which I've worked, the care has been provided without any questioning or consideration of immigration status. I'm aware that Medicaid coverage is dependent on immigration status, but, in my experience, that is only a consideration after the fact.

I'm sure that things work differently in community-based clinics. I'm sure that things work differently in lots of different settings in which I've never worked. Thank you for sharing a different perspective.

PinayUSA · Nov 18, 2015

We have a lot of undocumented immigrants in our city. For patients who are not US citizens and do not qualify for Medicaid, our facility does offer a very low-cost payment plan (typically, copays are $4-5). And because the facility has numerous public health clinics, that means these people can also receive primary care under the payment plan, not just hospital visits. And for those undocumented patients who are pregnant, they are eligible for "Emergency Medicaid" which covers their prenatal care and hospital visit for delivery.

Wonderful, A hospital who rewards some one for breaking federal laws

Will they also give discounts to bank robbers? This would seem only fair.........

klone, MSN, RN · Nov 18, 2015

Wonderful, A hospital who rewards some one for breaking federal laws
Will they also give discounts to bank robbers? This would seem only fair.........

What a effing ignorant thing to say. I was about to say "Go back to Texas" on a hunch. And then I looked at where you are from. Lo and behold! If you want to debate our immigration policy or the legalities of undocumented immigrants, do it in another thread.

Basic healthcare is not a reward.

Tenebrae, BSN, RN · Nov 19, 2015

What a effing ignorant thing to say. I was about to say "Go back to Texas" on a hunch. And then I looked at where you are from. Lo and behold! If you want to debate our immigration policy or the legalities of undocumented immigrants, do it in another thread.
Basic healthcare is not a reward.

:yes:

coast2coast · Nov 19, 2015

No offense was intended, I was merely trying to counter what I see as a widely-held belief that things like legal status are not a routine part of healthcare delivery.

An acute care example would be someone needing dispo to rehab or skilled nursing. Sure, a patient can come in emergently and by EMTALA be treated, and immigration status I would agree does not impact that emergency treatment, in general. But what do you do with someone who ends up profoundly disabled, but without the income or health insurance to be accepted into some level of rehab? Like any inpatient who overstays their welcome in acute care, the barriers to dispo become a matter of common knowledge and therefore, at times, judgment. It shouldn't impact care but the potential is there.

I apologize if my original comment seemed to negate your personal experiences, on re-reading I can see how it could come off like that. I just want to engage in a discussion on a topic that I am obviously quite passionate about, not looking to cause offense.