Melissa Frasco
The Coronavirus Pandemic has brought unforeseen changes to each of our lives. However, the pandemic has affected some of us more than others. For the past eighteen months I have been working remotely with the undocumented population in an NYC area devastated by Covid-19. I have had hundreds of phone calls with individuals discussing their needs and how I could connect them to resources. Speaking with clients, health insurance was one of the topics that would come up again and again. For many of us we do not have to think twice about making an appointment with our primary care doctor. For the undocumented clients I have worked with their immigration status has prevented them from seeking appropriate medical care. Some clients I spoke with had not seen a primary care doctor in almost a decade.
Most often clients are afraid of the costs associated with doctors and hospitals. They are also ineligible for most other insurances (often due to lack of identification or Social Security Number). The program I worked with was specifically designed for people who did not have any type of health insurance. At most clients would have Emergency Medicaid, which does not function as traditional insurance, but could be used only in emergencies (such as a car accident). Otherwise, for primary care needs we worked to give clients instructions on how to enroll in NYC Care. Although I have a few critiques of this program, it is perhaps one of the most accessible health plans in New York City. NYC Care is a low cost and no cost health care access program open to all New York City residents who cannot afford or qualify for traditional health insurance. The requirements to be eligible for NYC Care are simple, one must have lived in the city for at least six months, have a photo ID (people may use a photo ID from their country of origin), a letter describing their financial situation, and proof of address. You may have noticed that I have not referred to NYC Care as an insurance plan, that is because it is considered a health access plan. This program provides access to primary care, some specialty care, and low-cost prescriptions. NYC Care does not function outside of NYC Health + Hospitals, limiting participants to often underfunded and overwhelmed locations.
As I mentioned before, I do appreciate this program and I know many people who have benefitted from NYC Care. However, I have also seen some glaring gaps in coverage, one of the most obvious being lack of dental coverage. Dental services such as a cleaning or a filling may be easy to come by, as some hospitals do provide low-cost dental services. Although not all hospitals have this service, and if someone with NYC Care were to need a more invasive procedure they could be turned away from many low-cost dental services in hospitals. This is because NYC Care is not billable as an insurance agency would be. I have worked to find for clients where they could get a root canal. What I have been told by hospital employees is that they could not take anyone who needed a type oral surgery (such as a root canal). As this would result in clients without insurance being stuck with the bill. Although someone may have an dental emergency need Emergency Medicaid would most likely not be able to cover it for those without any other insurance. What would end up being the most helpful for clients with dental needs would be to refer them to low-cost dental services providers. There they would have the option to be enrolled in a pay-scale based on income so that they could only be billed for what they could afford.
It was not often I could tell clients about free medical services, but thankfully the Covid-19 vaccines and testing were free resources I could share with them. Many of them at first would ask if the test and vaccines were actually free, and I would explain again that they were. For those who are undocumented there is more to consider than just vaccine hesitancy and questions. For many vulnerable clients there was fear of hospital visits, most often for financial worries, but some clients I had to convince that if they went to the hospital they would not be reported to ICE (Immigration and Customs Enforcement). As citizenship status is protected under HIPAA (Health Insurance Portability and Accountability Act) and NYC public hospitals must be HIPAA compliant I was able to ensure clients that their citizenship status would not be shared with anyone else. For a majority of clients they had this notion that they did not have any rights or access to vital resources, such as medical care. This was a common misconception among older established immigrants and more recent arrivals. By default, a large amount of my work was informing people of their right to medical care, translation services.
This blog has only begun to scratch the surface in discussing access to healthcare for undocumented immigrants. The healthcare situation changes and become more complex for mixed status families and those who are pregnant. This is by now means an exhaustive account, but these are some of the most common issues I came across working with the undocumented Spanish speaking population. Below I have left more information regarding NYC Care and their information for immigrants, and an article complied by the National Immigrant Law Center on questions people may have on the vaccine and their immigration status.
NYC Care: Seek Care Without Fear
https://www.nychealthandhospitals.org/immigrant/
Answers to Common Questions about Immigrants’ Access to the COVID-19 Vaccines https://www.nilc.org/2021/04/12/immigrant-access-to-the-covid-19-vaccines/