NYC Care: How Healthcare Nonprofits Can Help Undocumented Immigrants

In his State of the City address, Mayor de Blasio unveiled his goal of expanding access to healthcare for approximately 600,000 uninsured New Yorkers. NYC Care will expand the healthcare options of those who cannot or do not currently have access to health insurance. The implementation of NYC Care would provide low-cost services to its beneficiaries at one of over 70 NYC Health + Hospitals locations. Giving greater access to care to the uninsured benefits all of us. Preventive care is not only more cost-effective than dealing with the long-term consequences of chronic diseases and conditions, it contributes greater public health overall.

Of those 600,000 uninsured New Yorkers who stand to benefit from this program, about half are undocumented immigrants. Their immigration status bars them from accessing federal health insurance programs such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the subsidies available under the Affordable Care Act. In New York, undocumented pregnant women and undocumented children under 19 years of age are eligible for participation in select state-funded health insurance programs. With few options available, those who seek regular access to care must either pay for services out-of-pocket or purchase prohibitively expensive private insurance.

Due to the limited insurance options available to this group, undocumented immigrants are among the most likely to be uninsured. 2013 estimates placed 63.9% of the City’s 540,000 undocumented immigrants as uninsured. When undocumented immigrants do access health care, it is primarily through one of two ways:

1. Hospital Emergency Rooms: Federal law requires that all hospitals receiving federal funding care for patients in need of emergency care, regardless of immigration status or ability to pay. Because of this guarantee, many undocumented immigrants who are uninsured and cannot afford private insurance utilize emergency rooms as their primary source of care.
2. Safety-net clinics: Safety-net institutions include public hospitals and clinics and nonprofit hospitals with emergency rooms. These institutions provide healthcare services to those, documented and undocumented, who lack health care insurance and overall care. Safety net clinics are frequently utilized by undocumented immigrants, as these providers do not check immigration status or one’s ability to pay. Uninsured patients are charged on a sliding scale determined by their ability to pay. While these clinics are vital to basic health care access for undocumented immigrants, the demand for services greatly exceeds their capacity and resources.

Everyone stands to benefit from immigrant patients’ full participation in the healthcare system. It is detrimental to public health as a whole if immigrants do not disclose important aspects of their health, or do not access necessary health services for fear of deportation.

Nonprofits, particularly those who work in the healthcare and immigration sectors, will play a significant role in the implementation and use of the NYC Care program. While the City is implementing several resources to inform the public about NYC Care, such as customer service and marketing, nonprofits will be crucial in seeing that undocumented immigrants access NYC Care’s services.  Below are some key ways to accomplish that goal:

1. Educate healthcare staff on protocol for engaging with immigration officials

Immigrations and Customs Enforcement (ICE) classifies healthcare centers as “sensitive locations,” meaning that agents are instructed to avoid detaining undocumented immigrants at these locations unless there are special circumstances for doing so. However, arrests of undocumented immigrants at these locations have been documented under the Trump administration. The fear of deportation has led many undocumented immigrants to avoid healthcare services altogether. Educating staff on what information they are allowed to withhold from immigration officials will allow them to focus on providing healthcare services, and assure immigrants that they can confide in staff and continue to safely access healthcare services.

2. Inform undocumented patients of their healthcare options

Undocumented immigrants may be under the impression that they are not eligible for certain insurance plans, or may not know about low-cost options at safety net clinics. Providers should consider holding a workshop or some other campaign after NYC Care is implemented to inform undocumented immigrants of their new healthcare options.

3. Become acquainted with changes in immigration policy, and how they affect immigrant patients

For vulnerable populations such as undocumented immigrants, health care and social services must be linked in order for this group to live healthy lives. The stressors of immigration policy can be detrimental to the health of immigrant patients, particularly their mental health. One way healthcare professionals can be attentive to this is by connecting immigrant patients to other social services that can positively impact their health. Northwell Health, a premiere healthcare organization, provides medical professionals with additional advice on improving healthcare for immigrants.

4. Make hospitals and healthcare centers more welcoming environments for immigrants

If immigrants don’t feel welcomed by hospitals and healthcare centers, they may be less willing to access them, even after NYC Care becomes available or their health condition requires it. Several key components of a welcoming environment include options for translation services, increasing diversity among medical professionals, and providing culturally competent medical care.

To learn more about Capalino’s Nonprofit Advisory services, contact Jeanne Mullgrav at jeanne@nullcapalino.com.

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