When 85-year-old retired farmworker and grandmother Amparo Mejia needed surgery on her spine because of a rare form of tuberculosis, she was able to pay for the procedure through emergency Medicaid. She was lucky. For many low-income immigrants – even those authorized to work in the US – it can be challenging or outright impossible to get health insurance.
The uninsured rate in the US has dropped to 11.4 percent since the Affordable Care Act went into effect. As recently as 2013, that number was 19 percent. But low-income immigrants, especially the undocumented, have been left out of that trend.
“In this country, the federally created health programs are built, a lot of them, on categorizing and excluding certain groups of immigrants,” says Matthew Lopas, a health policy attorney with the National Immigration Law Center.
Even under the Affordable Care Act, the roughly 11 million undocumented immigrants in the US remain ineligible for Medicaid, ineligible for health care tax subsidies and are not allowed to purchase insurance through the new exchanges, even at full cost.
Green card holders may qualify for Medicaid, but only under certain conditions. With few other options, many low-income immigrants rely instead on free or subsidized care.
A last resort
In southeast Missouri, where Mejia lives and where she worked picking watermelons for years, many migrant farmworkers go to the Otto Bean Health Center in the town of Kennett. Otto Bean is a federally qualified health center. It receives federal funding to provide primary care to patients regardless of their ability to pay or their immigration status.
According to preliminary data, a full 70 percent of the clinic’s mostly Hispanic or Latino migrant worker patient population was uninsured. On the national level, at the 169 organizations like Otto Bean that receive federal grants for migrant health, about 45 percent of migrant patients are uninsured.
2013 Insurance Rates at Migrant Health Centers by State
Note: Numbers only reflect data from the 169 organizations that received Migrant Health Center Program funding from HRSA in 2013.
Erica Rios, a navigator at Otto Bean, helps patients enroll in health coverage if they are eligible. Many of them are not.
“I tell them the requirements of what they need to apply, and a social [security number] is one of them,” says Rios, herself the daughter of an immigrant. “If they tell me they don’t have one, then it’s like, ‘Well I’m sorry. I can’t help you. I wish I could.’”
Hold Ups even for the Documented
The situation isn’t easy for green card holders either. Those who can afford to may purchase private insurance. But for those who can’t, there is a five-year waiting period to be eligible for Medicaid.
Thirty-four states have waived that wait for pregnant women and children, and 10 states fund their own health coverage for immigrants who fall in that waiting period, but Missouri is not one of them.
The state has also declined to expand Medicaid. And its eligibility requirements are among the most restrictive in the country – only parents of dependent children living at 22 percent of the federal poverty level are eligible. So even when the five-year waiting period is up, for most low-income immigrants, Medicaid is not an option.
That means patients must turn to clinics like the Otto Bean Medical Center. The only other choice is to go to the emergency room which cannot turn people away.
There, some patients qualify for emergency Medicaid. The federal government spends about $2 billion a year on this little known program to compensate hospitals when sudden treatment is needed for a patient without insurance. The bulk of those patients are immigrants.
Matthew Lopas says not allowing people the option of getting insured is creating a strain on local health care systems and the patients they serve.
“It can create an issue where the hospital is absorbing a lot of uncompensated care, which can be extremely expensive,” Lopas says. “Also it’s not providing particularly great care for the people that are involved. So it’s really a system that isn’t benefiting anybody.”