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. Sign up today.
Best Healthcare Options for Undocumented Immigrants
High rates of uninsured individuals present a huge barrier to healthcare services for undocumented immigrants. Individuals with Deferred Action for Childhood Arrivals (DACA) status are barred from enrolling in Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act (ACA) Marketplace plans.
When sick, people without insurance tend to rely on the emergency room or forgo care altogether. This forces people to trade off a large medical bill or sickness that disproportionately affects undocumented immigrants. We detail alternative options below.
Community Health Centers
Federally funded health centers, known as safety net providers, must treat anyone regardless of citizenship status. In fact, these health centers do not ask for citizenship documentation from anyone. Community and rural health centers charge for services on a sliding scale to accommodate for income levels.
As of 2020, over 500,000 undocumented immigrants were living in New York City, so a program with NYC Health + Hospitals was established to provide low-cost health services to New York regardless of immigration status. While community centers provide necessary care, these services are usually limited to preventive and primary care services. Very few centers offer specialty services leading to unmet care needs. The Health Resources and Services Administration website can help you find a community health center near you.
Private Health Insurance
Although the cost of premiums and deductibles of private health insurance plans can be very high, undocumented immigrants can purchase unsubsidized insurance plans from private companies. Although, these plans are often unaffordable without health insurance subsidies. Student health programs do cover undocumented immigrants.
Coverage Through a Spouse or Partner
Undocumented immigrants can sometimes obtain health coverage through their partner's plan. Depending on the type of plan, an employer who is offered employer-sponsored health insurance can add coverage for their spouse or dependents, even if they are undocumented. Have your spouse check their health insurance policy to see if this is an option for you.
The Centers for Medicare and Medicaid Services set rules that prevent adult undocumented immigrants from enrolling in Medicaid. There are six states, plus D.C., that cover income-eligible children regardless of immigration status. These include:
- New York
- Washington D.C.
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Low-income undocumented immigrants between the ages of 19 and 25 can now enroll in Medicaid in California. Soon the program will be expanded to immigrants over 50 years old as well. California is the first state to enact this change to help more people get access to healthcare coverage. Undocumented immigrants are entitled to emergency services, pregnancy-related care, and state-funded long-term care.
Health Insurance Alternatives
Another option for undocumented immigrants to get access to affordable healthcare services is Mira. For $45 per month, Mira partners with providers to offer low-copay urgent care visits, gym memberships, and up to 80% off prescription drug prices. To register, you only need to enter your full name, birthday, and gender to begin accessing services. Health insurance alternatives do not provide coverage based on immigration status and will never ask for documentation papers. These memberships do not have eligibility requirements that precede you accessing care.
Emergency Medical Treatment & Labor Act (EMTALA)
The Emergency Medical Treatment & Labor Act (EMTALA) provides access to emergency care services to all people, regardless of documentation status. This means that Medicaid-participating hospitals must see a patient whether they can pay for the service or not. EMTALA also requires treatment for emergency medical conditions (EMC) or transfer when appropriate.
Many people who are uninsured resort to the emergency room for care. The problem is that there are consequences downstream, like catastrophic medical bills and health resource wasting. If we can prevent people from relying on the emergency care system, we can save money and time for both the patient and the hospital system.
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 “children 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 families”.
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.
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 “be a U.S. citizen or be lawfully present in the United States.”
“Lawfully present” 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 “non-citizens” include:
- Lawful Permanent Residents (LPR/Green Card Holder)
- Cuban/Haitian entrants
- 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
- Granted withholding of deportation
- Member of a federally recognized Indian tribe or American Indian born in Canada
Additionally, some special cases determine eligibility:
- Mixed status families (made up of individuals with different citizenship or immigration statuses): 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 (COFA) migrants: Eligible for Marketplace plans, not eligible for Medicaid or CHIP
- Deferred Action of Childhood Arrivals (DACA) eligible individuals: Not eligible for Marketplace, Medicaid, or CHIP
- Undocumented immigrants: individuals Not eligible for Marketplace, Medicaid, or CHIP
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Healthcare Alternatives for Undocumented Immigrants Frequently Asked Questions (FAQs)
Health insurance makes a difference in health status, but health insurance eligibility requirements bar undocumented immigrants from enrolling. Below we expand on a few commonly asked questions about healthcare options for undocumented immigrants.
Why do undocumented immigrants have high rates of uninsurance?
Undocumented immigrants are ineligible for Medicaid or Medicare and cannot buy insurance through the Affordable Care Act marketplace. The ACA specifically excludes undocumented residents of the United States. This leaves undocumented persons few health insurance options other than private plans, which can be extremely expensive. Additionally, undocumented immigrants tend to work in industries that do not provide employer-sponsored health insurance.
Are undocumented immigrants eligible for ACA coverage?
No. As part of the enrollment process, enrollees must verify lawfully present status to obtain coverage on the Marketplace. DACA individuals are not eligible to enroll in health insurance on the Marketplace either. Each state has a guide to health insurance eligibility requirements.
What are the consequences of not having health coverage?
Being uninsured discourages people from seeking the care they need. Many people forgo preventative care services when uninsured, which leads to potential health complications down the line. If preventable conditions go undetected or chronic conditions go untreated, people are far more likely to have a shortened life span creating a health disparity between those who have access to insurance and those who do not.
Health insurance coverage also helps to pay for medical bills that exceed your deductible. This includes check-ups, hospital visits, treatment, diagnoses, shots, prescription drugs, and more. Your health insurance company negotiates better prices on your behalf.
Without health insurance, managing chronic conditions can be difficult, and routine screenings are often foregone. Undocumented immigrants have less access to health insurance which leads to poorer health outcomes.
To prevent this disparity, care membership plans like Mira can help close the gap by providing affordable access to necessary health services for a low monthly fee. Health insurance is not always an option, but Mira is.
Alexis Bryan MPH, is a recent graduate of Columbia’s Mailman School of Public Health. She is passionate about increasing access to care to improve health outcomes. Outside of work, she loves to travel, read, and pay too much attention to her plants.