DISCLAIMER: RECEIVING GOVERNMENT AID COULD SEVERELY IMPACT YOUR ABILITY TO BECOME A RESIDENT OF THE UNITED STATES. IT IS IMPERATIVE THAT YOU RESEARCH AND DISCUSS WITH AN IMMIGRATION ATTORNEY BEFORE RECEIVING ANY BENEFITS, SUCH AS FOOD STAMPS, MEDICAID, ETC.

The Health Insurance Marketplace 

Federally operated, the Health Insurance Marketplace is a resource for individuals, families, and small businesses to enroll in a health insurance coverage plan that best suits their medical and financial needs. Many federal health insurance plans grant premium tax credits, savings, and differing services. However, eligibility extends only within three statuses: U.S. citizens, U.S. nationals, and present lawful immigrants (1). Undocumented immigrants are not considered eligible to independently apply, thereby making it difficult to secure health coverage. Current restrictions regarding obtaining health care coverage as an undocumented immigrant often lead to being uninsured, limiting access to medical services and affecting the maintenance of one’s overall health.

Limited access to federal health insurance 

For undocumented immigrants, meeting the eligibility and criteria to apply for most federal health insurance plans acts as a barrier. The Health Insurance Marketplace is an open federal service, accessible at HealthCare.gov, that aids individuals in enrolling in affordable and need-basis health insurance plans. 

Plans include Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), the Affordable Care Act (ACA), employer-sponsored insurance, and spouse-dependent insurance, among others. For unauthorized immigrants, independently applying for Medicaid is often restricted by citizen-status regulations. However, Emergency Medicaid can be accessed by anyone eligible for Medicaid as it provides emergency care regardless of immigration status, insurance, ability to pay, or citizenship; it is inclusive to all (2). CHIP also functions to assist uninsured, CHIP also provides assistance to uninsured, low-income children and is especially beneficial because it serves even those whom Medicaid excludes those above the 200% poverty level (3). However, CHIP’s criteria is to have lawfully entered the United States or to be  a lawfully present immigrant, therefore excluding undocumented children (4). As it can be seen, for undocumented immigrant children, eligibility requirements are an obstacle in accessing health services and health insurance plans.  

According to the 2018 American Community Survey conducted by the Kaiser Family Foundations, the uninsured rates among children by immigration status and parent immigration status found a 33% rate of undocumented immigrant families with uninsured children, an 18% uninsured rate of lawfully present immigrant children, an 8% uninsured rate of citizen children with a noncitizen parent, and a 4% uninsured rate of citizen children with U.S. born citizen parents (5). Restrictions and the lack of available health resources for undocumented immigrants exemplify limiting accessibility. 

Health care and coverage resources for undocumented immigrants 

Apart from the number of health insurance plans offered through the federally operated Health Insurance Marketplace, there are a number of available health care and coverage resources for undocumented immigrants elsewhere.  

• Certain places of residence offer state-funded or locally-funded programs providing guidance on available health services for undocumented immigrants (6). 
• Health coverage plans may be procurable through select employers or through a spouse’s employer (7). 
• Primary or preventative care can be accessed at academic health centers or community health centers at a low cost (8). 
• Private health insurance can be purchased through individual markets without the need or proof of citizenship (9). 
• Six states, (CA, IL, MA, NY, OR, and WA) and DC have state-funds to run health care programs for income-eligible children regardless of immigrant-status (10). 
• The Emergency Medical Treatment and Labor Act (EMTALA) mandates that any patient in the emergency department has the right to be medically screened and stabilized regardless of identifiers such as citizenship status (11). 
• The Federal Health Insurance Portability and Accountability Act of 1996 protects the privacy of medical records. For example, one is not obligated to inform federal immigration authorities based on suspicion if the patient is undocumented (12). 
  

Informative Resources

• The Undocumented Patients project is a public database that provides information and resources pertaining to recent federal policy changes and new health-based resources. The project analyzes new policies and provides suggested guidance, tools, and solutions to navigate one’s healthcare as an undocumented immigrant. 
•  The National Immigrant Law Center offers information regarding undocumented patients’ health rights as well as information for health care providers on addressing immigration officials and law enforcement. 
  

Expanding health coverage for undocumented immigrants

According to the Pew Research Center, there were approximately 10.5 million undocumented immigrants in the United States in 2017 (13). Health insurance imitations affect undocumented immigrants’ access to medical care and services. Challenges with accessing health insurance increase the probability of being uninsured. For example, being uninsured or having no medical access makes one less likely to receive recommended screening tests such as blood pressure and cholesterol checks, or make it difficult to access a health professional’s office due to registration restrictions finances, among others (14). Broadening health care availability for undocumented immigrants would improve medical service accessibility, decrease potential health consequences from being uninsured, and allow one to better monitor their own health. 

Works Cited: 

1. Cindy Mann to State Official and Medicaid Director, August 28, 2012, Center for Medicaid and CHIP Services, "Re: Individuals with Deferred Action for Childhood Arrivals," SHO# 12-002, https://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-12-002.pdf.
2. Henry J. Kaiser Family Foundation. Medicaid and SCHIP eligibility for immigrants. Menlo Park (CA): KFF; 2006. Available at: http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7492.pdf. Retrieved September 25, 2014. 
3. Adeyinka A, Rewane A, Pierre L. Children's Health Insurance Program (CHIP) [Updated 2020 Apr 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539903/https://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-12-002.pdf.
4. Cindy Mann to State Official and Medicaid Director, August 28, 2012, Center for Medicaid and CHIP Services, "Re: Individuals with Deferred Action for Childhood Arrivals," SHO# 12-002, https://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-12-002.pdf.
5. https://www.kff.org/disparities-policy/fact-sheet/health-coverage-of-immigrants/ 
6. Kaiser Family Foundation, Health Coverage and Care for Immigrants, (Washington, DC: Kaiser Family Foundation, December 2017), https://www.kff.org/disparities-policy/fact-sheet/health-coverage-of-immigrants.
7. Buchmueller, T. C., Lo Sasso, A. T., Lurie, I., & Dolfin, S. (2007). Immigrants and employer-sponsored health insurance. Health services research, 42(1 Pt 1), 286–310. https://doi.org/10.1111/j.1475-6773.2006.00600.x 
8. Acosta, D. A., & Aguilar-Gaxiola, S. (2014). Academic health centers and care of undocumented immigrants in the United States: servant leaders or uncourageous followers?. Academic medicine : journal of the Association of American Medical Colleges, 89(4), 540–543. https://doi.org/10.1097/ACM.0000000000000182 
9. Onarheim, K. H., Melberg, A., Meier, B. M., & Miljeteig, I. (2018). Towards universal health coverage: including undocumented migrants. BMJ global health, 3(5), e001031. https://doi.org/10.1136/bmjgh-2018-001031 
10. Tricia Brooks, Lauren Roygardner, and Samantha Artiga, Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey, (Washington, DC: Kaiser Family Foundation, January 2019), available athttps://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-renewal-and-cost-sharing-policies-as-ofjanuary-2019-findings-from-a-50-state-survey/. 
11. Zibulewsky J. (2001). The Emergency Medical Treatment and Active Labor Act (EMTALA): what it is and what it means for physicians. Proceedings (Baylor University. Medical Center), 14(4), 339–346. https://doi.org/10.1080/08998280.2001.11927785 
12. National Immigration Law Center, "Is It Safe to Apply for Health Insurance or Seek Health Care?" www.nilc.org/issues/health-care/health-insurance-and-care-rights/ (accessed June 7, 2017). See also, National Immigration Law Center, "Health Care Providers and Immigration Enforcement: Know Your Rights, Know Your Patients' Rights"www.nilc.org/issues/immigration-enforcement/healthcare-provider-and-patients-rights-imm-enf/.
13. Krogstad, Jens Manuel, Jeffrey S. Passel, and D’Vera Cohn. “5 Facts about Illegal Immigration in the U.S.,” May 30, 2020. https://www.pewresearch.org/fact-tank/2019/06/12/5-facts-about-illegal-immigration-in-the-u-s/.
14.  Samuel L Dickman, David Himmelstein, and Steffie Woolhandler, Inequality and the health-care system in the USA (London, England: The Lancet, April 8, 2017), https://doi.org/10.1016/S0140-6736(17)30398-7.