Know Your Rights: Encouraging Undocumented Immigrants to Seek Health Care
California’s medical providers are accustomed to separating the fear of deportation from the implications of unmet health care needs. They serve 25 percent of the nation’s undocumented population, where growing fears of separation among families impact decisions to sign up for health care services.
Social Barriers to Medical Care
Undocumented residents experience myriad challenges when pursuing health care — e.g., English language proficiency, digital literacy, family income level and culturally relevant care — but throughout each of these roadblocks permeates a sense of concern about new executive orders targeting immigration services and undocumented residents.
“These [patients] are going through the worst time of their lives, and they are afraid of being deported on top of all that,” said Dr. Ilan Shapiro, medical director of health education and wellness at AltaMed, which provides care for low-income patients in Los Angeles County. He cited the necessity for multispecialty care to accommodate the complexity of medical needs and social determinants. “Some patients have uncomfortable conditions, like diabetes, or are pushing through a language barrier to understand the resources readily available to them,” he said.
Dr. Michelle Zappas, a professor with the USC Suzanne Dworak-Peck School of Social Work, Department of Nursing, has previously worked in the Saban Community Clinic in Los Angeles County, one of many programs in the area dedicated to serving patients regardless of their citizenship status.
According to Zappas, patients are often afraid to seek medical services because they don’t want their personal information known. It’s particularly difficult to navigate outpatient care when providers don’t have a way to check in after a visit. Some patients are “scared to come in for a follow-up visit, or apply for insurance. You just have to hope that they come back,” she said, adding that providers educate patients as much as they can during a visit.
Patients without coverage are less likely to pursue the care they need before or during the early stages of sickness or injury. This can result in expensive visits to the emergency room that could have been avoided with the preventive care offered at a routine checkup, according to Sandra Rossato, executive director at Clínica Romero in Los Angeles.
“Without managed care and health education, our patients’ lives are at risk and hospital emergency costs passed onto taxpayers are probable,” she said.
Advocating for Patients’ Rights
Across the country, reports of Medicare and Women, Infants, and Children (WIC) enrollments have shown steep decline among families with mixed immigration statuses — for example, families where undocumented parents are raising children who are U.S. citizens. California, however, has implemented a state-level program called Medi-Cal that allows the children of undocumented parents to receive health services without fear of retribution.
Imelda Plascencia, who serves as the health policy outreach manager at the Latino Coalition for a Healthy California (LCHC), said providers work hard to inform community members about the rights granted to patients whose children are eligible for Medi-Cal.
Though there haven’t been specific reports about Medi-Cal enrollment numbers, Plascencia said recent crackdowns by Immigration and Customs Enforcement (ICE) have resulted in heightened fear and worry among undocumented patients. “Unfortunately, health can be perceived as a privilege rather than a right, so having community members seek services is also a challenge,” she said.
Organizations like LCHC offer “Know Your Rights” literature to undocumented patients to share with others in their communities. According to Plascencia, they also conduct workshops to address the need for accurate information about rights to health services.
Stepping Up to the Plate
For many reasons, health insurance information for undocumented residents is difficult to find — a lack of translation services, internet access, transportation and literacy can all obstruct access. According to Zappas, the burden of educating undocumented patients about access to care falls equally on community organizations and local health care providers. Nurse practitioners and other providers need to know what resources are available in their communities so they can direct eligible patients to them.
“As a provider, if something extra needs to be done for the patient, bring on a social worker to talk to them,” Shapiro said from his Altamed office. “Patients are taking time out of their jobs to be there.” He highlighted the importance of opening a dialogue to establish trust between patients and providers. “You cannot force patients to open up to you,” he said. “Ask about their lives naturally, let them open up. Give them the respect they need.”
According to Rossato at Clínica Romero, establishing trust includes addressing fears about access to care. “We pride ourselves in approaching our patients both from a medical standpoint and with a culturally sensitive awareness,” she said.
Enrolling Despite Fear
While social determinants such as income and access to preventive care are currently viewed as a source of complication, Shapiro is hopeful that public health initiatives will direct investment to address social factors that will improve accessibility over time.
“Ultimately, quality of care will be a great equalizer. I also envision technology making a big difference in communities,” he said. “Telemedicine with multilingual providers will be more prevalent because it is cheaper. Mobile health centers will be stationed in areas of poor immigrant populations and feature a pop-up clinic.”
In the meantime, providers across many specialties are encouraging undocumented residents to enroll in health care programs despite their fear of deportation. “Look for safety nets,” Shapiro said, referring to providers who specifically deliver care to vulnerable or undocumented populations. “Those include health community centers that bring help to underserved areas. They can help with all kinds of things, even access to quality food.”
To ease any fears, enrollment information is protected by state and federal laws and cannot be used outside of determining eligibility for applicants. Also, county and state programs are not considered a public charge, and therefore do not impact patients’ ability to adjust immigration status in the future.
“Don’t risk your health,” said Plascencia. “Enroll, use the services available, know your rights and stay informed.”