Immigrants Face Confusion over Eligibility, Other Barriers to Medicaid Access
To obtain "adequate health care," immigrants need to know how to access care and communicate with providers to "understand their diagnosis and treatment," a study by Global Strategy Group reports. Prepared for the Kaiser Commission on Medicaid and the Uninsured, the study convened a series of 10 focus groups of immigrants in four cities -- Miami, New York City, Los Angeles/Orange County and San Antonio - - to ascertain their knowledge and perception of public programs, including Medicaid, CHIP, TANF and Food Stamps. The resulting report, titled "Immigrants' Access to Health Care After Welfare Reform: Findings from Focus Groups in Four Cities," found that immigrant populations face issues similar to other low-income families, but had additional barriers to access related to "language, culture, and recent immigration policy."
Misunderstandings
Many immigrants were unaware of or held "serious
misunderstandings" about how recent policy changes, including
welfare reform (the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996), impacted their ability to access and
keep Medicaid coverage, and some were fearful that seeking
benefits could affect their immigration status. Under welfare
reform, new legal immigrants are treated differently from
"existing" immigrants and citizens in determining eligibility for
public benefits, and many focus group participants expressed
frustration that "despite working and paying taxes, they were
often unable to obtain...Medicaid coverage." Many also thought
citizens and some immigrant groups received "preferential
treatment" in obtaining public or private coverage. In addition,
Medicaid's "difficul[t] and length[y]" enrollment process was
"often the biggest concern" voiced by focus group participants.
Nevertheless, many believed "Medicaid was a good program." Other
participants said they were not offered health insurance by
employers even though their families included a full-time worker,
but could not afford private coverage. Finally, the report noted
that the American health system is very different from those in
many immigrants' native countries, and that several participants
did not understand health insurance, "especially ... the concept
of cost sharing."
Access Issues
While many immigrants said they recognize the "importance of
check-ups," they often forgo or postpone care because of costs.
While citing "inadequate payment" from Medicaid or other
government programs, immigrants also said long waits,
transportation and work commitments were barriers to access. One
Cuban immigrant in Miami said, "I would have to leave work so I
could take the kids, and I don't make money to do that. I only
get three sick days a year." Language and cultural differences
often kept immigrants from seeking care as well. Therefore, many
immigrants rely on "home remedies" or delay care until they visit
their native country. Those who do access the health care system
tend to seek care from clinics and private doctors, as they
consider hospitals "notorious for long waiting periods [and] high
costs." But immigrants with longer tenure in the United States
found the system "easier" as they have "more experience" than
newer immigrants. The United States is a "very different world"
for many immigrants, the report said, and confusion over
eligibility policies, language difficulties, discrimination and
administrative hurdles all contribute to "immigrants faring
poorly in regard to health care" access. "As policymakers
discuss the nation's growing number of uninsured and issues of
access and quality, the plight of the noncitizen U.S. population
will need to be addressed," the report concludes (Feld/Power,
Immigrants' Access to Health Care After Welfare Reform:
Findings from Focus Groups in Four Cities, Nov. 2000).
The report is available on the Kaiser Family Foundation Web site
at
http://www.kff.org/content/2000/1608/.