How your immigration status affects healthcare and COVID-19 treatment in the United States

When you live in a new country, there are many new things that you may have to come accustomed to, from dealing with culture shock, experiencing new foods, and understanding how to navigate your new surroundings. On top of it all, it’s important to understand what resources are available when it comes to keeping you and your family healthy in your new country, especially during a public health crisis like COVID-19. 

COVID-19 has become a large part of our daily lives, and now more than ever, it’s important to know where you can go to access routine and emergency medical care regardless of your immigration status. Immigrant and minority communities continue to be one of the largest groups of people in the United States to suffer from the effects of COVID-19. 

Non-citizens are more likely to avoid seeking medical care because of the cost, fear of their immigration status being revealed, and a lack of knowledge regarding available resources. This underutilization puts their health at risk, and in regards to infectious diseases, it could potentially put the general public at risk. 

It’s important to understand that healthcare providers cannot ask patients about immigration status and have no legal obligation to report to federal immigration authorities. If you are a non-citizen, there are options available to you and your family to receive the medical care you need. Understanding all of your options can help to determine your next steps. 

Barriers to healthcare for immigrants

In the United States, Health insurance can make a real difference in when, where, and how a person receives health care. Due to a large uninsurance rate, non-citizens are much less likely than citizens to access routine care or have any recent contact with a health professional. 

Non-citizens also have more insufficient access to quality medical care and face language and cultural differences. Undocumented immigrants are also less likely to seek medical care because they tend to be younger and less likely to report health problems than U.S.-born citizens. Other factors that play a part in the reluctance to seek health care include:

  • Inability to pay for health services without insurance.
  • Lack of transportation.
  • Complex and overwhelming paperwork to gain access to healthcare.
  • Fear of being reported to authorities.
  • Cultural differences make it challenging to translate symptoms accurately.
  • Little knowledge about how healthcare systems works or their rights to access.
  • A lack of stability that forces an individual relocate, often resulting in inconsistent care.

Non-citizens and undocumented residents provide a much-needed workforce for many sectors of the U.S. economy. Yet, many lack access to proper healthcare or the misconception that they are not allowed to for fear of deportation. 

Health insurance in the United States

To understand how to access medical care in the United States, it’s essential to have a basic understanding of health insurance. According to Wikipedia, “Health insurance in the United States is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include “health coverage,” “health care coverage,” and “health benefits.” In a more technical sense, the term “health insurance” is used to describe any form of insurance providing protection against the costs of medical services.” You may receive health care coverage through your employer as part of an employee benefits package, or you can purchase a health care insurance plan on your own. 

To receive medical care, you are not required to have health insurance. However, without health insurance, the financial cost of medical care can sometimes be much higher. Different health insurance plans provide different levels of financial protection and may vary in what medical procedures are covered.

In 2010, the Affordable Care Act (ACA) was created to extend health coverage to those without it by expanding government-funded medical coverage like Medicaid, offering financial incentives to employers, and requiring those without coverage to purchase insurance. Currently, coverage under the Affordable Care Act is only extended to U.S. citizens or some lawfully present residents. 

Healthcare access for undocumented residents

Undocumented residents and DACA recipients are not eligible to receive federally funded benefits, including Medicare, non-emergency Medicaid, or subsidized health care coverage under ACA. However, other options are still available including, community health centers, migrant health centers, and free clinics. These facilities offer services to immigrants and their families, regardless of immigration status, at a reduced cost or free of charge. 

In our article, “10 common myths about living in the United States,” we briefly touched on the myth that immigrants cannot receive medical care without health insurance. Regardless of your immigration status, the Emergency Medical Treatment and Labor Act requires Medicare-participating hospitals with emergency departments to provide care for patients regardless of their ability to pay, insurance status, national origin, race, creed, or color. 

Undocumented residents may also purchase private healthcare coverage or an off-exchange healthcare plan outside of the ACA Marketplace or receive coverage through their employer or as a spouse or dependent of an employee. Eligible undocumented immigrants may also be covered through student health programs. 

Some states offer additional medical programs to undocumented residents. California allows undocumented immigrants access to state-run health insurance programs for full price through Covered California. Massachusetts provides healthcare coverage to all immigrants, regardless of status, if eligible for the state’s Health Safety Net program. Illinois recently became the first state to provide public health insurance to all low-income non-citizen seniors 65 and older, even if they’re in the country illegally.

Affordable Care Act coverage eligibility for immigrants

If you are a lawfully present immigrant, you are eligible for health insurance coverage under the Affordable Care Act (ACA). The Act, also referred to as “Obamacare,” is a comprehensive health care reform law and its amendments. The law addresses health insurance coverage, health care costs, and preventive care. As part of this coverage, qualified individuals can purchase healthcare coverage outside employer-provided insurance through the Health Insurance Marketplace

Eligibility for coverage found through the Health Insurance Marketplace includes:

  • “Qualified non-citizen” immigration status without a waiting period. 
  • Humanitarian statuses or circumstances (including Temporary Protected Status, Special Juvenile Status, asylum applicants, Convention Against Torture, victims of trafficking).
  • Valid non-immigrant visas.
  • Legal status conferred by other laws (temporary resident status, LIFE Act, Family Unity individuals). See a complete list of immigration statuses eligible for Marketplace coverage.

Lawfully present immigrants may also be eligible for lower costs based on annual income:

  • If your yearly income is between 100% and 400% of the federal poverty level (FPL): You may qualify for premium tax credits and other savings on Marketplace insurance.
  • If your annual household income is above 400% FPL: You may still be eligible for premium tax credits that lower your monthly cost for a 2021 Marketplace health insurance plan.
  • If your annual household income is below 100% FPL: If you’re not otherwise eligible for Medicaid, you’ll qualify for premium tax credits and other savings on Marketplace insurance if you meet all other eligibility requirements.

Medicaid access for immigrants

According to Wikipedia, “Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The main difference between the two programs is that Medicaid covers healthcare costs for people with low incomes while Medicare provides health coverage for the elderly.”

Non-citizens may enroll in Medicaid if they are a:

  • Lawful permanent resident (or green card holder).
  • Paroled into the U.S. for at least one year.
  • Granted conditional entry into the U.S. before 1980.
  • Asylee.
  • Refugee.
  • Cuban/Haitian entrant.
  • Victim of trafficking, including spouses, children, siblings, or parents.
  • Battered non-citizen, including spouses, children, or parents, or
  • Veteran and active member of the military, including spouses and children.

Non-citizens must wait five years after receiving “qualified” immigration status before they can enroll in Medicaid. However, refugees, asylees, Cuban/Haitian entrants, victims of sex trafficking or battery, veterans and active military members, or legal permanent residents who were once refugees or asylees are exempt from the 5-year waiting period. Qualified immigrants must also meet their state’s eligibility requirements for income and household size

Medicaid coverage may vary from state to state, but all coverage includes:

  1. Inpatient and outpatient services;
  2. Family planning services and supplies;
  3. Pediatric services (screening, diagnosis, and treatment) for children under 21;
  4. Laboratory and X-ray services;
  5. Short-term skilled healthcare services (includes inpatient short-term skilled nursing or rehabilitation facility care, as well as short-term home health care provided by a home healthcare agency);
  6. Physician, midwife, and nurse practitioner visits and services; and
  7. Rural health clinic and federally qualified health center services.
  8. Prescription drugs aren’t required to be covered, though many states do cover them under Medicaid. 

Public charge and healthcare access

Immigrants applying for visas or entry into the United States are subjected to a public charge rule. This rule denied visas or permission to enter the country for those “unable to take care of himself or herself without becoming a public charge.” First established by Congress in 1882, this rule denied U.S. visas to anyone likely at any time to become a public charge but did not provide clarity to what a “public charge” means. 

During the Trump administration, “public charge” was interpreted broadly to reduce the number of people eligible for green cards and other visas. Under a ruling in 2019, legal immigrants who received public benefits such as Supplemental Nutrition Assistance Program (SNAP), Medicaid, and public housing assistance for more than twelve months within any 36 month period could be classified as a “public charge” and were deemed ineligible for permanent residency. 

USCIS is no longer applying the 2019 Public Charge Final Rule. Following an executive order from President Biden in February 2021, the Department of Human Services and the Department of Justice ruled that receiving public benefits such as Medicaid will no longer be a “heavily weighted negative factor” in determining whether or not a visa applicant is likely to become a public charge. 

COVID-19 treatment for immigrants

It’s important to note that COVID-19 testing, treatment, and vaccination is eligible to all United States residents, regardless of immigration status, and has been explicitly excluded from the public charge rule.

The Department of Homeland Security and the federal government support equal access to COVID-19 treatment for all individuals residing in the United States as a matter of public health. Any medical data gathered by those tested, treated, or receive the COVID-19 vaccine will not be used in any immigration proceedings. 

In addition, COVID-19 treatment providers cannot:

  • Charge for the vaccine or tests.
  • Charge for any administration fees, copays, or coinsurance.
  • Deny vaccination or testing to anyone who does not have health insurance.
  • Charge for an office visit or any other cost if the only service provided was a COVID-19 test or vaccination.

If you or your family is new to the United States and needs medical care, do not hesitate to obtain the necessary resources to ensure your family’s health and wellbeing. While health care insurance access may vary based on your immigration status, remember, there are still options available for routine or emergency medical care. 


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