Immigrants Face 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."

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."

Many immigrants said they recognize the "importance of check-ups," but 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/.