Supporting Access the Health Care in Immigrant Communities Allison Neswood Colorado Center on Law and Policy 789 Sherman St., Suite 300, Denver, CO 80203 303-573-5669 x304, aneswood@cclponline.org 1

Concern: Increasing Detentions and Deportations The president has committed to deporting 2 million undocumented immigrants in an unspecified amount of time Trump says he will focus on deporting undocumented people with criminal records The president has already expanded the definition of ‘criminal’ and may expand it further to include anyone that is in the U.S. unlawfully Bystanders are getting caught up in the immigration enforcement process when officials are searching for immigrants with criminal records Copyright Julie Reiskin, CCDC

Health implications When immigrants fear deportation for themselves or a member of their household, they are more likely to – Miss medical appointments Avoid public services and clinics Forgo healthy food Avoid outdoor exercise Fear of immigration enforcement negatively impacts child mental and physical health Stress/Trauma Low birth weight

How Health Coverage Guides and Medical Providers Can Help Communicate the importance of having health insurance and obtaining needed care State publicly that immigrants are welcome at your organization or facility Know what rights immigrants and their families have to coverage, care and privacy Communicate your entity’s commitment to respecting the rights of immigrants and their families Copyright Julie Reiskin, CCDC

Immigrant eligibility for health coverage affordability programs Immigrants in the following statuses may qualify for “coverage affordability programs,” including Medicaid, CHP+, or health insurance through Connect for Health Colorado – Lawful permanent resident (LPR) status (“green card” holder) Refugee status Asylum status Immigrants for whom deportation is being withheld; and Certain Cuban, Haitian and Ameriasian immigrants The eligibility criteria for reduced priced health insurance from Connect for Health Colorado also include other lawfully present immigrants. Under a federal provision known as the “five-year bar,” LPRs are not eligible for Medicaid until five years after they enter the United States pregnant women and children are exempt from this limitation. LPRs who were granted refugee status, asylum status or other status outlined in 8 U.S.C. § 1613(b) are not subject to the five-year bar. LPRs that are not eligible for Medicaid due to the five-year bar may qualify for reduced-cost health insurance through Connect for Health Colorado LPRs that are not eligible for Medicaid or CHP+ may also qualify for reduced-cost care through the Colorado Indigent Care Program (CICP). For a list of entities that participate in (CICP), go to: https://www.colorado.gov/pacific/sites/default/files/2016%20June%20Provider%20Directory.pdf. Copyright Julie Reiskin, CCDC

Access to care for immigrants that do not qualify for coverage affordability programs Immigrants that do not qualify for coverage affordability programs including individuals with Deferred Action for Childhood Arrivals (DACA) status or that cannot demonstrate lawful presence have access to – Community health centers, migrant health centers and free clinics Find community health centers here: http://cchn.org/map/ Find free clinics here: http://www.nafcclinics.org/find-clinic Denver Health Hospital charity care programs Colorado’s Hospital Financial Assistance program under C.R.S., § 25-3-112. Emergency room care Public health services (immunizations, mental health, screening and treatment for communicable diseases) Emergency Medicaid for those that meet the income requirements Private insurance sold outside of Connect for Health Colorado if it’s affordable

Immigrant Rights When Seeking Coverage Eligibility for coverage affordability programs is not affected by the immigration status of other members of the applicant’s household; only the applicant’s status matters Applications for coverage should not ask for the immigration status of household members that are not applying for coverage Only individuals that have Social Security Numbers (SSNs) can be required to provide one Strong privacy rules protect families applying for coverage affordability programs – under federal law, information provided for the purposes of applying for a coverage affordability program can only be used for the purposes of determining the applicant’s eligibility; it cannot be used for immigration enforcement purposes Everyone, regardless of immigration status has the right to an interpretation services, at no cost, when applying for a coverage affordability program. Children should not be asked to interpret for their parents. Copyright Julie Reiskin, CCDC

Immigrant rights when seeking care Hospitals with emergency rooms must screen and treat people who need emergency medical services regardless of ability to pay, insurance status, or immigration status Anyone can seek care at community health centers regardless of ability to pay, insurance status, or immigration status Providers may not require citizenship, lawful immigration status, or an SSN as a condition of providing treatment – medical providers may ask for information about citizenship or immigration status in order to determine if a patient might be eligible for Medicaid, CHP+ or CICP, but they cannot deny medical treatment based solely on an individual’s immigration status Individuals that state “I am not eligible for health insurance and do not want to apply” should not be required to provide information about their immigration status No one should be refused treatment because they do not have a photo ID Everyone, regardless of immigration status has the right to interpretation services, at no cost, when receiving health care. Children should not be asked to interpret for their parents. Copyright Julie Reiskin, CCDC

Privacy Protections Privacy laws that protect patient information protect everyone, regardless of immigration status Providers should communicate to patients that patient information will not be shared with police or immigration enforcement officials unless required by a judicial warrant or subpoena Immigration enforcement officials cannot enter “limited access areas” of health care facilities, including patient care or treatment areas, without a warrant unless they have consent Staff should be trained regarding how to deal with law enforcement officials that request access to patient information or limited access areas Providers should communicate the policies they have in place to protect patient privacy

Are federal immigration enforcement officials likely to target health care facilities? Under the Obama administration, the Department of Homeland Security (DHS) issued memos to ICE and CBP officers providing that arrests, interviews, searches and surveillance should not generally focus on “sensitive locations,” including hospitals and other health care facilities. A DHS “Q&A” dated February 21, 2017 indicates that the “sensitive locations” guidance memos remain in effect but the memos are subject to withdrawal by the current administration. Even while they are in effect, the sensitive locations guidance is subject to explicit exceptions for enforcement actions involving national security or terrorism matters, or involving the immediate arrest or pursuit of a “dangerous felon, terrorist subject, or [others who] present an imminent danger to public safety.”

Sample communications materials Below are some examples of communications materials produced by advocates and providers to help immigrants and their families know their rights and feel safer seeking health coverage and care and to ensure employees know how to protect patients – Know Your Rights: Is it safe to apply for health insurance or seek health care? (National Immigration Law Center) A Resource of For Immigrant and Refugee Patients at Denver Health A Resource for Assisting Immigrant Patients at Denver Health A Resource for Health Coverage Guides and Assisters Attempting to Serve Immigrants and their Families Employee Guidance Template