Overcoming Barriers
to Access to Health Care by
Immigrant Families
Sonal Ambegaokar, Health Project Manager
National Immigration Law Center
March 4, 2013
What Barriers or Concerns
do Immigrant Families Have?
Helping with the Application –
Whose Info is Needed?
Goal: To make the application process put
immigrant and mixed-status families at ease and
be sensitive to their concerns.
From the start, application should make clear that an
individual can apply on behalf of someone else in the
family.
Request sensitive info only of applicant
Make clear that non-applicants will not have to provide
their SSN or citizenship/immigration status in order to
complete the application.
Helping with the Application –
Social Security Numbers and Individual Taxpayer
Identification Numbers (ITINs)
SSNs will be primary gateway to the electronic verification
system (the federal hub), including IRS data.
Applicants must provide SSN, IF they have one
Eligibility determination and enrollment should proceed
pending issuance of SSN or if only eligible for non-work SSN
Request for SSN of non-applicants must:
Make clear it is optional/voluntary
Not be required to proceed in electronic application
Explain how the SSN will be used and shared to
determine eligibility for those seeking coverage
Helping with the Application –
Immigration Status Requirements
Exchange and Medicaid/CHIP have different immigrant eligibility
rules; eligibility varies from state to state
Date of Entry: N/A for Exchange – no 5-year bar for eligible
immigrants in Exchange; N/A for certain immigrants for
Medicaid/CHIP
Screen first for income, then get into details about immigration
status
Have cheat sheets and info on eligible immigration statuses
handy
Provide multiple notices and reassuring messages about privacy,
confidentiality, and public charge
Helping with the Application –
Verifying Citizenship or Immigration Status
Citizenship- electronic database match via SSN - SSA, Vital
Statistics, other databases, SAVE
Ensure opportunity to provide alternative proof of citizenship if unable
to match via electronic match or do not have SSN
Naturalized citizens have higher error rates in SSA database match
Immigration status - Federal data services hub will use SAVE
Provide clear notice that immigration status will be verified only
to determine eligibility and not for immigration enforcement or
other purposes
Ensure applicants who are otherwise eligible and provide proof of status
to be aided pending verification without delay
Helping with the Application –
Documentation of Income
Variety of workers whose income not recorded by IRS
or state wage databases will need to provide
additional info.
Electronic data matching preferred – could be done
using data fields other than SSN
What happens when the hub can’t verify income?
Self-attestation of income should be allowed
when documentation does not exist or is not
reasonably available
Privacy, Security & Confidentiality
Need to address concerns about what info is collected, how it is
shared, and unintended consequences.
Info can be collected, used or disclosed ONLY if necessary to carry
out Exchange functions (eligibility determination and enrollment in
health insurance)
Info can only be used by/disclosed to those authorized to receive or
view it
Exchange will require the same or more stringent privacy and security
standards as a condition of contract or agreement with individuals or
entities (Navigators, agents, and brokers).
Exchange must ensure workforce compliance; training
No immigration consequences
Department of Homeland Security does NOT engage in
enforcement activities based on a SAVE inquiry
No “public charge”
Language Barriers
Medi-Cal and Covered California or other
entities that receive federal funding)
MUST provide free oral interpretation
services and translate key documents into
top languages.
Strategies to Enroll Immigrant Families
Provide a safe environment in which
immigrants, LEP persons, and other vulnerable
populations can seek services and information
Include reassuring language on application,
instructions, notices, outreach & education
materials
Strategies to Enroll Immigrant Families
Provide free interpretation and translation
services
All settings – call center, website, inperson, Navigators, consumer
assistance programs
Include tag lines on written materials
and website
Budget for appropriate language
assistance services
Strategies to Enroll Immigrant Families
Eligibility workers, call center personnel,
Navigators, consumer assistance programs
Include training on immigrant eligibility,
immigrants’ concerns, language access
policies, privacy & confidentiality procedures
Recruit culturally & linguistically appropriate
workforce, including organizations trusted by
immigrant communities