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The issues in health care for undocumented latinos in america

Replaces Committee Opinion Number 425, January 2009, Reaffirmed 2017 Committee on Health Care for Underserved Women This information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Unauthorized undocumented immigrants are less likely than other residents of the United States to have health insurance.

The American College of Obstetricians and Gynecologists has long supported a basic health care package for all women living within the United States without regard to their country of origin or documentation.

Providing access to quality health care for unauthorized immigrants and their children, who often were born in the United States and have U. Recommendations Health professionals can play an important role in improving access to needed health care for unauthorized immigrants by helping society understand the importance and widespread benefit of universal health care access for all U. Background The United States has been called a nation of immigrants.

The unauthorized immigrant population is spread throughout the United States, with one half concentrated in California, Texas, Florida, and New York 3. Because children born in the United States are granted citizenship by the 14th Amend-ment to the U. Constitution, many children living in families headed by unauthorized immigrants are U. Children who are U.

Most unauthorized immigrants live in poverty and have low rates of health insurance coverage 6โ€”8. Health Status of Unauthorized Immigrant Women Unauthorized immigrants are less likely than other residents of the United States to have health insurance. Their access to publicly funded health programs has become increasingly limited since the passage of welfare reform in 1996 and varies from state to state.

These barriers to access result in these individuals receiving fewer preventive health care services, including prenatal care, and reporting poorer reproductive health outcomes 6, 910.

  1. Most unauthorized immigrants live in poverty and have low rates of health insurance coverage 6โ€”8. J Immigr Minor Health 2010;12.
  2. Immigrant status also is associated with some positive health outcomes.
  3. In addition, a variety of search terms for undocumented were used, including undocumented, illegal, irregular, and noncitizen.
  4. However, conferring eligibility on the fetus, rather than the pregnant woman herself, leads to the exclusion of essential perinatal services, including postpartum care 23.
  5. American Community Survey Reports No. As growth stalls, unauthorized immigrant population becomes more settled.

In addition, the ACA cuts federal payments to Disproportionate Share Hospitals, which makes it more difficult for safety-net hospitals to take care of these individuals.

If every state were to accept the Medicaid expansion offered under the ACA, however, the impact of Disproportionate Share Hospital cuts would be effectively mitigated. To date, only 27 states and the District of Columbia have adopted the Medicaid expansion.

Barriers to health care for undocumented immigrants: a literature review

Unauthorized Latino immigrants are less likely to visit a physician in an outpatient setting than the general U. Conversely, their rate of childbirth-related hospitalization is significantly higher 6. Birth complications are more common among unauthorized women, as is neonatal morbidity, including fetal alcohol syndrome, respiratory distress syndrome, and seizures 10.

Studies in several areas of the country have found that unauthorized immigrant women begin prenatal care later and have fewer prenatal visits than the general population 9, 10. This disparity appears to be related to health care coverage.

When publicly funded prenatal programs are available, the use of prenatal care increases 9. Some evidence indicates that immigrants have less access to preventive services. For example, although the incidence and mortality from cervical cancer is decreasing among women born in the United States, it is increasing among immigrant women 1112.

A 1998 survey showed that U. A retrospective study of patients with cervical cancer in Chicago found recent immigrant status to be a risk factor for never having had a Pap test 14. Lack of health insurance was the strongest predictor of no recent mammogram, clinical breast examination, or Pap test 13. Immigrant status also is associated with some positive health outcomes.

Investigators have found that first-generation Latina immigrants have lower rates of premature births and low birth weight infants than the general U. This tendency toward better birth outcomes appears to last only one generation. Although some health care services are available to uninsured immigrants, the complexity and fear of accessing care in the face of ever-changing and complicated laws may inhibit many legal and unauthorized immigrants from seeking care.

Unauthorized immigrants and temporary immigrants in the United States generally are ineligible for Medicaid 19. The the issues in health care for undocumented latinos in america Welfare Reform Act made unauthorized immigrants ineligible for benefits previously provided by state and local governments unless new state legislation was enacted 20.

A number of states the issues in health care for undocumented latinos in america passed legislation to continue use of state funds to provide care, especially prenatal care, to unauthorized immigrants based on residence and financial need 9, 21. State grantees in the National Breast and Cervical Cancer Early Detection Program may elect to offer screening without regard to immigration status.

If cancer or premalignant conditions are diagnosed through this program, however, unauthorized patients may not receive care through its companion law, the Breast and Cervical Cancer Prevention and Treatment Act because unauthorized immigrants cannot receive Medicaid benefits 22. Some states have used this option as a way to finance coverage for legal and unauthorized pregnant women 23.

Although an unauthorized pregnant woman is ineligible for health insurance, her fetus qualifies her for pregnancy-related medical care 23. However, conferring eligibility on the fetus, rather than the pregnant woman herself, leads to the exclusion of essential perinatal services, including postpartum care 23.

Unauthorized immigrants who meet Medicaid financial and categorical eligibility requirements but who are not eligible for Medicaid because of their immigration status can receive Emergency Medicaid to cover emergency care, including labor and delivery 24. In addition, federal law requires provision of emergency care to any individual regardless of insurance or ability to pay, citizenship, or immigration status 25.

Under the Emergency Medical Treatment and Active Labor Act EMTALApassed in 1986, Medicare-participating hospitals that offer emergency services must provide an appropriate medical screening examination to any patient requesting examination or treatment for an emergency medical condition. If the hospital determines that the patient is experiencing an emergency medical condition, the hospital must provide treatment until the patient is stabilized or the patient is transferred in accordance with specific procedures 25.

The Emergency Medical Treatment and Active Labor Act was enacted to ensure that indigent and uninsured patients receive necessary emergency medical care, and the law specifically addresses emergency medical conditions and considerations for pregnant women. However, although EMTALA requires hospitals to provide necessary treatment, it does not require the federal government to reimburse hospitals for the cost of this care.

Funding for this care was addressed for the first time when Congress passed Section 1011 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 P. No funds have been allocated to Section 1011 since 2008, and most states have exhausted their allotments.

There are no plans to pass legislation to add additional funding 27. Immigration Detention Many unauthorized immigrants, at some point, will be detained by U. In 2012, ICE detained approximately 478,000 foreign nationals, the highest number ever detained 28.

It has been documented that women, especially pregnant women, held in immigration detention facilities have poor access to medical care 29.

Health Care for Unauthorized Immigrants

They are also highly vulnerable to sexual assault 29. As with incarcerated women in general in the United States, the gender-specific health care needs of women in immigration detention often are neglected 30.

Standards have been published by ICE in an attempt to improve a variety of aspects of immigration detention 31. Facility adherence to these standards is unknown. Citizen or lawfully present children of unauthorized parents, however, are eligible to purchase coverage through state marketplaces, for premium tax credits and lower copayments, and for Medicaid or CHIP.

In July 2012, the Obama administration announced a new policy, called Deferred Action for Childhood Arrivals, which allows unauthorized youth who meet certain criteria to apply for a 2-year deferral from deportation 32.

Although it is difficult at this time to predict how the law exactly will affect unauthorized immigrants, it appears that access to care may not improve.

  1. A retrospective study of patients with cervical cancer in Chicago found recent immigrant status to be a risk factor for never having had a Pap test 14.
  2. Funding for this care was addressed for the first time when Congress passed Section 1011 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 P. Am J Public Health 2003;93.
  3. There are no plans to pass legislation to add additional funding 27. In 2012, ICE detained approximately 478,000 foreign nationals, the highest number ever detained 28.
  4. Conclusion The ACA does not extend health care coverage for unauthorized immigrants.

Conclusion The ACA does not extend health care coverage for unauthorized immigrants. Because Disproportionate Share Hospital payments will decrease under the ACA, it is imperative that states accept the Medicaid expansion option, otherwise health care resources available to care for these individuals will be even further compromised. The American College of Obstetricians and Gynecologists supports a basic health care package for all women, without regard to immigration status, and helps achieve this by promoting universal access to health insurance for all individuals in the United States and advocating for the elimination of barriers to existing federal programs, including Medicaid 35.

Retrieved September 25, 2014. As growth stalls, unauthorized immigrant population becomes more settled. The foreign-born population in the United States: American Community Survey Reports No. Estimates of the unauthorized immigrant population residing in the United States: Health insurance and access to care for families with young children in California, 2001โ€”2005: J Immigr Minor Health 2010;12: Health care use among undocumented Latino immigrants.

Immigration status and health insurance coverage: Am J Public Health 2005;95: Legal status and health insurance among immigrants.

Background

Use of prenatal care by Hispanic women after welfare reform. BMC Public Health 2005;5: Immigrant women and cervical cancer prevention in the United States. Cervical cancer mortality among foreign-born women living in the United States, 1985 to 1996. Cancer Detect Prev 2003;27: Breast and cervical cancer screening: Ann Fam Med 2005;3: Social and cultural barriers to Papanicolaou test screening in an urban population.

Differences in low-birthweight among documented and undocumented foreign-born and US-born Latinas. Soc Sci Med 2002;55: Matern Child Health J 2006;10: Does the epidemiologic paradox hold in the presence of risk factors for low birth weight infants among Mexican-born women in Colorado? J Health Care Poor Underserved 2012;23: A demographic, socioeconomic, and health coverage profile of unauthorized immigrants in the United States. Migration Policy Institute; 2013.

Women's Health Care Physicians

Am J Public Health 2003;93: Deficit Reduction Act of 2005: Retrieved November 21, 2014. Who will cover the cost of undocumented immigrant trauma care? J Trauma Acute Care Surg 2012;72: Retrieved November 6, 2014. Immigration and Customs Enforcement. Performance-based national detention standards 2011. Deferred action for childhood arrivals. Migration Policy Institute; 2012. Retrieved January 15, 2015.