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Health Insurance for Undocumented Immigrants: Navigating the Options

Can Undocumented Immigrants Get Health Insurance? 

Yes, undocumented immigrants can get health insurance, though they will have less flexibility when choosing between policies. An undocumented person can opt into employer-sponsored healthcare benefits if given the option. If not, they must purchase a private standalone plan. 

These individuals cannot access public insurance programs such as Medicare, Medicaid, or CHIP or choose a plan from the ACA marketplace. 

Barriers to Medical Care 

In 2021, 20.8 million noncitizens lived in the United States, making up 6% of its total population.  Because these individuals have less access to private coverage and do not qualify for public healthcare benefits, nearly half of all undocumented immigrants go without health insurance. 

Undocumented immigrants face many barriers to care beyond insurance, such as:

  • Language gaps
  • Literacy challenges
  • Fear of deportation 

These barriers, and more, lead many undocumented individuals to neglect health concerns. Data has indicated that immigrant populations schedule fewer doctor’s appointments and receive medically necessary care at much lower rates than other citizens.

However, everyone in the U.S. has a right to medical attention, regardless of immigration or insurance status. Discriminatory medical practices qualify as human rights violations, directly breaching “the right to health” widely recognized by the United Nations and the World Health Organization. Unfortunately, due to the high cost of paying for health services out of pocket, undocumented populations do not have equal opportunities to seek healthcare. 

How Does Health Insurance Work for Undocumented Immigrants? 

Healthcare in the U.S. can get very expensive. Many people pay monthly premiums for comprehensive health insurance to offset medical costs. Unlike regular citizens, undocumented immigrants are not eligible for federally funded public health programs, often settling for more costly private coverage or going without insurance.

However, many states have expanded state-level Medicaid eligibility for children of undocumented immigrants and pregnant women. As of January 2022, 18 states now provide prenatal CHIP coverage to financially eligible immigrant mothers and their unborn children. 

Some states have passed legislation extending postpartum benefit windows through an entire year for undocumented families. Meanwhile, other states have begun providing medical benefits to individuals of all ages and genders no matter their citizenship status. 

Types of Health Insurance Undocumented Immigrants Can Access 

Typically, undocumented individuals must get private insurance on their own or through their employer. However, people in some states may have access to state-funded benefits or emergency Medicaid.

Private Health Insurance 

Since undocumented immigrants cannot access federally funded healthcare, their primary coverage options exist in the commercial market. Private companies can sell health insurance as part of employer-sponsored group plans or standalone policies. 

If an undocumented person does not work for a company with a benefits package, they can legally shop for and purchase comparable insurance through the private provider of their choice. Unlike regular low-income citizens who qualify for ACA premium subsidies, many undocumented people find private insurance well beyond their budget. 

Those in need of help can consult licensed insurance enrollment assisters or utilize the National Immigration Legal Services directory for enrollment guidance.

Employer-Sponsored Health Insurance 

Large businesses must offer all full-time employees privately-funded health insurance. Because employers tend to split the cost of premiums, undocumented immigrants often find company health insurance their cheapest available option. However, because legitimate businesses require proof of citizenship or work visas for legal employment, undocumented immigrants rarely work these sorts of jobs. Undocumented immigrants may apply for coverage on behalf on documented individuals with employer-sponsored health plans. 

Emergency Medicaid 

Some states, such as New York and Washington DC, offer emergency Medicaid to uninsured individuals ineligible for conventional coverage due to their immigration status. To qualify for this program, a doctor must determine that withholding medical care could do the following:

  • Jeopardize the patient’s life,
  • Cause significant impairment to bodily functions; or
  • Lead to permanent organ or limb damage

Once granted, coverage lasts the duration of the emergency in question and ends as soon as a patient’s condition stabilizes. Coverage details and application procedures vary by state. While most states allow you to apply for benefits in advance online or over the phone, many people apply for emergency Medicaid at the hospital while receiving treatment. 

Newly secured coverage can also extend retroactively to pay for recently performed emergency procedures or childbirth. Qualified beneficiaries will receive an annually renewable emergency Medicaid card explaining their healthcare benefits and limitations.

State-Funded Medicaid 

Various states also offer state-funded Medicaid for undocumented individuals of qualifying circumstances. As of December 2022, the following locations have all extended state Medicaid benefits to include coverage for undocumented children and pregnant women:

  • California
  • Washington D.C.
  • Illinois
  • Maine
  • New York
  • Rhode Island
  • Vermont
  • Massachusetts
  • Washington 

Connecticut offers comprehensive benefits to children 8 and below, and New Jersey and Colorado intend to expand Medicaid coverage for children of all citizenship statuses within the next 1-3 years.

Some other state Medicaid programs now even include insurance coverage for undocumented adults. For example, regardless of citizenship status, Washington DC provides low-income residents medical benefits through its state-funded Healthcare Alliance. California gives state-funded coverage to undocumented adults between 19-26 years old, plus those over 50, and intends to expand these benefits to include all age groups by 2024.  

Other states only offer Medicaid to undocumented adults in specific categories, such as lawfully present immigrants in a Medicaid wait period.

What Health Insurance is Unavailable to Undocumented Immigrants? 

Undocumented immigrants cannot enroll in federally funded Medicaid, Medicare, or CHIP.  Likewise, these individuals do not have access to the ACA marketplace.  

The Personal Responsibility and Work Opportunity Act of 1996 decreed that undocumented immigrants or others without permanent status may only access federal benefits deemed necessary to protect life in dire situations, such as emergency Medicaid, ER care, and access to nutrition programs. 

Because general enrollment in public healthcare does not qualify as an emergency, undocumented immigrants will not receive this type of federal coverage. Even immigrants in dire situations must meet the customary financial requirements to access emergency Medicaid. 

How to Get Health Insurance as an Undocumented Immigrant 

You can get health insurance if you are an undocumented immigrant needing comprehensive health insurance.

  1. Research your options. Search eligible health insurance agencies through the National Immigration Legal Defenses Directory. 
  2. Seek help if needed. Many institutions will guide prospective members through language barriers and legal fears that might otherwise deter them from benefits.  
  3. Consider employer-sponsored healthcare. Without ACA subsidies, health insurance options can quickly become expensive. If you have the opportunity, opt into the employer-sponsored healthcare provided at your workplace or a documented family member’s workplace to take advantage of split premium costs.
  4. Consider a private plan. If you cannot get employee healthcare, determine your budget and purchase a private policy that best suits your situation. 
  5. Depending on where you live, apply for benefits. If you live in a state like California, you might try applying for state-funded Medicaid benefits.

Alternative Options to Traditional Health Insurance 

If you cannot afford private health insurance or face other barriers, explore the options below to help cut down on medical costs.

Federally Qualified Health Centers (FQHC) 

Federally Qualified Health Centers (FQHCs) provide comprehensive healthcare services to underserved populations and communities, either onsite or in collaboration with an outside provider. Services may include the following:

  • Preventative healthcare
  • Dental work
  • Mental health and substance management
  • Covered transportation
  • Hospital or specialty care

FQHCs receive federal assistance and offer sliding-scale fees, making them a viable medical alternative for uninsured, undocumented immigrants. Examples of FQHCs include:

  • Community health centers
  • Specialized migrant or homeless facilities
  • Tribal health organizations

To qualify for service at an FQHC, your visit must prove medically necessary in treating a persisting illness or injury. You can browse the Human Resources and Services Administration’s online database to find a relevant health center near you.

Free and Low-Cost Clinics 

Most cities have multiple community health clinics providing free or low-cost medical and dental care to low-income, unemployed, and uninsurable individuals. Qualified volunteer doctors and nurses help run these establishments and only bill patients relative to their income level. Free clinics do not require a background check or citizenship verification to provide care, making them ideal for uninsured immigrants.

To qualify for discounted service, patients must apply for care and prove they meet specific income levels. If a clinic cannot assist you for a reasonable cost, they will often refer you to another affordable provider or help you apply for state-level government assistance. 

Nonprofit Organizations 

If you do not have convenient access to a free clinic or FQHC, look into relevant nonprofit organizations and immigrant advocacy groups. Some nonprofits, such as Planned Parenthood, provide free or low-cost healthcare benefits to everyone regardless of immigration status. 

Some national organizations have sizeable immigrant, refugee, and worker relief funds that help direct money to struggling families needing food, housing, healthcare, and other essential resources. Meanwhile, large and small nonprofit health centers and religious charities in every state nationwide provide free or low-cost healthcare to disenfranchised immigrant populations.

Paying Out of Pocket 

Some uninsured immigrants get stuck paying for healthcare services out of pocket. While not ideal, some healthcare providers will reduce fees for low-income families or allow long-term payment plans to reduce the burden of medical bills. Explain your situation and ask your healthcare provider about potential payment strategies before receiving care.

Can Healthcare Workers Report Undocumented Immigrants? 

All medical patients have a right to privacy and security. The HIPAA Privacy Rule restricts doctors and healthcare establishments from disclosing protected health information to outside entities, meaning they cannot report undocumented immigrants to the authorities. Furthermore, medical providers cannot legally require patients to reveal their immigration status before treating them.

However, HIPAA does allow a few key exceptions to the rule. Healthcare providers can release protected information if requested by court order, warrant, or subpoena. Similarly, suppose a crime has occurred on hospital grounds. In these situations, medical providers can share protected information with the police if they believe in good faith that it can help solve a criminal issue unrelated to immigration.

All in All 

Navigating the health insurance environment can be confusing, especially for undocumented immigrants with multiple language, literacy, and legal barriers. Even though they cannot use government health plans like Medicare and Medicaid, undocumented immigrants can still get health benefits through their jobs or by buying private plans.

Notably, many states and more to follow have expanded immigrant access to state-level public healthcare. If you have questions about your coverage options, contact an immigrant advocacy group or speak with a health insurance assister to find a policy that works for you. 

Remember that hospitals and doctors must provide equal care to all patients, regardless of immigration or insurance status, and cannot legally ask for citizenship documents.

Frequently Asked Questions 

No. The Affordable Care Act prevents undocumented residents from enrolling in marketplace coverage or other federally subsidized insurance programs like Medicare, Medicaid, or CHIP.  Unless their state has expanded state-level public insurance access, undocumented populations must purchase standalone private coverage or employer-sponsored group insurance.

Yes. Undocumented immigrants can enroll in employer-sponsored healthcare if they work for a company offering private group coverage. However, the law requires all businesses to verify the citizenship status of potential employees before hiring them. Because of that, many larger companies with healthcare benefits avoid hiring unauthorized immigrants to begin with.

Yes, depending on their location. Many states have expanded state-level public health insurance programs to include coverage for undocumented children and pregnant women, while others plan to in the coming years. Pregnant women and children in other states will still have access to immigrant health insurance, albeit only through the private sector.

No. While reception staff prefer some kind of identifying evidence to create and access your medical record, you do not need an ID to receive healthcare. ID or no ID, medical providers cannot legally ask for proof of citizenship or share private health information with outside authorities.

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