Healthcare for Refugees, Immigrants and Asylum Seekers


In the wake of the Affordable Care Act, New York State has continued to lead the way in offering Medicaid to immigrants of different legal statuses.

While the passage of the Affordable Care Act extended health coverage to an unprecedented number of individuals and allowed states to expand their Medicaid coverage, federal provisions did not mandate that certain legal categories of immigrants, such as asylum seekers, receive coverage.

The provision of Medicaid is particularly critical for asylum seekers who may arrive with a variety of medical needs directly related to their request for asylum, who have no financial means to pay due to their inability to receive immediate work authorization.  As well, many are ineligible for housing benefits or assistance with food costs.

Rihana Shash, an asylum seeker, has directly experienced such a need.  She traveled from Ethiopia in search of safety for herself and her three children, one of whom was born in the United States.  She maintains that Medicaid was particularly important for her situation, “It is good…for my kids it helps a lot.”

Shash received Emergency Medicaid for the duration of her pregnancy with her youngest child, and afterwards.  Her older son Kareem also had health issues. Diagnosed with a skin disease, Kareem needed an expensive prescription cream to treat his ailment, “For Kareem, they (Medicaid providers) helped me a lot.  It’s too expensive. One (tube) is like $400.”   

While the coverage has helped many, there are still others who lament that the income requirements can restrict those who are working yet still need the aid.

Olivier Birhalya, from the Democratic Republic of Congo, works two part time jobs and is still unable to receive coverage because his income exceeds the maximum eligibility requirements. NYS income eligibility is within 133% of the federal poverty guideline: $1,293 per month.

Unfortunately, both of his employers refuse to hire him full time which prevents him from obtaining coverage through his employer(s).

Birhalya has medical issues that he is unable to pay for, “I had one issue with blood and then they asked me to pay, but I can’t pay.  Emergency (Medicaid), I don’t have.”  He had to pay $72 for a related expense, but says this shouldn’t be the case for others in his situation.  “Even (though I’m) working, I’m not able to pay fees for hospital.”

However, Birhalya may be eligible for supplemental coverage and is searching for a caseworker to help him reapply, “In November, I want to try again.”

Since 2001, New York State has considered asylum-seekers and other lawfully present immigrants eligible to receive Medicaid. This consideration is in contrast to the Federal policy which was a result of the 1996 federal welfare reform.  Federal policy effectively restricts state and federal benefits for non-US citizens (including Permanent Residents), and enables states to refuse other benefits at their own discretion.

New York State court decision Aliessa v. Novello (2001), held that it was against New York’s state constitution to withhold Medicaid from those that were lawfully present and in need of coverage.

The decision mandated that Medicaid be extended to what it called Permanent Residents Under the Color of the Law (PRUCOL), or immigrants who had the state government’s permission to reside within and included categories such as asylum seekers, tourists, and students.

Recently, the federal policy has changed under the Affordable Care Act. Now refugees and asylees as well as permanent residents are included as eligible recipients. However, the federal government still does not mandate that other immigrant categories—such as asylum seekers—receive coverage. Instead, each state is allowed to make that decision.

Case worker Janet Lawton of Jericho Road Community Health Center helps ensure that these eligible applicants, such as Shash and Birhalya, properly complete their forms.  She commented on the ease of applying, “If the online process goes smoothly, individuals may notice in a matter of minutes what type of coverage they are eligible for.”

In her view, the need is clear: “The medical issues in this community are great.  So many issues have been neglected for so long and helping asylum seekers get medical coverage seems like the practical and hospitable thing to do.”

Eligible applicants must now apply for Medicaid through the New York State Marketplace website.

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