Immigration and Health Care
This section is aimed at highlighting aspects of the very complex world of immigration in the U.S. and identifying some of the services and supports that may be available. It is intended for general informational purposes only and is not legal advice. You should consult an attorney specializing in immigration to advise you on how U.S. immigration laws may impact you and your family, given your individual circumstances. For lawyer assistance, links to Legal Aid can be found in the legal assistance section.
As the parent of a child who needs medical care, you may be asked about your citizenship or immigration status. Sometimes the answer to this question is not entirely clear or is something that you may not want to discuss. However, it is important for you to know the health care benefits and family supports that depend on your immigration status as well as the services and programs that are available to everyone. Since program information, interpretation and eligibility requirements may change, we provide you with links to key organizations that may be able to help you.
The Center for Infants and Children with Special Needs at Cincinnati Children's Hospital Medical Center provides general information to help families and health care providers identify sources of support available to immigrants. It will be particularly helpful for you to look at our glossary to become familiar with the often confusing maze of immigration terms and definitions.
Barriers to Health Care | Frequent Questions | Immigration Status | Benefits Available to Anyone | Emergency Care | Specialized Relief Programs | Immigrant Eligibility for Public Benefits | Public Charge Test | Private Insurance | Interpreter Services | International Adoption | Legal Assistance | Additional Resources
Barriers to Receiving Health Care
A number of reasons have been identified as to why immigrants do not automatically seek traditional health care services. These often include:
- Cost of health care
- Lack of bilingual care
- Significant waiting periods before being seen in a clinic
- Transportation difficulties
- Inability to leave work
- Discrimination
- Fear of receiving aid and its potential effect on citizenship status
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Frequent Questions
Finding out which health care programs and services you are eligible to receive can be very confusing. You may be wondering about:
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Immigration Status
Under U.S. immigration law, there are several categories of immigration status. Some of these include:
Citizens may be born in the U.S. or in a U.S. territory, born to parents who are U.S. citizens, or become citizens through naturalization. Citizens may be eligible to receive a full-range of public benefits. Children born in the U.S. to immigrant parents (regardless of their status), are citizens and are eligible to receive public benefits, even though their parents may not qualify.
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Immigrants are here for an indefinite period of time and are either Lawful Permanent Residents (LPR) or are in the process of becoming permanent residents. Lawful Permanent Residents are legally given the privilege of residing permanently in the U.S. They are also sometimes referred to as "Permanent Resident Aliens," "Resident Alien Permit Holders" or "Green Card Holders. "
There are many different procedures for becoming permanent residents, from asylees, to employees of U.S. companies, to family members of citizens and permanent residents, to certain victims of crime or abuse.
Some benefits are available to anyone, regardless of your immigration status.
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Non-immigrants include individuals who have permission to be in the U.S. for a specified and limited amount of time, such as visitors or students, and have entered the U.S. on a visa. Most non-immigrants who entered the U.S. with a visa are in a status that has a letter of the alphabet as its title, such as B-visa or F-visa. There are many types of visas, each with specific requirements, benefits and limitations.
Some benefits are available to anyone, regardless of immigration status.
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Individuals who enter the U.S. illegally, without a visa or proper authorization and documents, are considered Undocumented. They may sometimes be referred to as "illegal" or "illegal aliens." These individuals may be able to obtain immigration status, but only in rare cases. They should speak to an immigration lawyer to explore any possible options.
If a person entered the U.S. with a visa but stayed for more time than they were permitted to stay, they may be considered "out-of-status." An individual who wants to get back into status shouldconsult with an immigration lawyer who is familiar with the options available for "overstays."
Undocumented individuals may be eligible for limited services and benefits available to anyone, regardless of immigration status.
If you have questions or concerns about your own immigration status, you should speak to a lawyer specializing in immigration.
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Benefits Available to Anyone
There is often confusion about eligibility for benefits because of the complex immigration and welfare laws and differences in various state programs. As a result, many eligible immigrants have assumed that they should not seek any services and many agencies have mistakenly turned away eligible immigrants.
Some benefits are available to everyone, even those who are non-immigrants or are undocumented. In general, if the service is provided to the whole community in order to protect life and safety, then it should be provided without anyone asking about immigration or citizenship status. These can include:
Health Care
The following health care services have their own financial eligibility requirements based on your income.
Vaccinations (may not include all vaccines currently recommended). Testing for and treatment of symptoms of communicable diseases . Community programs and services necessary for basic health and safety, including treatment of mental illness or substance abuse, crisis counseling, child and adult protective services, violence and abuse prevention programs or victim assistance. General and Community Pediatrics at Cincinnati Children's: Hopple Street Neighborhood Health Center Primary Pediatric Care Center The Patient Financial Assistance Program at Cincinnati Children's can assist eligible patients and families who live in our primary service area and do not have health insurance. Our service area includes Hamilton, Warren, Butler, Clermont, Boone, Kenton, Campbell and Dearborn counties. Our policy is to provide medically necessary hospital-level services without regard to the patient's ability to pay or citizenship status. This policy applies to inpatient, outpatient and emergency room services, and to professional services performed by providers employed by Cincinnati Children's. Several of our financial counselors are bilingual and can assist you with the required information including the financial assistance application and proof of family size and income. Hamilton County Health and Hospitalization Tax Levy can provide free or reduced cost health care to Hamilton County residents who do not have health insurance and who have limited or no financial resources for medical care.Food
- Soup kitchens and food banks do not have financial eligibility reuirements.
Non-Medical Emergencies / Disasters
- Assistance during periods of hot, cold or other adverse weather conditions.
- Short-term emergency disaster relief services.
- Short-term shelter or housing assistance for the homeless, for victims of domestic violence or for runaway, abused or abandoned children.
- Emergency services including police, fire, shelter or ambulance that are provided because there is an emergency situation such as health or safety at risk or a crime committed.
Education
- All children, regardless of legal status, have a right to equal access to K-12 public school programs.
Non-Government Assistance
- Private, religious and local resources often do not have restrictions based on immigration status but may have their own inedividual requirements.
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Emergency Care
Universal Health Care Action Network of Ohio (UHCAN) has aditional information on these programs:
Medicaid
Emergency medical services provided to any person, regardless of immigration status, may be covered under state Medicaid programs. Specific program requirements may vary from state to state. Generally, the individual must meet certain Medicaid financial requirements and may not have other sources of coverage, such as private health insurance. Alien Emergency Medical Assistance (AEMA) is a category of Medicaid that provides coverage for treatment of an emergency medical condition for non-citizens. The condition must be so severe that a lack of medical attention could be expected to result in placing the patient's health in serious jeopardy. Emergency Medicaid only pays for emergencies and not for treatment of chronic, life-threatening conditions. Examples can include:
- A child with a lung disease cannot get coverage until there is a sudden onset of a medical emergency. Routine, preventative and follow-up care are not covered.
- Labor and delivery for pregnant women are covered but prenatal and postpartum care are not. However, if there are pregnancy complications, the cost of care will be covered.
The emergency treatment cannot last longer than 90 days. There is no a limit on the number of times that a person can apply for and receive Emergency Medicaid. However, Medicaid coverage for emergency services is not approved in advance. The request for coverage must be made after the emergency but within three months of the date of the emergency. It is then reviewed by state panels who apply the state's rules to determine if coverage will be provided.
SCHIP, the State Children's Health Insurance Program, extends financial coverage for medical services to those with incomes above the poverty level who might not otherwise qualify for Medicaid. Programs vary by state.
Emergency Medical Treatment and Active Labor Act (EMTALA)
Hospitals cannot deny anyone certain emergency medical services based on the person's ability to pay. EMTALA, the Emergency Medical Treatment and Active Labor Act, requires hospitals to provide screening, and, if necessary and within the family's means, stabilization to anyone coming to the hospital's emergency department with an emergency medical condition.
Hospital Care Assurance Program (HCAP)
HCAP is an Ohio law that requires hospitals to "provide, without charge to the individual, basic, medically necessary hospital-level services" for patients at or below the federal poverty level. You must be an Ohio resident, do not receive Medicaid and have a family income at or below federal poverty guidelines. It is available al all Ohio residents, regardless of citizenship or immigration status.
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Specialized Relief Programs
Working with children who lack legal immigration status requires knowledge of specialized relief programs, creativity and timeliness. While in foster care, undocumented children usually receive all necessary services. There are several possibilities to explore for eligibility:
- Special Immigrant Juvenile Status (SIJS) may be available for an undocumented child who is eligible for long-term foster care. This can enable the child to remain in the U.S. and eventually become a Lawful Permanent Resident. This can be a time-consuming and complicated process. For a child to be eligible for SIJS the court must find that:
- The child cannot be reunified with either parent because of abuse, neglect or abandonment.
- It would not be in the child's best interest to be returned to the home country.
While undocumented children usually receive all necessary services while in foster care, they lose their benefits when they age out of the system, between ages 18 and 21. The John H. Chafee Foster Care Independence Program created by the Foster Care Independence Act of 1999 expanded funding and services up to age 21 for adolescents making the transition from foster care to self-sufficiency and independent living.
- Violence Against Women Act (VAWA) permits an abused and undocumented child to petition for Lawful Permanent Resident status without the cooperation of the abuser. A child can also receive VAWA benefits if the child's parent qualifies for VAWA due to abuse.
- Victims of Trafficking and Violence Protection Act (VTVPA) created visas to allow undocumented children who have been victims of serious crimes or trafficking to apply for Lawful Permanent Resident status. The child's parents and siblings may also be eligible.
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Immigrant Eligibility for Public Benefits
Determining whether you are eligible for public benefits can be complicated. Some federal assistance programs require that you meet one of the requirements in the following "List A." These requirements are identified under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and the Illegal Immigration Reform and Immigrant Responsibility Act of 1996. Changes and/or updates to this list can be found at U.S. Citizenship and Immigration Services and National Immigration Law Center web sites:
List A:
- Lawful Permanent Resident
- Refugee
- Person granted asylum (not just with a pending asylum application)
- Person protected against deportation or removal
- Cuban or Haitian
- Person paroled into the U.S. for at least one year
- Battered spouse and children of a U.S. citizen or Lawful Permanent Resident
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 requires most legal immigrants who entered the U.S. on or after August 22, 1996 to wait five years after obtaining Lawful Permanent Resident status before they are eligible to apply for some public benefits.
Be aware that each program may have its own additional set of income and eligibility requirements.
Additional programs including Food Stamps and Temporary Assistance for Needy Families (TANF) cash assistance are available to a very long and complicated list of people. You can apply and consult an immigration lawyer if your application is denied.
Find additional information on financial assistance programs.
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Public Charge Test
Public charge is a term used in immigration law to describe individuals who cannot support themselves and who depend on the government for economic support. Lawful Permanent Resident status can be denied if the government thinks you will not be able to support yourself without these cash benefits in the future. However, it does not apply to all applicants and sometimes the test can be waived. It requires a very specific legal analysis and may be overcome in some cases. Receiving assistance for medical care should not be a basis for finding that you will be a "Public Charge." Consult an immigration lawyer familiar with these issues.
However, receiving benefits that are available to anyone is not a basis for finding that you will be a public charge.
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Private Health Insurance
There is no restriction concerning a Lawful Permanent Resident having private health insurance coverage regardless of how long they have been in the U.S. Undocumented individuals, however, are not able to purchase private health insurance in Ohio, but this can vary by State. You should be aware that many private health insurance plans can exclude coverage for pre-existing conditions unless you had coverage for that condition through a previous U.S. insurance plan and have maintained coverage without a break of more than 63 days. Thus, if you are a U.S. citizen that is considering international adoption you should be aware that your private insurance plan may not cover your child's pre-existing conditions even after the adoption is final.
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Interpreter Services
You have the right to an interpreter if you have difficulty speaking or understanding English, regardless of your immigration status. The cost of the interpreter should be paid by the hospital or agency.
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International Adoption
International adoptions can be a more complicated process than U.S. adoptions, with additional paperwork, waiting lists, health concerns and foreign country laws. It is important to learn about the health care benefits that may be available to your child in an international adoption. You should be aware that your private insurance plan may not cover your child's pre-existing conditions even after the adoption is final. This may be particularly important if you adopt a child with pre-existing conditions special needs. Failing to anticipate the financial obligations that could result from medical costs incurred by foreign adoptees with significant or chronic medical conditions has resulted in some sponsoring organizations and "well meaning families" having to file bankruptcy. The International Adoption Center at Cincinnati Children's provides information and resources to support your interest adopting a child from another country.
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Legal Assistance
You may need to contact a lawyer specializing in immigration issues to advise you on your individual situation. Ask questions about their areas of expertise as some may be experienced only in obtaining citizenship while others have specific background in public and private benefits eligibility.
Additional Resources
In spite of very specific legal guidelines, immigration laws may be prone to contradictory interpretations. We encourage families and professionals to use this section on immigration and health care as an overview and guide and then seek additional information from immigration lawyers, local organizations, government programs and reliable web sites. We have included some helpful resources:
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If your questions are not fully answered by our Special Needs Resource Directory and its links, please contact us via email.
Rev. 4/08
