Current Issues in Immigrant Health

Current Issues in Immigrant Health Elena Rios, MD, MSPH President and CEO National Hispanic Medical Association National Hispanic Medical Association Established in Washington, DC in 1994 for 36,000 physicians in U.S. Mission: to improve the health of Hispanics and other underserved NHMA Council of Medical Societies (14 state and local societies) Focus: leadership training and nominations to government committees National Hispanic Health Foundation (501c3) scholarship program, policy research

NHMA and CHC 2002 National Hispanic Health Leadership Summit, San Antonio, TX Purpose: to build consensus recommendations to improve Hispanic health programs and policies at the Federal, State, private, and community levels for the next 5 years. Partners: Congress, DHHS, RWJF, Ca Endowment, Amgen, Aventis, GSK, PhRMA, EPA, NHTSA, HSHPS, natl groups; 170 participants For Final Report see: www.nhmamd.org Defining the Immigrant US Citizenship and Immigration Services (USCIS) defines an immigrant as one who is a Permanent Resident Alien A Permanent Resident Alien is an alien who has been legally accorded the privilege of residing permanently in the United States, also known as a Green Card Holder or a Lawful Permanent Resident An alien is any person not a citizen of the US Immigration and Nationality Act of 1952 (PL 82-414) more broadly defines an immigrant as any alien in the United States, unless legally admitted on a nonimmigrant basis US Citizenship and Immigration Services (USCIS), formerly known as US Immigration and Naturalization Service (INS), is a Bureau of the Department of Homeland Security

Defining the Nonimmigrant USCIS defines a nonimmigrant as any alien who seeks temporary entry to the US for a specific purpose Includes: Foreign government officials Students Temporary workers Religious workers Fiancé(e)s of US citizens US Citizenship and Immigration Services (USCIS), formerly known as US Immigration and Naturalization Service (INS), is a Bureau of the Department of Homeland Security Trends in Immigration From 1905 to 2005 numbers of persons granted Legal Permanent Resident status varied largely Low of 23,000 in 1930 s Over one million around 1910 All-time high of 1.8 million in 1991 Within the last decade immigration numbers have maintained levels well over 500,000 per year Source: Department of Homeland Security, Office of Immigration Statistics, http://www.uscis.gov/graphics/shared/statistics/yearbook/lpr05.htm

2005 Immigration Demographics 1.12 million people became Legal Permanent Residents (LPR) of the U.S. 58% of these immigrants received LPR status due to relationships with U.S. citizens, 22% for employment reasons, including 42,000 professionals with advanced degrees 26% were between the ages of 24 and 34, with 80% of all immigrants under the age of 45 Source: Department of Homeland Security, Office of Immigration Statistics, Annual Flow Report, Legal Permanent Residents: 2005, April 2006 2005 Immigration Demographics 14% were born in Mexico, 8% in India, and 6% in China, other origins include Central American, South American and Asian nations Nearly 45% of all 2005 immigrants reside in California, New York or Florida Hispanic immigrants tend to reside Mexico: California-63,000, Texas-38,000 Cuba: Florida-30,600 Dominican Republic: New York-14,000 Source: Department of Homeland Security, Office of Immigration Statistics, http://www.uscis.gov/graphics/shared/statistics/yearbook/lpr05.htm

Immigrant Health Care Challenges- Access to Health Insurance & Services Ineligible for Federal and State health care programs Large portion of immigrants are uninsured In 2004 immigrants comprised 12% of US population, 7% non-citizens and 5% naturalized citizens Non-citizens account for 21% of the US uninsured population Naturalized immigrants of equivalent income and age levels are 40% more likely to be uninsured than native born citizens Lack of Hispanic physicians (only 5% of total physicians) lack of cultural competent health systems Source: Kaiser Commission on Medicaid and the Uninsured, Medicaid and SCHIP Eligibility for Immigrants, April 2006

Current Laws Regarding Immigrant Health Personal Responsibility and Work Opportunity Reconciliation Act of 1996 Prevents legal permanent residents from receiving Medicaid and State children s health insurance program (SCHIP) benefits for first 5 years residing in US Immigrants still have emergency care In 2004 22 States allocated funds to health care of immigrants ineligible for Medicaid and SCHIP concern is geographic trends with migration to states without coverage Shifted burden also to local safety net providers Source: Kaiser Commission on Medicaid and the Uninsured, Medicaid and SCHIP Eligibility for Immigrants, April 2006 Current Laws Regarding Immigrant Health Deficit Reduction Act of 2005 Requires persons seeking Medicaid assistance to provide documentation of US citizenship (CBO estimate savings $270M in 5 years & loss of coverage to 35,000 by 2015) Becomes effective July 1, 2006 Repeal of portion of Deficit Reduction Act of 2005 Purpose: To repeal requirement of citizenship documentation for Medicaid assistance Status: Referred to respective Senate and House committees in February and April of 2006 Sponsored by: Senator Akaka and Representative Christensen

Federal Legislation Regarding Immigrant Health- Pending Immigrant Children s Health Improvement Act of 2005 (ICHIA) Purpose: To provide States with the option to cover certain legal immigrants (children and pregnant women) under Medicaid and SCHIP. Status: Referred to House and Senate Committees in April and May of 2005, gained more support in May of 2006 Sponsored by: Senator Clinton and Representative Diaz-Balart Federal Legislation Regarding Immigrant Health- Pending Health Disparities Bills in 109 th Congress Healthcare Equality and Accountability Act, July 2005 Sponsored by: Senator Akaka and Black, Hispanic, Asian Caucuses of the Congress Bipartisan Bill Senator Frist, Kennedy and HELP Committee offices (Enzi, Gregg, Clinton, Obama) to be introduced July

Frist-Kennedy Bill Priority Areas Outreach to increase Access to Services Diversity Health Professions (HCOP, COE) Cultural Competence, Literacy Research at Agency for Healthcare Research & Quality, Center for Minority Health & Health Disparities Research, NIH National Health Disparities Report Leadership & Accountability at HHS with the Office of Minority Health Health Professions Title VII to be reauthorized in 2007 Major Recommendation: to reinstate programs at FY05 Levels at a minimum New 5 Regional Hispanic Centers of Excellence $2M, 10 year grants Data collection of students by SS#, outcome measures, regional workforce centers Continue Diversity Programs (HCOP, AHEC, HETC and COE with partnership with Dept of Ed) Faculty development fellowship, loan repayment Mandate training in community clinics Culture & language training curriculum Incorporate diversity in AHC Boards of Trustees

Federal Legislation Regarding Immigration Comprehensive Immigration Reform Act of 2006 Purpose: Provides a Guest Worker program, increases cap on Legal Permanent Residents per year, offers a path to citizenship for many unauthorized immigrants, adds visas for doctors, nurses, dream act for higher education Status: Passed in Senate on May 25, 2006, 62-36 vote Sponsored by: Senator Specter President Bush stated his support for the Guest Worker program and the idea of providing a chance to gain citizenship in his speech on May 15 State Programs to Improve Immigrant Health New Jersey In Jan. 2005, CME legislation 10 hours per year California In October 2005 AB 1195, a bill to require cultural and linguistic training to be part of all CME curricula, was passed (Assemblyman Coto)

Cultural Competence Recommendations Promote HHS OMH CLAS Standards Mandate and reimburse cultural competence and language services Develop measures for performance, outcome Develop a database of experts and model programs Support research on cultural competence to increase knowledge on quality and pt safety US-Mexico Binational Health Insurance Senate Republican Task Force on Uninsured Briefing by NHMA, California Endowment, Blue Cross of CA Feb. 4, 2005 HHS, Mexico Ministry of Health, Texas Health Insurance Commissioner, Dept. of Labor, presentation on Health Net, Blue Cross, SIMNSA, physicians, employers, researchers Demonstration Project Request recommended in Border Health Security Act of 2006 (Senator Bingamon and Rep. Reyes) along with support for the US-Mexico Border Health Commission

State Immigrant Health Programs Massachusetts Bill passed in House and Senate to require all residents of state to have health insurance Provides subsidies for private insurance on a slidingscale for all families with income under 300% of poverty level Office of Multicultural Health-Refugee and Immigrant Health Program Improve general health and increase access to health care for refugees and immigrants Program includes an initial health assessment and outreach services by trained bilingual and bicultural staff For more information on the Refugee and Immigrant Health Program visit the Massachusetts Office of Multicultural Health website: www.mass.gov/dph/orih/orih.htm State Immigrant Health Programs Illinois Covering All Kids Health Insurance Act (Public Act 94-0693) November 15, 2005 Provides health insurance at discounted rates based on income for middle-class families ineligible for Medicaid State will cover costs with savings gained from a primary care case management program For more information visit the program website: http://www.allkidscovered.com Minnesota Immigrant Health Task Force created in 2002 Provides action steps and recommendations to policymakers, health care providers, and educators Focus areas include health care access, clinical guidelines for immigrant health care, and bilingual/bicultural services For more information visit the Minnesota Immigrant Health Task Force website: www.health.state.mn.us/divs/idepc/refugee/ihtf/ihtfabout.html

Localized Immigrant Health Projects New York University Center for Immigrant Health: Current Programs Cultural Competency Training Early results have shown significant gains in knowledge and attitude concerning interpreters, immigrant epidemiology, and cross-cultural health beliefs Portal navigation project For more information visit the NYU Center for Immigrant Health website: www.med.nyu.edu/cih/ Localized Immigrant Health Projects Community Voices for Immigrant Health Project-Oakland, CA Family Care plan developed to provide subsidized, affordable, status-blind coverage to uninsured immigrant families The program seeks input from Latino and Asian and Pacific Islander communities regarding health policies and barriers to health care access, using the information to affect policy changes For more information visit the Community Voices Oakland website: http://www.communityvoices.org/community.aspx?id=3

Policy Recommendations Incentives in the system for increased enrollment in insurance (decrease price, limit copay, best practices) Develop media campaign with business on insurance Targeted, bilingual marketing for enrollment Focus on Family coverage affordability Focus on insuring all children with SCHIP reauthorization Immigrant Policy to include more health care (visas for IMGs, nurses, funds to hospitals for uncompensated care, occupational health program for guest workers) and less obstruction to care (doctors should not be INS agents nor criminals for providing care) Language services needed Develop incentives to providers to increase insured NHMA www.nhmamd.org Future Direction: Congressional and State Briefings with the NHMA Council of Medical Societies National Hispanic Health Conference March 23-26, 2007, San Antonio Hispanic Health Portal with the National Hispanic Health Professionals Leadership Network (www.hispanichealth.info)