Massachusetts Medical Society: Immigration Status as a Social Determinant of Health

Immigration Status as a Social Determinant of Health

Kimball

“The impacts of policy decisions on the human body show up when we talk about the different type of health services you can get depending on whether you have MassHealth Limited or Medicaid. MassHealth Limited [which covers emergency health services] doesn’t cover rehab (for example, post-surgery). This is because of decisions we’ve made about access to care based on immigration status. The concept of immigration status as a social determinant of health ignores the volitional aspect of that status being weaponized to promote social exclusion. It’s like talking about racial inequality without talking about racism. A lot of the differences we see are entirely needless.”

— Sarah L. Kimball, MD, co-director of the Immigrant Health Center, Boston Medical Center
Joseph

“The Affordable Care Act made documentation status a more salient factor because of federal restrictions. Consequently, accessing coverage has become more difficult for immigrants. Language proficiency is another big barrier to care, not only in using coverage but also in who enrolls for coverage. A lot of paperwork about the Health Safety Net and MassHealth options is primarily set out in English. In addition, if you’re sharing housing with others and your name is not on the lease, and you’re being paid under the table, you can’t demonstrate proof of your residential or income eligibility for these programs.”

— Tiffany Joseph, PhD, associate professor of sociology and international affairs, Northeastern University
Herbert

“How can you be added to the EHR if you can’t prove who you are? While it appears that anyone can get care in at least some of our emergency departments, and programs like my outpatient clinic will initially take anyone for an intake, follow up care, laboratory studies, and diagnostic radiology are nearly impossible without being identifiable in an EHR. This is one of the frequent collateral losses for ‘undocumented’ people.’ Calling people undocumented implies that the only documentation that counts is from this country, but truly undocumented people lose (or have taken) whatever identification they had from their starting country. International agencies — for example, Doctors Without Borders — struggle with how to provide identification for people who cross borders, and who will get access to those documents.”

— Barbara Herbert, MD, medical director, Common Health
Cohen

“Undocumented people with low incomes in Massachusetts can get access to MassHealth Limited, the Health Safety Net, and Children’s Medical Security Plan. If they go to certain providers, such as Boston Medical Center, Cambridge Health Alliance, or a community health center, they will get excellent and comprehensive health care services. But other providers may not accept them except in medical emergencies.”

— Andrew P. Cohen, public benefits attorney, Health Law Advocates
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