NAM Coverage

“Who Will Care for Us?”: Many Immigrant Elders Lack Health Care Access

Photo: The India Community Center in Milpitas, Calif., hosts a free medical clinic with volunteer doctors providing basic care. (Courtesy: India Community Center)

Part 2

FREMONT, Calif.--While immigration-reform advocates welcomed President Obama’s executive actions this week and some provisions of Obamacare are helping many families, restrictions for both authorized and undocumented immigrants in the United States still leave many in need. That goes especially for elders who often come here to help their children and grandchildren, then find themselves without health care coverage.

For example, legal permanent resident (LPR) seniors who have lived in the U.S. for less than five years are barred from receiving Medi-Cal (California’s name for low-income Medicaid) or Medicare benefits, with some exceptions.

In California, however, LPRs may purchase subsidized health care from the California Covered federally backed health insurance exchange, until they have lived in the U.S. for five years to qualify for federal benefits, a representative for Covered California said.

However, the subsidy is based on the annual income of the household; many elders living with their adult children will exceed the income requirements for subsidized premiums.

Affordable Care Act’s Limits

Analysis of Covered California’s online calculator, which determines eligibility, shows that a family of three earning the mean California household income of $82,000 per year would receive no subsidy for adding an elderly parent to their insurance plan. The extra monthly cost in a family plan via Covered California raised premiums by about $900 a month, on average.

Under the Affordable Care Act (ACA), insurance companies have been banned from using pre-existing conditions to determine premium costs. But all applicants must have a valid Social Security number. Therefore, documented immigrants cannot purchase health insurance for undocumented family members.

Even more troubling, the federal Department of Health and Human Services announced in September that more than 115,000 people who bought coverage through health care exchanges would lose their coverage – often without warning – for failing to provide proof of U.S. citizenship or legal residency. In California, more than 50,000 families stand to lose their coverage because of unresolved residency issues, reported The Washington Post.

Rishi Manchanda, president and founder of HealthBegins, which aims to improve health care access in vulnerable communities, said he dove into the boggy morass of the pre-ACA health insurance environment as his parents contemplated permanently emigrating from Botswana to spend more time with their grandchildren.

Manchanda had to buy health insurance for his parents before they met the five-year residency requirement that might have qualified them for MediCal or Medicare. He said he was shocked by the cost of health insurance and the lack of benefits.

His parents stocked up on all their medications in Botswana and got their check-ups there as well.
“My family’s experience is not uncommon. It is a demographic phenomenon that is happening in our community. A lot of Indians are trying to bring their parents over,” said Manchanda, formerly the director of social Medicine and health equity at St. John’s Well Child and Family Centers, a community health center network in South Central Los Angeles.

ACA Benefits Communities

South Asian American community organizers, however, contend that Indian American seniors have largely benefited from the Affordable Care Act.

“Formerly, premiums were very high,” Manju Kulkarni, executive director of the South Asian Network (SAN), [] commented. One couple she works with were formerly paying $1,500 per month for health insurance premiums, and having to cut down on groceries and other essentials as a result.

With their new, ACA-backed plan, the couple now pays under $500 per month, she said.

Indian American seniors have increased health care needs as they age, but would in the past often put off seeing a doctor or getting treatments because they cannot afford them. “Now they are getting treated,” said Kulkarni, adding that over the past year, SAN has been doing outreach and education in the South Asian American community to inform people of their benefits under the ACA. The organization has also enrolled a number of people in the Covered California health insurance exchange.

“Seniors don’t understand insurance,” asserted Kulkarni, recalling an instance when SAN was being interviewed by the Los Angeles Times. The reporter interviewed a gentleman from Bangladesh, who said he didn’t have insurance. “But he opened up his wallet and there was a Medi-Cal card,” she said.

Federally Qualified Health Care Centers (FQHCs) have also received a “bump up” as part of health care reform, said Kulkarni. “It was understood that they would be serving more clients.” FQHCs are a safety net for the undocumented, providing a lot of free, individual care to those who lack health insurance.

ACA mandates that $11 billion of additional funding would be allocated to FQHCs from 2011 to 2015 to serve 15 to 20 million more people by the year 2015.

In 2011, California Gov. Jerry Brown proposed a $100 million cut in state funding to the 36 California community clinics that receive federal funds. The proposal was blocked by the state Legislature.

“Many of the draconian cuts the governor had proposed have not gone through, but there’s just basically enough funding to maintain the status quo,” said Daniel Zingale, senior vice president of the Healthy California Team at The California Endowment.

Many Unaware of Benefits

Moina Shaiq, founder of the Muslim Support Network (MSN) in Fremont, Calif., also said seniors are unaware of the services they can avail of. While there are few resources for people who lack health insurance, the Tri City Health Center in Fremont – home to one of the largest concentrations of Indian Americans in the nation – offers sliding scale health care services.

The MSN holds a monthly meeting with local seniors to inform them about health care resources they can access, Shaiq said.

But Zingale and Mahal both contended that undocumented residents are loathe to accessing health care at community clinics for fear of somehow getting “under the radar” of immigration agencies.

“The basic [ethos] of the undocumented is that you don’t want to become visible to the system,” said Mahal.

“The spirit of the ACA was to provide health care access to all. We must now see how we can address the undocumented population,” said Manchanda.

Mahal thinks otherwise: “The desire to cover the undocumented – I don’t see that changing.”

Sunita Sohrabji wrote this article for India-West with support from the MetLife Journalists in Aging Fellows program, a project of New America Media and the Gerontological Society of America.

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