Migrating Away From an Exclusionary Healthcare System
Life, liberty, and the pursuit of happiness: the cost of the ‘American Dream.’ Immigrants are historically excluded from this right as they are repeatedly subjected to healthcare barriers in the form of identity and status verification, exacerbated by a lack of translated resources and services. Even more, navigating a new and foreign healthcare system is very taxing, as misinformation about plan benefits and tax credits runs rampant. Fear of detainment is another barrier preventing people with emergent needs from seeking care.
These compounding issues demand structural reform to increase healthcare access for immigrant populations. Georgia must commit to banning exclusionary policies and expanding immigrant information and financial assistance programs.
Nationally, only certain immigrants qualify for Medicaid and Children’s Healthcare Insurance Program (CHIP) benefits. Qualified immigrants include lawful permanent residents (LPR), asylees and refugees. However, lawfully permanent residents who have lived within the country for less than five years do not qualify for Medicaid or CHIP benefits. This discriminatory five-year waiting period is restrictive and outdated, contributing to health inaccessibility for many immigrants.
Further, foreign-born women have double the risk of lacking health insurance compared to U.S.-born women. While the CHIP Reauthorization Act of 2009 gave states the authority to remove the five-year waiting period for pregnant women and children, the legislation still leaves the rest of all immigrant women and undocumented children hanging on by a thread at best.
A core flaw is that this federal law was not binding. Twenty-one states, including Georgia, have yet to adopt this measure. Implementing this act would reduce Georgia’s maternal mortality rates and child uninsurance rates. Georgia needs to remove this five-year waiting period immediately to foster the well-being of immigrant individuals and increase the equity between non-citizens and citizens.
Refugee Medical Assistance (RMA) provides crucial healthcare coverage for individuals who don’t qualify for Medicaid. However, the 12-month eligibility period for RMA starts the moment a refugee arrives in the U.S., often without their knowledge. Many prioritize finding jobs and adjusting to life in a new culture, delaying their application for coverage. Additionally, waiting for a Medicaid determination can reduce the effective duration of RMA coverage.
As a result, too many refugees find themselves uninsured. Georgia and the Office of Refugee Resettlement (ORR) should pre-enroll refugees in RMA upon arrival, ensuring uninterrupted access to healthcare during their first year. This further grants refugees sufficient time to address any medical or mental health concerns that impede their self-sufficiency.
We also must apply for the waiver to allow Refugee Medical Assistance Coverage for Full-Time Students, an expansion passed in 2023 under ORR. This would enable refugee students enrolled full-time in higher education institutions that are ineligible for Medicaid but eligible for RMA to access benefits.
Deferred Action for Childhood Arrivals (DACA) recipients have faced similar exclusionary policies manifesting through information asymmetry. Many DACA recipients face barriers to healthcare: 20% lack health coverage, with many unaware of subsidies or worried about eligibility. As a result, 61% delay care, and 24% struggle with medical debt. This financial strain explains why many families skip dental visits, medical tests and do not fill or ration prescriptions.
Before November 2024, DACA recipients were not acknowledged as “lawfully present,” resulting in their alienation from Affordable Care Act (ACA) Coverage. While this eligibility criteria modification is a success, many will likely not know of this new policy. Launching a strong public outreach and enrollment program to enroll all eligible recipients is vital.
The National Immigration Law Center supports legislation like the LIFT the BAR and HEAL for Immigrant Families Acts to expand health coverage regardless of immigration status. The HEAL Act would remove waiting periods for LPR, open the ACA marketplace to undocumented immigrants and improve healthcare access for DACA recipients. Although this legislation poses challenges due to its large scale and complexity, its passage would be a landmark moment, illuminating the responsibility of states to ensure healthcare access for all.
The broader issue lies in exclusionary policies that restrict healthcare access for immigrant individuals. Georgia policymakers should work together to foster a healthier, more inclusive Georgia.
Ruhee Merchant is a third-year student at the University of Georgia studying Regenerative Bioscience with minors in Public Health and Spanish. She is a member of the healthcare group.