Undocumented Immigrants and Access to Health Care in New York City

Octo­ber 14, 2015

New York City May­or Bill de Blasio’s plan, announced on Octo­ber 8, 2015, to cre­ate a pro­gram to improve health care access for immi­grants in the nation’s largest city incor­po­rates the prin­ci­pal rec­om­men­da­tion from an April 2015 report by The Hast­ings Center’s Undoc­u­ment­ed Patients Project and the New York Immi­gra­tion Coali­tion (NYIC).  The rec­om­men­da­tion for a net­worked pri­ma­ry care med­ical home sys­tem for unin­sured immi­grants was pre­sent­ed in Undoc­u­ment­ed Immi­grants and Access to Health Care in New York City: Iden­ti­fy­ing Fair, Effec­tive, and Sus­tain­able Local Pol­i­cy Solu­tions (See below for sum­ma­ry and link to full text.) Nan­cy Berlinger and Michael K. Gus­mano, co-direc­tors of the Undoc­u­ment­ed Patients Project, served on the Mayor’s Task Force on Immi­grant Health Care Access con­vened in 2014 to iden­ti­fy ways to meet the health care needs of thou­sands of New York City res­i­dents left out of the Patient Pro­tec­tion and Afford­able Care Act (ACA).

The pilot phase of New York City’s pro­gram, called Direct Access, will be launched in Spring 2016 with 1000 patients and an ini­tial invest­ment of $6 mil­lion from the Robin Hood Foun­da­tion and oth­er fun­ders. Data from the one-year pilot will be used to design a city­wide mod­el to provide reli­able, coor­di­nat­ed access to low-cost health care for immi­grants who are exclud­ed from fed­er­al and state insur­ance pro­grams such as Medicare and Med­ic­aid.  This pri­ma­ry care med­ical home mod­el reflects lessons from inno­va­tors in oth­er cities, includ­ing Los Ange­les and San Fran­cis­co, and makes use of the city’s exist­ing safe­ty-net resources to close health care gaps for New York City’s remain­ing unin­sured. This major reform on the part of New York City may also spur fresh think­ing about local solu­tions to a nation­al prob­lem of immi­gra­tion pol­i­cy and health care access.

Click for descrip­tion of NYC Direct Access plan. 

Click for NYC Mayor’s Task Force on Immi­grant Health Care Access. 

Cov­er­age of NYC Mayor’s Task Force report and rec­om­men­da­tions:

  • WSJ — Octo­ber 1, 2015
  • Reuters — Octo­ber 8, 2015

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Undocumented Immigrants and Access to Health Care in New York City

Identifying Fair, Effective, and Sustainable Local Policy Solutions

April 2015

Click to access the Report and Recommendations

About this report

This inde­pen­dent report is based on a meet­ing con­vened by the New York Immi­gra­tion Coali­tion and the Undoc­u­ment­ed Patients Project of The Hast­ings Cen­ter, which was host­ed by the Vera Insti­tute of Jus­tice in New York City on Decem­ber 11–12, 2014. The goals of this meet­ing were to sharp­en local stake­hold­ers’ under­stand­ing of gaps in access to health care for pop­u­la­tions left out of the Patient Pro­tec­tion and Afford­able Care Act of 2010 (ACA)—in par­tic­u­lar, New York City res­i­dents who are both undoc­u­ment­ed and uninsured—and to iden­ti­fy proven or promis­ing local solu­tions to clos­ing the­se gaps in oth­er cities, coun­ties, and states. Although this report and its rec­om­men­da­tions focus on chal­lenges and solu­tions in New York City, it may also be use­ful to oth­er New York State munic­i­pal­i­ties, and to oth­er cities and coun­ties in the Unit­ed States.

This doc­u­ment describes New York City’s undoc­u­ment­ed unin­sured pop­u­la­tion, the City’s safe­ty-net health care sys­tem, and the speci­fic gaps in cov­er­age and financ­ing that impede access to health care for this pop­u­la­tion. It also describes spe­cial oppor­tu­ni­ties and chal­lenges for health care sys­tem improve­ment in the City and com­pares mod­els that are proven or promis­ing as sus­tain­able ways to improve access to health care for undoc­u­ment­ed immi­grants and oth­er unin­sured pop­u­la­tions. It con­cludes with six action­able rec­om­men­da­tions for City stake­hold­ers, sup­port­ed by guid­ance for ongo­ing plan­ning, pro­gram devel­op­ment, and sys­tem improve­ment. The final draft of this report was pro­vid­ed to the Office of the May­or of New York City, Task Force on Immi­grant Health Access, Care & Cov­er­age Sub­group, on Feb­ru­ary 28, 2015.

Contributors

Nan­cy Berlinger, PhD, is a Research Schol­ar at The Hast­ings Cen­ter and the co-direc­tor of the Undoc­u­ment­ed Patients Project.

Clau­dia Cal­hoon, MPH, is Health Advo­ca­cy Senior Spe­cial­ist at the New York Immi­gra­tion Coali­tion.

Michael K. Gus­mano, PhD, is a Research Schol­ar at The Hast­ings Cen­ter and the co-direc­tor of the Undoc­u­ment­ed Patients Project.

Jack­ie Vimo, MA, is Region­al Advo­ca­cy Direc­tor at the New York Immi­gra­tion Coali­tion.

The authors of this report are respon­si­ble for the rec­om­men­da­tions that fol­low. The authors acknowl­edge the assis­tance of Mohini Baner­jee and Chelsea Jack, Research Assis­tants at The Hast­ings Cen­ter, in prepar­ing this report, which was designed by Nora Porter. The Decem­ber 2014 stake­hold­er meet­ing and the sub­se­quent prepa­ra­tion of a work­ing paper and this pub­lic report were made pos­si­ble by a dis­cre­tionary grant from The Robert Ster­ling Clark Foun­da­tion.

How to Cite this Report

Berlinger, Nan­cy, Clau­dia Cal­hoon, Michael K. Gus­mano, and Jack­ie Vimo, Undoc­u­ment­ed Immi­grants and Access to Health Care in New York City: Iden­ti­fy­ing Fair, Effec­tive, and Sus­tain­able Local Pol­i­cy Solu­tions: Report and Rec­om­men­da­tions to the Office of the May­or of New York City, The Hast­ings Cen­ter and the New York Immi­gra­tion Coali­tion, April 2015. Full text avail­able at: www.undocumentedpatients.org and www.thenyic.org/healthcare

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