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Millions of children and their families who have a lawful right to receive health care may not be receiving it.
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When Immigration Policy Disrupts Health Care Access

By Sara Kramer | Wednesday, June 12, 2019

Photo by Omar Lopez | Unsplash

Health care providers want to provide the best care possible to their patients and communities, but this is not always easy. Clinicians must often treat patients quickly, which may not allow for time to develop trusting relationships and communication. They may not be aware of factors that may have an impact on a patient’s health beyond the walls of a hospital or clinic. These issues can include difficulty paying for care, lack of transportation, language barriers, and other factors linked to socioeconomic status, identity, and education level.

The team at the Children’s Hospital of Los Angeles (CHLA) Innovation Studio brings internal and external communities together to develop ways to solve complex pediatric care challenges. They have found that one of the most difficult of these challenges has been the unpredictability of US immigration policy and the major impact it’s having on the health of many patients and families.

Charlotte Cramer, MSc, a CHLA innovation strategist, explains, “In Los Angeles, 98 percent of children are lawfully residing. About 50 percent of our population identify as Latinx [a gender-neutral alternative to Latina or Latino] and one in four Latinx children have at least one undocumented immigrant parent.” This, Cramer says, means that children with a lawful right to receive care may not necessarily be getting it if they have parents who are not documented.

“Parents’ immigration status is significantly affecting their ability to provide their children with appropriate medical resources,” says Cramer. She describes a “culture of confusion and uncertainty” in immigrant communities in Los Angeles that’s leading to lower utilization of health care even when it’s needed. As news circulates about undocumented immigrants being detained when going to work or keeping court appointments, for example, “We’re hearing stories from providers about parents being nervous to take their kids to health care appointments, avoiding vaccinations, and being scared of getting on public transport,” says Cramer.

Cramer cites a Kaiser Family Foundation report that predicted that some changes to immigration policy would likely lead to decreased participation in Medicaid and the Children’s Health Insurance Program (CHIP) among legal immigrants and their citizen children, even though they would remain eligible. “One of their projections estimated that Medicaid/CHIP involvement could drop between 15 and 35 percent,” Cramer notes. “That’s an estimated 875,000 to 2 million citizen children not receiving the health care to which they are legally entitled.”

The challenges facing CHLA’s young patients are not unique to Los Angeles. According to CHLA, “Latinx youth are among the largest and fastest-growing youth populations in the US.”

Cramer sees CHLA’s innovation work as part of an evolution in health care toward addressing the full range of social determinants of health. “Especially as payers and providers work more closely together,” she remarks, “it becomes clearer that we must work in communities, and address [issues that include] food access, access to social services and health care, improvements in mental health, air quality, and transportation.” No matter where people live such factors influence the health of individuals and their communities.

Community Commitment

Discussions surrounding immigration policy can be divisive, but a shared commitment to the welfare of children helps unite the care providers at CHLA. They’ve been able get support throughout their organization by explaining the data on health inequities and outcomes and sharing stories.

To tap into the knowledge and insights of the community they serve, CHLA and Healthcare Information & Management Systems Society held a developer challenge earlier this year. They asked the public to help them identify innovative solutions to improve mental health care access, empower youth, and build community connections. The winners will get support from CHLA’s Innovation Studio, developers, and community organizations to make their idea a reality.

First-place winners MotiSpark want to deliver text messages of personalized videos that teach and reinforce coping strategies. MiTia, the second-place winner, is building a local social networking platform that provides health advice specific to the user from tias (influential older women) that is aligned with cultural beliefs and health evidence. TherapyforLatinx came in third place and hopes to provide a searchable directory for mental health services to help the community thrive and become advocates for their own mental health. It includes licensed therapists, resources, and community organizations.

Sara Kramer is an IHI Project Coordinator.

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