Ricardo Correa of Lincoln Community Health Center assists the Ramos family in registering for the event
Ricardo Correa of Lincoln Community Health Center assists the Ramos family in registering for the insurance sign-up event. Photo credit: Hyun Namkoong

Many Latinos find themselves caught between immigration policies and health-insurance rules that make it difficult to sign up for coverage available through the Affordable Care Act before the Feb. 15 deadline.

By Hyun Namkoong

Hilario and Olivia Ramos and their 15-year-old son, David, walked out of Durham County Library with big smiles on their faces last weekend. For the first time, they had enrolled for health care coverage.

The Ramos family moved to North Carolina from Mexico more than a decade ago, and without health insurance they relied on community health services such as Lincoln Community Health Center in Durham to see a doctor. But after a two-hour appointment with a bilingual assistor from Lincoln at an Affordable Care Act enrollment event held at the library on Jan. 24, they found out they qualified for $800 in tax subsidies and enrolled in a plan that is affordable and fits their health care needs.

Ricardo Correa of Lincoln Community Health Center assists the Ramos family in registering for the event
Ricardo Correa of Lincoln Community Health Center assists the Ramos family in registering for the insurance sign-up event. Photo credit: Hyun Namkoong

“[The Ramos family] were super happy with their plan,” said Verlissa Mason, the bilingual assistor who helped them navigate the byzantine process of enrolling for coverage.

Mason said it’s a long process to enroll legal permanent residents like the Ramos because they have to get their identities verified before proceeding with their application on the federal health exchange marketplace.

Madison Hardee, a family-support and health care attorney for Legal Services of Southern Piedmont, explained in a NC Get Covered Coalition meeting earlier this month that online identity verification relies on credit history, something that many recently arrived immigrants don’t have, preventing them from submitting an application online.

This is one of the many hurdles that Latinos and other immigrants face in enrolling for coverage. Language and communication is another.

While the federal exchange marketplace and its hotline is available in Spanish, in-person assistance is especially critical for establishing trust for the Latino population, according to Ricardo Correa, outreach and enrollment coordinator for Lincoln Community Health Center.

“In-person assistance really makes a difference,” he said. “Let’s go back old school. Forget the phone and Internet.”

Immigration status

Kate Woomer-Deters, a staff attorney with the Immigrant Rights Project of the NC Justice Center, said fear, misinformation, language barriers and confusion about immigration statuses prevent many eligible immigrants from enrolling for coverage.

Most immigrant families in North Carolina have mixed statuses, meaning that some members have legal permanent residency while other family members may be undocumented.

Woomer-Deters said North Carolina had great numbers for enrolling citizen families, but that rates for immigrant families are much lower.

rooms of Durham County Main Library where assistors help folks find out about their different options for coverage
Assistors helped people learn about their coverage options in private rooms at the Durham County Library. Photo credit: Hyun Namkoong

The uninsured rate among children who are foreign-born Hispanics was more than four times higher than the uninsured rate among native-born Hispanic children, according to data from the Pew Research Hispanic Trends Project. And more than half of all foreign-born Hispanic adults between 18 and 64 are uninsured, compared to 27.8 percent of native-born Hispanic adults. At the time of the survey, only an estimated 15 percent of white adults between 18 to 64 were uninsured.

Woomer-Deters said two types of barriers exist for many immigrant families in receiving health care coverage: eligibility and access barriers.

“The rules simply say they cannot enroll,” she said.

Undocumented immigrants and immigrants who qualify for the Deferred Action for Childhood Arrivals, commonly known as DACA, do not qualify for coverage under the Affordable Care Act.

In November 2014, President Barack Obama announced a number of executive actions to expand eligibility requirements for DACA and allow parents, spouses and children of DACA immigrants to also request deferred action and employment authorization.

In 2012, an estimated 350,000 undocumented immigrants lived in North Carolina, according to the Pew Research Hispanic Trends Project.

North Carolina has one of the fastest-growing Latino populations in the country. From 2000 to 2010, the Latino population increased by 111 percent, according to the North Carolina Department of Health and Human Services.

While lawfully residing immigrants are eligible for coverage under the ACA, they are barred from receiving Medicaid or other public benefits such as food stamps for the first five years of their residency.

Woomer-Deters said only certain types of immigration statuses allow people to apply for Medicaid. These include refugees or people who have been victims of human trafficking.

“Medicaid is very complicated,” she said.

Stuck in the gap

For people like Claudia Campos, the state’s decision to opt out of Medicaid expansion has left her with virtually zero options for getting coverage. Campos walked away from the weekend enrollment event without enrolling for a plan.

Claudia Campos waits after finding out that she fell into the coverage gap caused by the state's decision to opt-out of Medicaid expansion.
Claudia Campos waits after finding out that she falls into the coverage gap caused by the state’s decision to opt out of Medicaid expansion. Photo credit: Hyun Namkoong

As a 28-year-old mother of two children with an annual income of $15,000, she doesn’t qualify for Medicaid or financial assistance.

Campos is one of an estimated 319,000 North Carolinians that fall into this coverage gap.

To qualify for Medicaid in North Carolina, eligibility is limited to parents with incomes below 43 percent of the poverty line, or about $10,427 a year for a family of four.

Campos said it is difficult for her to buy health insurance because she earns very little.

“I’m not going to have insurance,” she said quietly, in Spanish. “I’m sad because I thought I was going to get it today, but I can’t.”

Campos said she wanted to get coverage for emergencies or any other kind of accident that might happen to her or her family.

In North Carolina, a total of 458,676 people who do qualify signed up for coverage as of Jan. 16, according to the U.S. Department of Health and Human Services. Ninety-two percent of North Carolinians who signed up during the first month of enrollment qualified for financial assistance. But people such as Campos and her family are out of luck unless North Carolina chooses to expand the Medicaid program, as allowed for under the law.

Gov. Pat McCrory has publicly said that he would consider Medicaid expansion if the state can get a waiver to require employment or participation in a job-training program as a condition of Medicaid eligibility.

Stephanie Owens, a senior policy analyst for U.S. DHHS, said that while there is a lot of debate about Medicaid expansion, some states are being very creative about ways they might accept the funding that the federal government has made available.

However, Senate President Pro Temp Phil Berger (R-Eden) and Speaker of the House Tim Moore (R-King’s Mountain) have rejected the possibility of expanding Medicaid. Both leaders expressed doubt in a Jan. 14 press conference at the General Assembly that they would support expansion.

The Feb. 15 deadline is approaching fast and there will be 80 to 100 events held across the state to sign people up for coverage, according to Alec Hoffman, sales manager of Blue Cross and Blue Shield of North Carolina.

“If it’s anything like last year, there will be a huge surge at the end [because of] procrastination,” he said.

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Hyun graduated from the UNC-Chapel Hill Gillings Global School of Public Health in the health behavior department and she worked as the NC Health News intern from Jan-Aug 2014.