Local support groups in Iowa estimate that nearly 2,000 refugees are feeling the impact of new eligibility rules for Medicaid that took effect early October. The requirements restrict refugees without a green card from being eligible for coverage.
Some local health departments are stepping in to fill the gap. They are warning that the shift could leave refugees without access to both basic and specialized healthcare.
In central Iowa, the Polk County Health Department has been working with community partners to update its website with information as well as legal and healthcare resources. It's also trying to create a safety net.
“It’s really about trying to patch together an informal care network across organizations — seeing who can take who for what and where we have to try to identify new resources,” said Juliann Van Liew, director of the Polk County Health Department. “When people don’t have access to care, that need doesn’t go away. It just shows up somewhere else in that health system or in somebody’s long-term well-being.”
Van Liew said the health department is suggesting that refugees turn to Free Clinics of Iowa, a volunteer-led healthcare agency that provides free services, or Primary Health Care, a health center that provides more affordable care."
She said health departments can be a resource too, but not in every community, like rural areas with smaller departments. The Polk County Health Department is looking at what additional services they would have the capacity to provide, she said.
But Van Liew said this change is going to impact a system that’s already strained. She said Iowa’s healthcare system is already overwhelmed due to funding cuts, but local providers still won’t turn uninsured people away.
“We do have some places to send people, but it’s not going to be the same kind of care that they perhaps could have gotten if we had a better system in place,” she said. “So, not a ton of places to send people.”
The Linn County Health Department in eastern Iowa is suggesting that refugees in the area look at the health resources sheet on the Linn County website. It includes a few free clinics in the Cedar Rapids area and the Eastern Iowa Health Center, which provides a sliding fee discount program.
Cindy Fiester, the chronic disease services coordinator at the health department, said even with resources in place to help fill the gap, she’s concerned refugees may stop seeking long-term care.
“But we are here to try to help people figure out if there is something that they qualify for that can take the place of their Medicaid coverage,” she said.
Fiester said it’s important that refugees exhaust all their coverage options, even if they don’t think they qualify for other kinds of health insurance.
The Linn County Health Department has insurance navigators, Fiester said, and they can connect people with the Public Health Insurance Workgroup of Eastern Iowa. It’s a group made up of different insurance agencies that help people apply for health insurance. She added that the statewide service Iowa Navigator can also help people figure out their options.
Fiester said language is an added barrier that makes this situation especially difficult. She said Linn County added an assistance request form to its website a few years ago to try to make it easier to ask for help.
“This assistance request form can be translated into many languages as a person uses it, and so they could submit their information requesting help with health insurance,” Fiester said. “And it’s an instant kind of intake, if you will, without the person having to use a translator or to have to have a phone call with someone.”
Helping refugees understand their options has been a priority for the Mary J. Treglia Community House, too. The Sioux City organization helps refugees overcome barriers with insurance, housing and employment.
Melissa Anderson, the organization's director of programs and family services, said free clinics are limited in Woodbury County, but one health agency, called the Siouxland Community Health Center, offers a “sliding scale.”
“They don’t turn anyone away for not having health coverage, but they also have it where the families can be put on a sliding scale going off the family’s income,” Anderson said.
But without more free or low-cost healthcare options, she said the Mary J. Treglia Community House is mainly just trying to help refugees understand the situation and figure out the next step.
“We are seeing the families starting to get letters from Health and Human Services, and they’re not understanding it, so they do bring it in to us and we explain it to them,” she said.
Depending on what the letter says, Anderson said the Mary J. Treglia Community House is reaching out to Iowa Department of Health and Human Services to see if renewing is an option, or they are helping refugees sign up for the community health center’s sliding scale. She said they are also helping a lot of their clients apply for other kinds of health insurance through their employer or find employment that offers healthcare coverage.
Anderson said the biggest concern is that some refugees won’t understand the severity of not having healthcare due to language barriers.
“Having to explain to them, ‘You no longer have health coverage,’ and them totally not understanding what that means," Anderson said. "They just think they can still go to the doctor’s office and not have to pay for anything."
The change could leave refugees without primary and preventative care, she said, and leave vulnerable groups like pregnant women, children and people with chronic illnesses without specialty care and prescriptions.
