When I visit free and charitable clinics across the country, I often hear it is one of the community’s best-kept secrets. What isn’t a secret among those who know the clinic is immigrant healthcare is often provided without worrying about legal status. Free and charitable clinics serve all comers who meet their criteria, which almost never includes citizenship status. Care for immigrants is a “secret” only in that it is generally not discussed or publicized – it’s simply assumed as a given,
Free and charitable clinics are defined as “gap-fillers”. The provision of health care to immigrant populations is most certainly a gap everywhere in the United States. Immigrant populations are ineligible for care supported by federal funding. An individual may meet all the requirements for publicly assisted care – low income, residence in a community, etc, but lack of legal residency excludes them from coverage.
This makes immigrants a logical population to be served by free and charitable clinics.
Most clinics in our sector serve this group without question – consistent with clinic values. Unfortunately, they are often limited to in-clinic services because referral services used for others may not be available for illegal residents.
Three challenges, among many, stand out in delivering charitable healthcare to immigrant populations:
- Sensitivity to cultural norms. Cultural norms that may differ from other groups served may require adjustments in approach and delivery of care. Gender norms within a family may require involvement of family units in a manner different than a typical patient. In some cultures, the concept of “free” is viewed as sub-standard and there is a strong desire to make some sort of contribution to offset the cost of care, for example. There are many other specific norms that must be understood and accommodated.
- Sustaining support. While it may be well known by those familiar with the clinic that immigrant populations are served, it can present challenges in securing funding and support from less-aware prospects. Limitations may be placed on certain funds – public or private – that limit use to exclude immigrant populations. If a clinic is to accept such funds, they must be certain that such requirements can be kept. Also in promoting awareness and general support from the overall community, a clinic must have heightened awareness of differing community attitudes that may exist in regard to providing for this population. A clinic must be prepared for a full range of response and be prepared to be celebrated or rejected because of this service.
- Creating a safe environment. During times of heightened political sensitivity around immigration issues, a clinic must create an environment that is “safe” for those whose immigration status is questionable. Some people generally assume health care means government, and if there is a medical record they may be reported to the authorities. Some assume a health clinic may be a target for immigration authorities. Clinics must be diligent in reassuring patients and immigrant communities that they will be safe in seeking service from their facilities. They must be consistent in their messaging to immigrant communities and advocates that their services are available to this population. Any clinic that serves an immigrant population should have protocols in place on how to respond should immigration official appear at the clinic to check credentials. Remember – it is difficult to build trust, but very easy to lose it.
As political winds change, policies and practices in regard to immigrant populations will change and evolve. It is important that clinics stay abreast of these changes and the potential impact they may have on their clinic and its mission. Staying current will help keep your patients safe.
Finally, a story from an ECHO Partner, the Center for Healing and Hope in Goshen, Indiana:
When this clinic was founded, service to immigrants was specifically referenced in their mission statement. Recognized as a significant community need, this clinic specifically established itself to meet this need, among others.
When the political climate regarding immigrants significantly shifted with the 2016 election, rather than mute their mission, The Center for Healing and Hope proclaimed it anew. If anything they re-emphasized it! Their community has responded favorably. They lost a very small number of donors, and gained far more donors specifically because of that awareness. This clinic gained a higher level of community acceptance and support through emphasizing their mission of service to all.
How would your community respond in similar circumstances?