Funders’ Efforts To Improve Health Of Immigrants

Funders’ Efforts To Improve Health Of Immigrants

Citing American Community Survey results, a 2020 Kaiser Family Foundation (KFF) fact sheet says that “22 million noncitizens” (including “lawfully present and undocumented immigrants”) lived in the US in 2018. Certain lawfully present immigrants can enroll in Medicaid, the Children’s Health Insurance Program, or the Affordable Care Act Marketplaces, but the undocumented cannot, the fact sheet says. Medicaid covers limited emergency services for the undocumented. Also, some states (such as California) and localities provide other coverage or help for some undocumented people.

Public charge policies govern how the likely future use of “public benefits may affect individuals’ ability to enter the U.S. or adjust to legal permanent resident” status (that is, get a green card), a 2019 KFF fact sheet explains. Under the Trump administration’s 2019 change to the public charge rule, for example, “non-emergency Medicaid for non-pregnant adults” and Supplemental Nutrition Assistance Program (SNAP) benefits could be newly considered “in public charge determinations.” In April 2021 the Department of Homeland Security (DHS) reversed the 2019 rule change, which had “contributed to reduced access to health care and other programs” for certain immigrants, says a May 2021 KFF issue brief. Going forward, Medicaid (except for long-term institutionalization) and SNAP benefits, as well as “medical treatment or preventive services for COVID-19, including vaccinations, will not be considered” in public charge determination, a DHS letter states.

An April 2021 Stat News article offers advice about vaccinating immigrants residing in the US: “Experts agree that door-knocking campaigns…are a crucial tool for contacting hard-to-reach populations—especially vulnerable immigrant communities that have been otherwise shut out from accessible vaccine information.” And a May 13, 2021, El Paso Times article discusses the “vaccine disparities on display at [the] El Paso-Juárez border,” noting that vaccines are far more readily available on the US side of the border.

In October 2020 the Bush School at Texas A&M University held a webinar on “Philanthropy in the U.S.-Mexico Border Regions: Myths and Realities” with Andy Carey from the US-Mexico Border Philanthropy Partnership (BPP). The BPP is legally incorporated in both countries. Its network includes foundations, governments, businesses, universities, and nonprofits, and it works in public policy advocacy, public health, and more. Among the several border “myths” that Carey highlighted in the webinar is that “a border wall would stem the opioid epidemic.” The BPP and partners also help Mexicans residing in the San Diego County, California, area gain access to health and wellness services at the Mexican consulate, which is considered a “safe zone.” This means that US immigration services cannot interfere with undocumented people there. Carey later told Health Affairs that the consulate now offers free COVID-19 testing and vaccines.

A small sampling of recent foundation efforts related to immigrants and border health follows.

Recent Grants

The California Endowment (TCE), in response to the “significant spike in violence” toward Asian American and Pacific Islander (AAPI) communities, announced that it will commit $100 million over ten years to “AAPI led power building organizations” across the state, according to an April 2021 press release. TCE aims to ensure that the groups have an “infrastructure that advances health equity, racial justice and transformative solidarity.”

The California Wellness Foundation’s Equity in Access funding portfolio “champions health care coverage and access for all and defends the rights of immigrants to enjoy access to health services, coverage and other benefits,” according to its website. The foundation states, “All people, regardless of immigration status, deserve access to public benefits.” It says that “because California is a border state and home to the highest number of immigrants” in the US, their needs are important. For example, in March 2021 the foundation awarded $750,000 in core operating support to the California Immigrant Policy Center “for public policy and communications efforts to preserve and expand access to vital health and human services” for immigrants in the state.

The Maine Health Access Foundation awarded $250,000 to Maine Initiatives (a public charity) to be used for the Immigrant & Refugee Funders Collaborative’s Immigrant-Led Organizations Pooled Fund. In 2021 the fund awarded new grants totaling $445,000 to forty immigrant-led and -serving groups on the front lines of COVID-19 response in Maine. Immigrants “have been among the most directly and disproportionately impacted” by the pandemic, according to Maine Initiatives’ website. Grantees’ activities include public health education and outreach and more. Other collaborative members include the Bingham Program and the Elmina B. Sewall Foundation.

As of May 2021 Con Alma Health Foundation, in Santa Fe, New Mexico, was able to leverage more than $1.5 million for its COVID-19 Relief for Immigrant Communities in New Mexico Fund from partners including the W. K. Kellogg Foundation, the Robert Wood Johnson Foundation (RWJF), the Annie E. Casey Foundation, and numerous other entities. The fund has supported “both relief and recovery efforts including direct assistance for New Mexicans who are immigrants, and recovery efforts to create awareness about the structural barriers to their well-being,” according to a press release. Also, Con Alma’s COVID-19 Emergency Assistance Project, which used a “health equity lens” in choosing grantees and was supported by RWJF funding, included a grant to the New Mexico Immigrant Law Center, according to a November 2020 press release. That grant included money for “legal representation, information and advocacy, including for immigrants in detention centers.”

Grant Outcomes

In May 2021, as part of its “The Dose” podcast series, the Commonwealth Fund released an episode titled “Sick in the Shadows: Why Immigrants Should Have Health Care.” Shanoor Seervai interviewed pediatrician Carrie Byington of University of California Health, who mentions the “real concerns for…unaccompanied minors,” many younger than age five, who are at the border, as well as for people in “mixed-status” families (some US citizens and some not) who may be fearful of getting testing or vaccination during the pandemic. Byington says that the university is caring for such minors and also is going into agricultural fields and to churches and workplaces to do COVID-19 testing and vaccination.

In April 2021 the UCLA (University of California Los Angeles) Center for Health Policy Research (CHPR) held a webinar titled “Immigration and Health: The Harmful Impact of ‘Public Charge’ and Other Policies.” Center researcher Susan Babey, lead author of a TCE-supported study using 2019 California Health Interview Survey data, discussed its findings. One in four “low-income immigrant adults in the state reported avoiding public services because they feared jeopardizing their own or a family member’s immigration status,” according to an e-alert.

The Paso del Norte Health Foundation (PdNHF) funded development of the Healthy Paso del Norte website, which contains “non-biased data” about a border region (also the foundation’s funding area) encompassing El Paso and Hudspeth Counties, Texas; three counties in New Mexico; and Ciudad Juárez, Mexico, according to a March 2021 PdNHF news item. The website includes data on diabetes incidence, engagement in physical activity, and access to health services, to cite just three examples. Health associations, public health practitioners, economic development entities, and others can use the website to inform decisions, compare health and quality-of-life indicators, and more, the PdNHF explains.

The first results of the Episcopal Health Foundation’s 2020 statewide Texas health policy poll were released in March 2021; immigration was one topic included. Nearly half of respondents said that state government was “not doing enough to make sure [immigrants] can get the health care they need.” SSRS conducted the poll in late 2020.

The New York State Health Foundation (NYSHealth) held an October 2020 webinar titled “Protecting Patients from Immigration and Customs Enforcement during COVID-19.” An e-alert explained the context: “The detrimental impact of immigration officials’ presence and enforcement actions at health care facilities [has been] especially acute during the pandemic.” One example cited was “patients shackled to beds and not permitted to use restrooms.” Often physicians and staff do not know “what rights they may have to challenge” such practices. The speakers shared strategies for protecting patients and discussed the importance of expanding protection policies during COVID-19, NYSHealth reported.

Published Work

The Migration Policy Institute (MPI) published “The Integration of Immigrant Health Professionals: Looking Beyond the COVID-19 Crisis,” an April 2021 issue brief. “Several states adopted emergency measures to rapidly expand the number of health-care workers,” including creating “pathways for internationally trained health professionals,” such as underemployed immigrants and refugees already in the US, to get licensed and practice. The brief, funded by the Open Society Foundations and the Walder Foundation, discusses future opportunities to draw from this pool of “underutilized workers with at least a four-year college degree in health or medicine,” according to a press release. They have “linguistic and cultural skills that could bring much-needed diversity” to the US health system.

The California Health Care Foundation (CHCF) has an emphasis on strengthening Medi-Cal (California Medicaid) as a means to help low-income residents get the care they need. It’s important to “get everyone covered,” regardless of income or immigration status, its website says. “Immigrants play such a huge role in California’s communities and economy,” Kara Carter, CHCFs senior vice president of strategy and programs, told Health Affairs. “We absolutely need them to be included in our health care system for California to be a healthy state.” In April 2021 CHCF reprinted a blog post by researchers at two grantee organizations, UC Berkeley Labor Center and UCLA’s CHPR: “Undocumented Projected to Remain California’s Largest Group of Uninsured in 2022.” The post reminds readers that “low-income undocumented children and young adults are [already] eligible for Medi-Cal under state policy.” The authors also note that most undocumented adults “are already enrolled in restricted-scope Medi-Cal” covering emergency and pregnancy-related services. But to get “California closer to universal coverage,” the “biggest step” would be expanding Medi-Cal to all low-income people regardless of immigration status, which policy makers have been discussing since 2014.

Key Personnel Change

Dolores E. Roybal,

long-time executive director of the Con Alma Health Foundation, retired in late May 2021. “She has been a passionate advocate for advancing health equity,” commented Deborah Walker, president of Con Alma’s board. Denise Herrera is Roybal’s successor, according to a May 2021 press release. Herrera previously was senior capacity building officer at St. David’s Foundation, in Texas. She has also worked for the RWJF.

Compiled and written by Lee L. Prina, senior editor