About three years ago, Eduardo Mora, a deacon at Saint Mary Parish Church in Waltham, Mass., attended an enrollment event of the Latino Health Insurance Program. Mora, an Ecuadorian immigrant, was worried about the fate of his mother-in-law, whose leg had just been amputated in the hospital due to untreated diabetes.
Mora’s mother-in-law didn’t have health insurance. But it wasn’t because she didn’t qualify.
As a result of the event, the deacon got in touch with Dr. Milagros Abreu, founder and director of the Latino Health Insurance Program in Massachusetts.
“Many immigrants just don’t know how to navigate the system; they’re misinformed about the requirements needed for enrollment, and in many cases don’t even know they are eligible under a program,” said Abreu.
Not only did Mora enroll his mother-in-law in a health insurance program, but he was also able to enroll her in long-term care. But the Ecuadorian immigrant went further. Mora became a “case manager” for the Latino Health Insurance Program. In his church’s parish, the deacon helps parishioners who are legal immigrants from Guatemalan, Ugandan and Haitian fill out electronic health forms and translate the fine print.
Case managers like Mora also teach immigrant families simple but crucial information, such as notifying insurance companies if they change addresses or phone numbers. Information seminars take place in church basements, bodegas and beauty salons.
“Immigrants come here to work, to be productive,” said Abreu, who herself immigrated from the Dominican Republic more than a decade ago. “They just need the tools to be healthy and to become engines in their community.”
Helping people navigate the system
Abreu is an epidemiologist and faculty member at the Boston University School of Public Health. Years ago, while researching Latino children’s access to medical care, Abreu found that a large number of the immigrant children she saw did not have health insurance. Yet most of them were born in Massachusetts and were thus eligible for the state’s children’s insurance program.
In 2006, Abreu and her colleagues decided to conduct a randomized trial. She gave one group of legal immigrant families access to a case manager who guided them through the process of applying for state-subsidized or non-subsidized insurance and compared them to another group of families who didn't have any help.
The result? More than 90 percent of families with case managers successfully enrolled in health insurance, as opposed to fewer than 50 percent of the families without case managers.
With these results in hand, Abreu started the Latino Health Program in East Boston in May 2006 to help legal immigrants with lawful permanent resident status – so called green card holders – navigate and enroll in Massachusetts health insurance program.
Over the course of six months, they had enrolled more than 200 children and adults. Four years later, the program has helped about 3,000 families enroll in a health insurance plan. Abreu said that some families they helped enroll had not seen a doctor in 14 years.
“Not only are we making immigrant families healthier and more productive, but we are creating workforce development,” Abreu explained. “We train pastors and schoolteachers as case managers, and they not only help their community members with insurance enrollment but with information on healthy eating, chronic disease prevention and cancer screening.”
Abreu’s program does not receive state funding to pay the case managers; the program is funded through non-profits, foundations and local churches.
Even in Massachusetts, a state that requires that residents maintain health insurance, about 2 percent of the population does not have coverage. But of that 2 percent, more than 10 percent are Latino. According to Abreu and her colleagues, the reasons are varied.
Some immigrants fear that even though they are here legally as green card holders, if they “burden” the insurance system they lessen their family’s chances of obtaining citizenship. In many cases, immigrants are employed by small businesses that do not offer health insurance or who offer plans with high premiums. Yet many workers do not know that they qualify for other subsidized insurance plans.
Unhealthy immigrants, strained resources
The lack of health insurance, Abreu points out, has negative consequences that go beyond the uninsured individual. Immigrants without health insurance are more likely to wait until they are very sick and then use the emergency room, which increases the costs of the state insurance system.
A study done by Abreu and her team of researchers gave the example of a child who comes into an emergency room with uncomplicated appendicitis and spends about two days at the hospital, at a cost of about $2,000. But a child who comes in with a more serious perforated appendix and has to have a more complicated surgery will spend about a week in the hospital and it will cost about $100,000.
“As we start to implement healthcare reform at the national level, there have to be more programs like ours to help immigrant families navigate the insurance and healthcare process,” Abreu said. “Sometimes, the simplest facts are not a given in this community,” she added.
As Abreu seeks to obtain more funding and expand her program, she believes her model of community-based health care information works. She says it helps to achieve the reason most immigrants come to the United States. “Immigrants come to the United States because they want their families to progress. When they are healthy, the community progresses too.”