Ask Emily: Health care advice for unauthorized immigrants and 'Dreamers'

Health coverage and immigration status are inextricably linked for many Californians.

Citizens and many lawfully present immigrants are eligible for most health coverage options.

For other immigrants, insurance availability varies by status.

If you are living in the country illegally, for instance, you can’t purchase a plan from Covered California, the state health insurance exchange, or get full access to Medi-Cal, the state’s Medicaid program for low-income residents. Your children, however, may qualify for comprehensive Medi-Cal benefits even if they don’t have permanent legal status.

But President-elect Donald Trump’s promises to crack down on unauthorized immigration and rewrite the health care system have hung a cloud of uncertainty over the heads of many immigrants.

As a result, many immigrants are unsure whether they should use the health coverage they currently have — and if those options will be available to them in the future.

"People are very scared. They’re doubting. They’re coming to us like we have all the answers, but we don’t have all the answers," says Celia Valdez, director of outreach and education for Maternal and Child Health Access, an advocacy group based in Los Angeles County.

I don’t have the answers, either, but I’m going to pass along some information and advice for these uncertain times.

The first and most important tidbit is this: If you currently have health coverage and you need medical care, you "should use it and not wait. Seek the services you need while they’re available," says Cary Sanders, director of policy analysis for the California Pan-Ethnic Health Network.

"No policies will change until at least after Jan. 20," which is Trump’s inauguration day, adds Priya Murthy, policy and advocacy director at Services, Immigrant Rights and Education Network in San Jose.

“If you have a doctor’s appointment, please go to your doctor to make sure you get the proper care you need,” she says.

Should you apply?

Open enrollment for Covered California began before the election and runs through Jan. 31, 2017. You can apply for Medi-Cal any time of year if you’re eligible.

You may fear that enrolling yourself or your children for coverage can expose you to unwanted attention from immigration officials. But advocates and state officials say that’s not the case.

"If you are eligible for Medi-Cal or Covered California, you should recognize there are laws in place to protect the confidentiality of any information you provide," says Gabrielle Lessard, senior policy attorney for the Los Angeles-based National Immigration Law Center.

The state Department of Health Care Services says it shares Medi-Cal enrollee information only with federal health — not immigration — officials, and only "for the purpose of administering the Medicaid program."

Health Care Services "takes its responsibility to safeguard personal health information seriously," the department says.

Covered California, too, assures Californians that "the information you provide to Covered California will not be used for immigration enforcement purposes."

The agency requires immigration details for those requesting coverage. But if you’re in the country without authorization and are applying for someone else, like your child, you don’t need to provide information about your own immigration status.

Still, after the election, advocates began to analyze California’s laws and policies to determine whether there are "vulnerabilities in the system … that could result in the sharing of a California resident’s information," says Ronald Coleman, government affairs manager for the California Immigrant Policy Center.

If there are, advocates will ask state lawmakers to strengthen privacy and confidentiality protections, he says.

For now, don’t be afraid to enroll, Coleman says. "Until we are able to see what the Trump administration is going to do, we would urge people to continue moving forward with applications for programs they’re eligible for."

Up in the air

Earlier this year, state officials asked the federal government to allow Californians who are in the country illegally to purchase health insurance from Covered California. (They wouldn’t be eligible for federal tax credits, so they would have to pay the full insurance premiums on their own.)

"That will probably not move forward," says Sarah de Guia, executive director of the Pan-Ethnic Health Network.

Also earlier this year, California made full Medi-Cal benefits available to the children of immigrants living in the country without authorization, using only state funding. Since then, about 153,000 of them have enrolled, according to the Department of Health Care Services.

Because this program relies on state — not federal — money, advocates expect it to remain in place, at least initially.

But if Trump and Congress dramatically alter or reduce funding to the Medicaid program, that could "potentially trigger big deficits within Medi-Cal, which essentially puts many Medi-Cal programs in jeopardy," Coleman says.

Dreamers

"Dreamers," those born after June 15, 1981 whose parents brought them to the U.S. illegally, are a group of immigrants with particular anxiety about their health coverage.

Via executive order, President Obama created the Deferred Action for Childhood Arrivals program, known as DACA, for that group in 2012. It defers deportation for two years, allows them to work and can be renewed.

People in this category are barred from purchasing insurance from Covered California, but they can sign up for Medi-Cal if they qualify.

As of June, there were about 214,000 immigrants with DACA status in California, Lessard says.

But Trump has vowed to "immediately terminate" Obama’s executive actions on immigration.

"For the DACA youth, it’s just devastating," Valdez says. "All questions are left unanswered. Folks are wondering, 'Should I be exposing myself?'"

Because of the uncertainty, the National Immigration Law Center is advising people who are thinking of applying for DACA for the first time to wait "until we have a better understanding of how things are going to unfold," Lessard says.

For those whose DACA status will be up for renewal soon, different groups offer different advice, but most suggest consulting with an immigration attorney or an immigrant rights group before moving forward with renewal.

But a related health question looms: If the DACA program ends, does that mean these young people’s access to Medi-Cal also ends?

That remains to be seen, advocates say.

"Originally we thought their Medi-Cal eligibility may be at risk," says Coleman. "That may not necessarily be the case if DACA goes away."

Twenty-year-old Yesenia, who asked to be identified by first name only, got DACA status right away in 2012. However, the Los Angeles resident didn’t sign up for full Medi-Cal benefits until last week, with the help of Maternal and Child Health Access.

For one thing, she needs her tonsils removed. For another, she’s worried about her future status. "Now with Trump, I have to get [Medi-Cal]," she says. "He says he’s going to take DACA from people."

Yesenia figures that once she’s enrolled in full Medi-Cal benefits, "it will be harder for him to take it away than if I didn’t have it."

But that’s just a guess. Mostly, she’s just unsure and uneasy.

"I don’t know what will happen," she says.

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.