Refugees are individuals forcibly displaced from their home countries due to political, economic, environmental, or military factors. Right now, the world is seeing the highest number of displacements ever recorded. The United Nations High Commissioner for Refugees (UNHCR) estimated that the number of forcibly displaced people rose to 100 million for the first time in 2022. Numbers continue to rise with the continued wars, conflicts, environmental conditions, and persecutions worldwide. When refugees do resettle, accessing quality healthcare is a major obstacle.
Refugees who are resettled in the United States have numerous barriers to accessing quality medical care due to their language, cultural, logistical, financial, and knowledge barriers. These barriers are exacerbated due to lack of health insurance access. Refugees resettled in the United States, often arrive with limited financial resources, and can suffer from a myriad of health-related problems and challenges, severely impacting their lives.
Tennessee ranks among the top twenty states for resettling refugees annually, coming in at number eighteen for total number of refugee resettlements in 2022 and over the past ten years. Refugees are a sizeable group in the United States and they contribute to the economic and social wellbeing of our country by revitalizing their local communities. Yet, many refugees are unable to access health insurance because of the system we have in place.
Medicaid and Refugee Medical Assistance (RMA)
The Refugee Act of 1980 was a key piece of legislation that provided a path to health insurance coverage for refugees but there are still many barriers to access. The Act allows for medical assistance to refugees through either Medicaid or the Refugee Medical Assistance (RMA) program. Medicaid, which is called TennCare in Tennessee, is a public health insurance program for low-income individuals. RMA is an insurance-like program that reduces healthcare costs for a short period of time after resettlement. Usually, RMA coverage lasts only eight months after resettlement. However, as a result of the COVID-19 pandemic, the Office of Refugee Resettlement (ORR) expanded coverage to twelve months, but the additional four months may be removed at any time.
A significant barrier to RMA coverage is the requirement that refugee-applicants must have already applied for, and been denied, Medicaid coverage. This cuts into valuable time for potential RMA coverage. Even if a refugee starts working on their Medicaid application the day they arrive, by the time they submit the application and wait for a decision, they have already lost many days that they could be covered under the RMA. Then, having to apply and wait for acceptance to the RMA program can take another month at a minimum. Though RMA coverage will be backdated to the day the RMA application was accepted, the final day of coverage is still eight months (or currently 12 due to the COVID expansion) from the applicant’s date of resettlement. Thus, having to apply and wait for a Medicaid decision reduces the length of time that an individual's coverage is active through the RMA.
Applying for Medicaid can also be a difficult process itself, made more difficult for individuals with limited English proficiency (LEP). Studies show that many refugees have a higher likelihood of interrupted healthcare coverage and are more likely to be completely uninsured. The uninsured rate among refugees is made more significant in non-Medicaid expansion states like Tennessee.
Refugees often do not apply for health coverage immediately upon arrival, placing them among the uninsured population. Individuals without health insurance often delay seeking healthcare and therefore do not receive preventative health services. Additionally, those who are uninsured often do not apply for health insurance until they really need it. Refugees fall in line with this trend, especially as their priority after resettlement is developing English language acquisition skills, and job hunting. The rhetoric around “public charge” also has a chilling effect on immigrants and refugees in seeking public health insurance. Altogether, while refugees focus on adjusting to a new environment and providing for themselves or their families, their timeline to access critical healthcare coverage is running out.
What do we take away from this?
To ensure refugees can effectively resettle and have a good quality of life, the federal government must make RMA a stronger program with less barriers. To improve the RMA program, two major policy changes should be implemented. First, the ORR should pre-register all arriving refuges into the RMA program for the allotted months, guaranteeing that all refugees have coverage from the moment they arrive. Access to these benefits would allow for healthier refugees, limiting healthcare and Medicaid costs in the long-term.
States that have not expanded Medicaid must do so. Overall, states that do not expand Medicaid end up with more refugees not obtaining health insurance. Many refugees in the South have a higher likelihood of interrupted healthcare coverage and are more likely to be completely uninsured. Even if the RMA program is improved, many refugees will still need Medicaid, and expansion will help them get the care they need without additional cost burdens as they become significant contributors to our economy as earners and taxpayers. Even if the RMA program is improved, many refugees will still need Medicaid, and expansion will help them get the care they need without additional cost burdens as they become significant contributors to our economy as earners and taxpayers.