Bridging the access to healthcare gap  

By Amy Harris 

Accessing healthcare in the U.S. is complicated, even for those born here. For immigrants, the healthcare system can seem downright impossible to navigate. Nationwide, noncitizen immigrants are much less likely than citizens to have health insurance and to access healthcare. In 2020, 20% of Maine’s population was uninsured. Yet decades of research shows that those without regular healthcare are more likely to get sick, suffer from chronic conditions, and die younger.  

With support, Maine’s healthcare system can work for immigrants. Mohammed (who asked that his real name not be used for this article) is a refugee from Sudan who immigrated to Maine by way of Egypt in 2014. After he arrived, he had five eye surgeries and had his thyroid removed at Maine Medical Center. 

“Healthcare in the U.S. is 360 degrees different. In Africa, there is no insurance. If you have the money, the doctor will do your surgery, maybe even the next day. Here, in the U.S., things move more slowly,” he said. 

Because he received his vision-saving surgeries, today he can see.  He now works full-time at a large company, supports his wife and four children, pays taxes – and has health insurance for the family. But without help and advocacy from his Arabic-speaking neighbor, who helped him access care, Mohammed is not sure he would be able to see today.  

Some of Maine’s healthcare systems offer support services to help immigrants find, understand, and use insurance, get transportation to appointments, and benefit from interpreter and translation services. Others collaborate with nonprofits and other community organizations that offer these services. Case management is a mainstay of successful support, as are employing members of the refugee, immigrant, and asylum-seeking communities, and collaborating with community-based organizations. But many immigrants do still fall through the healthcare cracks, either because they do not know about the services available to them, are only eligible for emergency care, or don’t receive the case management they need.   

The case management model tailors help to a particular patient’s health needs, which can be complex, and multi-layered. Case managers determine a patient’s health situation, plan for and coordinate that patient’s care, and establish the most economical healthcare plan. Case management often works best when provided by people whose life journeys resemble a client’s own. Providers widely believe that employing immigrants improves access to care, reduces bias, and improves the quality of care for immigrants. 

Elizabeth Jackson, Chief Administrative Officer of Greater Portland Health, prioritizes hiring “team members who are originally from around the world to work in intake, financial assistance, revenue cycle, and community health worker positions, among others. This is incredibly valuable in supporting our patients in culturally sensitive and appropriate ways.”   

Maine’s largest healthcare system, MaineHealth, also prioritizes recruiting and hiring immigrants, refugees, and asylum seekers to their teams. Over the past 20 years, its Access to Care program has helped over 162,000 people statewide – including immigrants – get medical care who otherwise may not have been able to do so. But accessing care is so complicated that MaineHealth has six different teams working to eliminate barriers to care, such as transportation, homelessness, and language. CarePartners is their free program for people not eligible for MaineCare.  

Just as Mohammed’s neighbor helped him access healthcare, noncitizens often learn about the U.S. healthcare system through word of mouth and informal referrals. This is where community-based organizations like Maine Access Immigrant Network, Catholic Charities Refugee and Immigraion Services, and the many member organizations of the Maine Immigrants’ Rights Coalition located throughout the state, play a crucial role in opening the door to healthcare. Informal relationships formed through these community groups can help people find the affordable care they need. Collaboration with community-based organizations helps break down barriers to care – even physical ones.  To build trust and connection, MaineHealth Access to Care (located next door to Maine Access Immigrant Network (MAIN)), regularly walks clients from their office to MAIN. These are known as “warm hand-offs.”  

Greater Portland Health also frequently uses a “warm hand-off” model to introduce hesitant new clients to healthcare providers, after completing the enrollment process. Without community connections and personal relationships to build trust, noncitizens and those most in need of healthcare may never access it. This is especially true when seeking care for taboo health conditions such as mental health or sexual health concerns. Greater Portland Health frequently collaborates with In Her Presence, an immigrant-led organization focused on women, to help more people access healthcare and to find employees for GPH’s 12 locations in Portland and South Portland. 

Currently, six of the 87-member MaineHealth Access to Care team are from immigrant communities. According to Carol Zechman, Access to Care Senior Director, “Our focus has been on really trying to expand our workforce in Cumberland County to include people of color, New Mainers, and people from varied backgrounds, who bring perspective, patience, humility, and competence.” She acknowledged that the U.S. healthcare system is not intuitive. “You can’t know the ins and outs of the healthcare system unless you’re living and breathing healthcare coverage, 24-7. You can’t just Google it.”  

Amata Binti, a 39-year-old mother of three, earned her social work degree in Rwanda before coming to Maine in 2014. Hired by Access to Care in February 2020, at the beginning of the COVID-19 pandemic, she quickly applied her social work skills to “triaging New Mainers’ needs” over the phone in the five languages she speaks – English, French, Kinyarwanda, Lingala, and Swahili.  

Aline Uwanyiligira, now a Medical Outreach Case Worker for MaineHealth’s Coverage Team, remembers being scared upon learning she needed weekly doctor’s appointments after arriving in Maine, six months into her pregnancy.  An Access to Care social worker  not only helped her get health insurance but later recruited her to join the team. Seven years later, Uwanyiligira is grateful to MaineHealth and her mentor for hiring, supporting and promoting her career as a social worker. 

Noncitizens may be less likely to access or use healthcare because of fears about citizenship status, and worry that trying to get healthcare would lead to deportation or the denial of a green card. Numerous studies have reported increased fears about seeking both care and insurance. Binti and Uwanyiligira confirm this was especially true after former President Donald Trump’s administration changed immigration policy. Chantal Ruzindana, a social worker trained in Rwanda, her country of origin, frequently must reassure noncitizens that what they might have heard about dangers in accessing the U.S. healthcare system is untrue.   

Some worry that signing up for free care for themselves will impact other family members’ health insurance status. Kaiser Family Foundation reported that in 2020, one out of every four U.S. children had an immigrant parent, yet the majority of these children are citizens, with different rights than their parents. This can be confusing to understand and navigate. 

In Maine, where many recent arrivals live in temporary housing in hotels – or sometimes have to move hotels – accessing healthcare is further complicated by lack of transportation. Maine Association for New Americans (MANA) offers a free multilingual transportation service to take people to non-emergency appointments in southern Maine. MaineHealth Access to Care is researching shuttles to bring people from the hotels to appointments. And Greater Portland Health has providers working on-site at some hotels, and at a school-based health center in South Portland.  

For Maine’s communities to be healthier, all people need help accessing affordable health insurance as well as healthcare. Most healthcare agencies that offer support services for immigrants are clustered in areas of the state with the greatest numbers of immigrants.  MaineHealth’s Access to Care has 17 office sites in nine counties, and is expanding staff and offices in York and the midcoast region to meet increasing need, said Senior Director Carol Zechman. Lewiston has a number of immigrant-led health care organizations, such as New Mainers Public Health Initiative, with Gateway Community Services Maine having offices in Lewiston as well as Greater Portland. 

Employing dedicated foreign-born people like Aline Uwanyiligira, Amata Binti, and Chantal Ruzindana helps bridge the access-to-care gap for all Mainers. Their lived experiences as immigrants, combined with their insider knowledge and training about how Maine’s healthcare system works, make them critical to achieving better health for all.