By Haley Nilsson, Summer intern

According to the World Health Organization (WHO), every human being has the right to the highest attainable standard of physical and mental health. Immigrants are not exempt from this right, though they often face barriers to receiving care.

Healthcare is often prohibitively expensive in the U.S., and many people cannot afford to pay for essential services out of pocket. Medicaid, a publicly funded health insurance program, provides relief for millions of people. Unfortunately, most immigrants are not eligible for the program unless they are U.S. citizens, lawful permanent residents, or fall into a state-specific eligibility category. It is paradoxical and dehumanizing that immigration status can be used to prevent vulnerable people from enjoying what is supposed to be a universal right. 

While some states have expanded Medicaid coverage to immigrants, Tennessee’s state program, TennCare, only provides health insurance to those who the state regards as “qualified” non-citizens. That category insures asylees, refugees, and victims of severe forms of trafficking. However, it leaves unprotected others who are among the most vulnerable: people who are granted Temporary Protection Status (TPS), and those who have pending asylum and Special Immigrant Juvenile (SIJ) applications.

In search of an expert perspective on the issue of immigrants’ access to TennCare, I reached out to the Tennessee Justice Center (TJC), a local non-profit that provides advisory and legal services to thousands of prospective TennCare enrollees every year. I had the opportunity to interview TJC Executive Director Michele Johnson and Casework Supervisor Diana Gallaher, both of whom have extensive experience supporting immigrants applying to public benefit programs.

Michele shed light on a striking statistic I had come across before the interview: the spread of Medicaid misinformation deters one in ten potentially eligible individuals from even applying. She suggested that due to confusing legislation many people wrongly assume that being an immigrant automatically makes them ineligible for TennCare.

Diana noted that many immigrants are also apprehensive about applying for TennCare because they fear that using federal aid programs will have an adverse effect on their immigration status. Currently, documented immigrants are eligible to apply for TennCare. Likewise, undocumented people can apply without penalty on behalf of an eligible child. 

Despite the protection that legislation grants immigrants today, Diana suggested that many immigrants are still traumatized from the Public Charge Rule: an administrative rule that, during the Trump administration, required that green card applicants not depend on public assistance including all services covered by Medicaid. In 2022, the Biden administration modified the rule so that eligible immigrants may use Medicaid except to finance long-term care. Even so, both variations of the rule unfairly label immigrants as an economic burden without regard to their needs as people.

Unsurprisingly, about half of all undocumented and one in five of lawfully present immigrants are uninsured. Lack of insurance, in turn, reduces immigrants' healthcare options to few other than the emergency room, where providers are required to stabilize, but not guarantee continued care for individuals who arrive in critical condition. 

Diana emphasized that current policy presents serious concerns for immigrant adults suffering from chronic illness. Necessary long-term care services can be difficult to finance if the recipient is not eligible for TennCare’s CHOICES category, as is the case with undocumented immigrants. These barriers to care represent a humanitarian crisis, as people suffering from untreated chronic illnesses are likely to experience greater difficulty supporting themselves and their families. 

When many people in our communities struggle to access healthcare, public health overall suffers. The National Academy of Science has found that high rates of uninsurance in a community are associated with lower average self-reported health status and greater severity of illness as measured by hospitalization rates. When people’s only option for healthcare is the emergency room, hospitals struggle to meet the demand, making access a challenge for both insured and uninsured patients. Facilitating immigrants’ access to healthcare would strengthen our communities as a whole, regardless of immigration status. 

The question largely remains regarding how Tennessee immigrants’ access to affordable healthcare may or may not change in the future. As it stands, Michele is not optimistic about the situation. Disappointment was evident in her tone when she said, “it is infuriating and shameful that Tennessee fails to protect immigrants’ right to health.”

Michele believes that policy change will have to be brought about by the federal government, which, in turn, will require building political will to universally insure children, a cause that might build common ground between traditionally opposing sides. In the meantime, Tennesseans can support their neighbors by fighting the spread of misinformation and volunteering at local clinics providing free or reduced-cost healthcare. Like all human beings, immigrants have a right to health, and thus should have access to affordable healthcare.

To learn more about TennCare and the resources available to those applying for coverage, please visit tnjustice.org/our-issues.