Photo Courtesy of San Francisco General Hospital and Trauma Center.

Dear La Receta,

I’m 42 years old and I’ve been living in San Francisco for the past nine years. In that time, I’ve never seen a doctor, but lately I’ve been feeling sick. The problem is that I don’t have health insurance and I’m undocumented. I’ve heard that there are programs out there that can help, but I don’t know where to go or if I even qualify for those services. I’ve also heard that signing up for those programs can make becoming a naturalized citizen very difficult. What should I do?

—Preocupado in the Mission

Dear Preocupado,

There are a lot of misconceptions out there regarding health care for undocumented immigrants. And unfortunately the fierce debate this issue has incited between those who feel that access to healthcare should be available to everyone who needs it and those who feel that it should only be available to some have not helped debunk these half-truths. High costs and lack of access often put basic medical care out of the reach for many people. A recent report by the Kaiser Foundation reported that financial hardship and a lack of affordable insurance was the most commonly cited barrier to healthcare for undocumented Latinos. The same report also found that undocumented Latino adults used fewer physician services than other Latino or non-Latino adults. Another study published in the Archives of Internal Medicine found that undocumented Latinos reported a higher degree of difficulty in obtaining care, more negative experiences associated with healthcare, and poorer health than U.S.-born Latinos or whites.

So to answer the last part of your question first, it is true that signing up for certain government assistance programs can be taken into account when you apply for citizenship, as can age, income, family size, health and education. However, the ICE does not consider non-cash benefits such as healthcare and food stamps when determining eligibility for citizenship.

Wading through all of the government-run healthcare programs can be difficult. You may have already heard about programs like Medi-cal, Healthy Families, Healthy Kids and Healthy San Francisco. Not all of these programs are available to undocumented immigrants. Who qualifies for which programs is information that can be confusing and hard to come by. I’ll do my best to help you sort through it, but your first step should be to call the San Francisco Health Plan Enrollment Team or stop by San Francisco General Hospital to set up an appointment. With that, let’s talk a little about the different programs.

Medicaid is for those who can’t afford medical care. It pays for some or all of their medical bills. Medicaid is a state-run program and each state sets its own guidelines regarding eligibility and services. In California, our Medicaid program is called Medi-Cal, and it is only available to uninsured California residents who are US citizens, nationals, or eligible qualified immigrants, such as refugees, asylum recipients, and some victims of violence or trafficking. In San Francisco, your monthly income for a family of four has to fall below $3,675 to qualify. The reason that it’s important to know about Medi-Cal is that children who are US citizens will qualify even if their parents do not.

Then there are the Healthy Kids and Healthy Families programs that are designed to cover children and pay for items such as doctor visits, hospital and emergency care, prescription drugs, immunizations, pregnancy care, and mental health services among other things. Eligibility for these programs is also based on income but, generally, only the Healthy Kids program is available to undocumented immigrants. For the children in a family of four to qualify, you must earn less than $5513 a month. The cost to use the program depends on your income and family size, and ranges from $48 to $189 a year.

Finally, there’s the Healthy San Francisco program. Healthy San Francisco is a new program created by the city of San Francisco to improve access to affordable health care services for uninsured residents. It started in 2006 with the passage of the Worker Health Care Security Ordinance and is run by the Department of Public Health. It currently covers 49,107 San Francisco residents.

Participants in the program choose a clinic or hospital where they will see their primary care doctor and receive preventive and urgent care. The current network includes several clinics, hospitals and private providers all over the city. The program covers preventive and routine care, prescription medicines, specialty care, urgent care, emergency care, hospital care, and mental health services, among other things. It even covers the cost of an ambulance, but only for emergencies.

To qualify for Healthy San Francisco, you need to be an uninsured San Francisco resident between the ages of 18 and 64 with a monthly income of less than $9190 for a 4-person household (or $4515 if you’re single). Documentation status does not matter for this program. The cost to participants ranges from free to $1800 a year depending on your income and household size. There may also be a small fee at the time you receive services, but this is also based on your income.

One drawback to the Healthy San Francisco program is that it doesn’t cover everything that traditional medical insurance would cover, such as dental, vision, and long-term care. It also doesn’t provide coverage outside of San Francisco, so if you need to go to the hospital outside of the city, you will not be covered.

It’s also important to remember that if you have an urgent medical problem, any emergency room is required by law to treat you, regardless of your financial or migratory status. Many of the hospitals in San Francisco have reduced fees for emergency services based on your income, or may even waive the fees entirely. You should also know that since 1989, San Francisco has been a “sanctuary city,” which means that city employees are prohibited from helping Immigration and Customs Enforcement with immigration investigations or arrests, except when required by federal or state law or a warrant.

Navigating the healthcare system can be scary, especially if you’re undocumented. The stress of feeling like you’re always one accident away from poverty or one phone call away from deportation can be overwhelming and a real barrier to healthcare for many people. I’m worried that by putting off getting medical care, you may be ignoring a medical problem that will get worse without treatment, Precupado. Please call the San Francisco Health Plan Enrollment Team or stop by San Francisco General as soon as possible.

San Francisco Health Plan Enrollment Team
201 3rd Street, 7th floor San Francisco, CA
You can also stop by the San Francisco General Hospital Billing Office in Ward 24 or call them at 415-206-8448 to get started.