Piloting ‘Direct Access’ to Health Care in NYC

Mayor Bill de Blasio holding his IDNYC. The new identity card should help undocumented to receive "Direct Access" health care. (Photo by William Alatriste via Gotham Gazette)

Mayor Bill de Blasio holding his IDNYC. The new identity card should help undocumented immigrants to receive “Direct Access” health care. (Photo by William Alatriste/Flickr via Gotham Gazette)

The challenge of offering and ensuring health care to all of NYC’s undocumented residents is great. Young people who have registered under the Deferred Action for Childhood Arrivals (DACA) may qualify for state Medicaid coverage, but most undocumented immigrants are not covered by the Affordable Care Act. The New York City Health and Hospitals Corporation (HHC) and community health centers have traditionally been providers for uninsured New Yorkers, but that care is often accessed only in emergencies, and preventive and continuous care is not offered in a systematic or affordable fashion to the undocumented.

Mayor Bill de Blasio is proposing to offer “reliable and coordinated access to affordable care” to the nearly 350,000 undocumented immigrants in the city without any form of health coverage or insurance. A pilot for this proposed “Direct Access” program is to be rolled out in 2016.

The pilot, costing $6 million in public and private funds, is slated to cover about 1,000 people. Sarah Betancourt in Gotham Gazette reports on differing views of the pilot.

Dr. Ramin Asgary, professor of population health at the NYU School of Medicine, is skeptical. “The thinking is right, but it is nothing and close to a joke,” he said of the plan and its affect on the overall population of uninsured undocumented New Yorkers. “On paper they can say we are doing something, but it is a drop in a bucket in the ocean.”

But Nancy Berlinger of the Hastings Center for Bioethics and Public Policy thought that the small start made sense.

“You don’t want to launch a citywide program and then realize you don’t have enough doctors, social workers, and nurses,” she said. “You make a commitment to people when you promise ‘direct access.’” The Hastings Center co-released a report on immigrant health care access with the New York Immigration Coalition (NYIC) in March with recommendations for the mayor’s office.

The Direct Access program, writes Betancourt, “aims to address four issues for the undocumented uninsured: language barriers; coordination shortfalls between health centers and hospitals; lack of education of healthcare options; and the mountain of high-priced services.” New York’s IDNYC program should facilitate verification of identity and residency in New York.

For an analysis of the landscape for health care services for NYC’s undocumented, and more reactions to Direct Access, go to Gotham Gazette.

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