Physicians and their teams play an essential role in caring for asylum seekers, refugees, undocumented immigrants, and migrants. Clinicians may use this toolkit to better understand the background, healthcare coverage options and health considerations for this patient population.
Key Terms and Definitions
Asylum Seeker – A person who has left their country and is seeking protection from persecution and serious human rights violations in another country, but who hasn’t yet been legally recognized as a refugee and is waiting to receive a decision on their asylum claim. Asylum seekers are considered to be lawfully present in the United States.
Refugee (based on US law) – A person who is located outside of the United States and can demonstrate that they were forced to flee their country because of persecution or fear of persecution due to race, religion, nationality, political opinion, or membership in a particular group. Refugees may also include a person who is of special humanitarian concern to the United States. Individuals who qualify as refugees are afforded legal protections in the United States.
Migrant – A person who chooses to move not because of a direct threat of persecution or death, but mainly to improve their lives by finding work, or in some cases, for education, family reunion, or other reasons.
Undocumented Immigrant – A person who enters a country, usually in search of employment, without the necessary documents and permits.
Sources:
The Role of the Health Care Team in Caring for Refugees, Asylees, and Asylum Seekers
Resources for Physicians and Their Teams
- Refugee Health Guidance - The CDC recommends that asylum applicants arriving in the US receive a domestic medical examination. During this medical screening process, asylum seekers may be referred for a health interview or medical assessment performed by medical personnel. Persons who require treatment, including medical procedures beyond first aid, may be referred to a local health care facility. The CDC developed domestic and overseas medical screening guidance for clinicians who may see refugees during the resettlement process. This guidance includes a communication toolkit for migrants and refugees with limited English proficiency.
- Trauma-informed Care – A trauma-informed care approach may be appropriate for use among asylum seeker populations, as these patients are more likely to suffer from physical, mental, and emotional trauma. Detention in immigration facilities, even for short periods of time, may have long and short-term health effects for asylum seekers, including depression and post-traumatic stress disorder. This approach to care acknowledges that health care organizations and care teams need to have a complete picture of a patient’s life situation, past and present, in order to provide effective health care services with a healing orientation. Adopting trauma-informed practices can potentially improve patient engagement, treatment adherence, and health outcomes, as well as provider and staff wellness.
- The Physicians for Human Rights Organization – This organization connects physicians and other health care professionals with asylum seekers to conduct forensic medical evaluations. This resource provides training on working with asylum seekers, support placing physicians with asylum seeker cases, etc.
- Center for Victims of Torture – Asylum seekers may be survivors of torture and need specific resources to address their physical and mental health concerns. This organization supports clinicians who care for survivors of torture and provides resources including links to a US-based network of torture treatment centers, resources to support emotional well-being, and other resources to support torture survivors.
Health Coverage Options for Refugees, Asylees, and Asylum Seekers
- Applicants for asylum may be eligible for Marketplace-based coverage if they have an employment authorization or are under the age of 14 and have an application pending for a minimum of 180 days.
- Lawfully present immigrants, including asylum applicants present under humanitarian circumstances, may be eligible for premium tax credits and cost-sharing reductions if they meet income and other eligibility requirements.
- Generally, asylum seekers are not eligible for federal benefits like Medicaid until they have been granted asylum.
Example Benefits for Refugees/Asylees, Asylum Seekers, and Undocumented Persons
| Refugees or Asylees | Asylum Seekers | Undocumented Persons |
|---|---|---|
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May be eligible for:
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May be eligible for:
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May be eligible for:
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Sources:
- https://www.acf.hhs.gov/sites/default/files/documents/orr/orr_asylee_fact_sheet.pdf
- https://www.nilc.org/issues/economic-support/overview-immeligfedprograms/
- https://www.humanrightsfirst.org/asylum/frequently-asked-questions-asylum-seekers
Health Coverage Resources
- Health Coverage of Immigrants – This article outlines considerations that pertain to health coverage of immigrants, including access to coverage, eligibility for ACA coverage, and impact of the COVID-19 pandemic on different immigrant populations.
- Healthcare.gov Coverage for lawfully-present immigrants – This site explains coverage available for immigrants that are lawfully present in the United States. This site also offers resources in different languages.
- Office of Refugee Resettlement – This site explains health insurance eligibility and resources for refugees, including brief videos to introduce the health insurance marketplace to refugees (available in 6 language translations).
- Cash & Medical Assistance Resources – This site provides information on resources for eligible populations, including the Refugee Cash Assistance, Refugee Medical Assistance, and Unaccompanied Refugee Minors programs.
General Links and Resources for Asylum Seekers (to share with Your Patients)
- Benefits.gov – Provides immigration and refugee assistance resources (can be filtered by state)
- Lutheran Immigration and Refugee Services – This non-profit organization provides housing referrals, legal assistance, and job placement to asylum seekers.
- Asylum Seeker Advocacy Project – Provides legal resources to help asylum seekers navigate the legal system
- US Committee for Refugees and Immigrants – Provides a directory of local agencies to help connect individuals to local health care, education, and interpretation services.
Additional Background Information
The United Nations estimates that there are over 82 million forcibly displaced people worldwide, including 4.1 million asylum seekers. Many asylum seekers have a fear of persecution or a past history of persecution based on their race, nationality, religious beliefs, or other factors.
Understanding the Asylum Process in the United States
The asylum process is lengthy and complex. Asylum can be granted “affirmatively” by a U.S. Customs and Immigration Service officer. If asylum is not granted affirmatively, then the individual enters removal proceedings in immigration court where they can renew their asylum request. Asylum may also be granted “defensively” by a U.S. Department of Justice’s judge during a removal hearing if the individual does not request asylum at the border. Those requesting asylum at the border may be screened and detained. Upon arrival at a port of entry, the Customs and Border Patrol (CBP) ask the individual whether they have a fear of persecution or torture in their home country and whether they will seek asylum. They are then placed in custody of the Immigration and Customs Enforcement, which determines if the asylum seeker will be detained or released. If they demonstrate a credible fear of persecution, their case will be heard by an immigration court judge. *
*Source: “Literature Review on Implementation of 7-S21. Increasing Access to Healthcare for Non-Detained Asylum Seekers Living in the United States for the Health and Public Policy Committee” Crowley, Ryan. 16 February 2022.
More Resources on Health Concerns Among Asylum Seekers, Refugees, and Undocumented Immigrants
- About Immigrant, Refugee, and Migrant Health - CDC works to promote and improve the health of immigrants, refugees, and migrants and prevent the importation of infectious diseases and other conditions of public health significance into the U.S. by these groups.
- Medical Care for Undocumented Immigrants - Medical care for undocumented immigrants is a complex area involving challenges for accessing care, barriers in financing care, and unique medical conditions. Fear, stigma, cost, and cultural barriers often prevent undocumented immigrants from seeking medical care.
- National Resource Center for Refugees, Immigrants, and Migrants (NRC-RIM) - The National Resource Center for Refugees, Immigrants, and Migrants (NRC-RIM) is funded by the U.S. Centers for Disease Control and Prevention and the International Organization for Migration to support health departments and community organizations working with refugee, immigrant, and migrant communities that have been impacted by COVID-19. This includes a library of patient education materials in over 100 languages.
Resources in the Literature
- Improving primary health care quality for refugees and asylum seekers: A systematic review of interventional approaches (Iqbal et al., 2021)
- A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries - the 3C model (Brandenberger et al., 2019)
- Refugees’ experiences of healthcare in the host country: a scoping review (Mangrio & Sjogren Forss, 2017)