OLYMPIA — By the close of Washington's legislative session last week, state lawmakers had added more funding to help reduce health care insurance costs for undocumented immigrants, as the state also prepares to expand Apple Health, its free or low-cost health insurance, to the same population in July.
This year, the Legislature added $28.4 million, nearly twice as much as its first allocation of such funding during the 2023 session, to continue helping the 16,000 individuals who applied for coverage during the recent enrollment period, which ended Jan. 15.
In May 2022, Washington was the first state to file a waiver application to allow undocumented immigrants to buy private health insurance; a year later, the waiver was approved by the U.S. Department of Health and Human Services and the Department of the Treasury.
The waiver meant undocumented immigrants could apply for Medicaid or shop for private health care insurance through Healthplanfinder, the website to apply for health care in Washington.
Mixed-status families, or families with different citizenship or immigration statuses, can also purchase private insurance coverage together.
With the waiver, anyone facing significant life changes such as job loss, change in marital status, birth of a child or other circumstance may be eligible to apply for private health insurance during special enrollment periods — regardless of citizenship.
Undocumented immigrants are also eligible for assistance through the federal government's Premium Tax Credit program.
"You have almost two opportunities of savings to bring down that monthly premium," said Wynne McHale, chief of staff at Washington Health Benefit Exchange, the state agency coordinating Healthplanfinder.
It's illegal for states to use federal dollars on undocumented people, so Washington can only use state dollars to try to help bring down the cost of health care.
Each undocumented individual can get up to $250 off their monthly cost when purchasing private health care insurance through Healthplanfinder, according to Genevieve Arredondo, associate director of outreach at Washington Health Benefit Exchange.
The cost for private insurance for undocumented immigrants can vary depending on income and family size, but the average monthly cost after the discount is applied is $210, Arredondo said.
Many low-income undocumented immigrants can't afford to pay hundreds of dollars a month in premiums just to access health care, said Catalina Velasquez, the executive director of the Washington Immigrant Solidarity Network, who marched last month in Olympia to advocate for health care and unemployment benefits for undocumented immigrants.
According to state Rep. My-Linh Thai, D-Bellevue, only about 8,000 to 10,000 of the 16,000 undocumented individuals who applied via Healthplanfinder were covered under the funding the Legislature allocated last year.
These programs heavily rely on budget provisos — without passing a bill, they aren't officially a law. If funding stopped, these health care services would no longer exist. The goal is to have a bill that would make these programs permanent, Thai said.
Starting in July, Apple Health will expand to undocumented immigrants with incomes below 138% of the federal poverty level to cover medical, dental and behavioral health services.
Data from the 2019 Migration Policy Institute showed Washington's undocumented population is 246,000; half of this population is uninsured and almost a quarter live below the poverty level.
Many undocumented immigrants work labor-intensive jobs with occupational and environmental hazards, Velasquez said. If they need health care, their only option is going to an emergency room with limited services or a community health clinic which can be saturated and underfunded, Velasquez said.
When undocumented immigrants reach the emergency room, the care they receive is partial, and there's never a proper follow-up, Velasquez said. The hospital bill ultimately gets paid through taxpayer money or charitable donations, Thai said.
Reducing these emergency department visits and increasing access to preventive care is less costly, Thai said. It also reduces cancer rates, HIV and other preventable illnesses, according to Velasquez.
Many immigrants have distrust toward the government, Velasquez said. While this safety net is finally being extended to this community, people may be reluctant to use it because of fears of public charge — instances when an immigrant's pathway toward citizenship becomes jeopardized, leading to denial of a green card or American citizenship — if they use government assistance.
"We can't just go from never having access to health care for immigrants to expecting immigrants to trust government agencies and apply," Velasquez said.
According to Velasquez, the government will need to use community members and grassroots organizations to help build trust and get the word out.
The Washington Health Benefit Exchange has more than 3,000 individuals across the state to help people, free of charge, get connected and see what health care they qualify for, McHale said.
Velasquez said some people may believe that immigrants come to the United States to simply take government handouts. She said immigrants are building cities in the state, picking produce in the fields and contributing to the greater sociocultural fabric of the state.
"We're just like any other human, we get sick," Velasquez said. "We know our health is interconnected, and it's not about free health care for immigrants. It's about a healthier Washington."
