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Changing Demographics, Immigration Policy

Monday, April 13, 2015   (0 Comments)
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Changing Demographics, Immigration Policy, and Their Impact on Health Centers

Roger Rosenthal is the Executive Director of the Migrant Legal Action Program, a non-profit support and advocacy center located in Washington, DC. 

Rosenthal will present the session "The Complex World of Immigration Policy and its Impact on Health Center Patients and Providers" at the NWRPCA Spring Conference May 18 in Portland, Oregon. Click here for more information.


The United States today has more immigrants in its population than any country in the world.1 That immigrant population has been growing in every state, including, of course, the states served by Northwest Regional Primary Care Association: Washington, Oregon, Idaho, and Alaska.  This growth is occurring in both urban and rural communities in the region.  Following is a chart showing in particular years the percentage of the overall state population that is foreign-born.





Foreign-born Population as a Percentage of Total State Population




















Migration Policy Institute. (2013). [Tabulations of the U.S. Bureau of the Census’ American Community Survey (ACS) and Decennial Census]. State Immigration Data Profiles. Retrieved from  http://www.migrationpolicy.org/programs/data-hub/state-immigration-data-profiles


When demographic changes such as these occur, health centers have to adapt on a number of different fronts:  outreach, intake, ensuring access by all eligible individuals (including taking into account the need for language interpretation), ensuring appropriate services are provided to meet the needs of a changing population, and training of and professional development for staff (to educate employees about these demographic changes and how they will impact services and staff roles.)  Everyone would agree that this immigrant population is an important one to serve.

At the same time that diversity is growing in the region, the provision of health services is becoming more complex.  All immigrants are eligible for services from federally-funded health centers, and no immigrants should be barred based on their immigration status or language proficiency.  However, undocumented immigrant adults are not eligible for federally-funded Medicaid.  At the same time, the citizen children of these undocumented adults are eligible for assistance under Medicaid (or the Children’s Health Insurance Program), even if the parents are not.  Legal permanent resident children of undocumented individuals may be eligible for both programs, depending on their state of residence and the length of time they have resided in the United States.  Undocumented individuals are not covered by the Affordable Care Act, are not required to have insurance, and are not eligible for federal subsidies for such insurance, even if they are otherwise income-eligible for those subsidies.

Because we do not yet have comprehensive immigration reform, there have been several initiatives by the Executive Branch in the past several years which have resulted in new classifications of immigrants.  It is important that health center managers and staff understand who these individuals are and for what programs they may be eligible.

On June 15, 2012, the Obama Administration announced that certain undocumented youth who had entered the United States as children would be eligible for protection from deportation for a two-year period and able also to obtain work authorization for the same period if that protection from deportation was granted.  Youth granted this protection could apply for renewal of the protection at the end of the two-year period.  That policy is called the Deferred Action for Childhood Arrivals (DACA) program.  These children remain undocumented (although they are protected from deportation).  Health centers are, therefore, required to treat them as undocumented individuals for the purpose of determining eligibility for services.  This 2012 DACA program continues to be in effect.

On November 20, 2014, President Obama announced two new programs:  an expanded DACA program and a program called Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA).  The expanded DACA program, among other things, allows for a three-year protected status and allows applicants who are older than 30 to apply for that protection if they came to the United States as children or youth.  The DAPA program is intended to apply to undocumented parents of U.S. citizen and lawful permanent resident children and would protect the parents from deportation and allow them to apply for work authorization.  Currently, these two programs, the new, expanded DACA and the DAPA programs, are enjoined from implementation by a federal court.  Should either or both of these programs take effect, the individuals protected remain undocumented and should be treated as such by health centers.

Training opportunities such as at the NWRPCA Spring Primary Care Conference and online materials from organizations such as the National Immigration Law Center at www.nilc.org  help provide health center administrators and staff with up-to-date information which will facilitate access by and the provision of services to the growing immigrant population in the region.

1.  (Brown, A. (2015, March 9).  U.S. immigrant population projected to rise, even as share falls among Hispanic, Asians. Retrieved from http://www.pewresearch.org/fact-tank/2015/03/09/u-s-immigrant-population-projected-to-rise-even-as-share-falls-among-hispanics-asians/)


NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.


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