Efforts underway to expand care to undocumented immigrants with kidney failure
Click Here to Manage Email Alerts
Although progress has been made, undocumented immigrants with kidney failure are underserved and in desperate need of care, according to a presenter at Innovations in Dialysis: Expediting Advances Symposium.
“U.S. citizens have access to kidney replacement therapy because of the 1972 Medicare End-Stage Renal Disease Entitlement program, but for undocumented immigrants care varies,” Lilia Cervantes, MD, director of immigrant health, associate professor from the department of medicine at University of Colorado and member of Nephrology News & Issues Editorial Advisory Board, said. “They're excluded from Medicare, most Medicaid programs and the provisions of the Affordable Care Act. Across the country, some states have modified their emergency Medicaid program to include dialysis services or to include end-stage kidney disease (ESKD) as a qualifying condition, and so care varies throughout the country.”
Currently, there are an estimated 6,000 to 9,000 undocumented immigrants with kidney failure who are mostly Latino, male, employed, impoverished and had lived in the U.S. longer than 5 years before ESKD diagnosis, Cervantes said
In states where scheduled dialysis care is not included in emergency Medicaid, undocumented patients with kidney failure are given two options when they request care: they can choose to return to their home country for scheduled treatment or they can receive emergency dialysis every 7 days in the United States if their symptoms are considered severe enough. However, Cervantes noted that it is not uncommon that undocumented immigrants will arrive with extreme symptoms and still be turned away because the dialysis machines are unavailable.
Cervantes said that studies have shown undocumented immigrants experience burnout from these conditions and have described psychosocial distress and burdens on their children.
Policy changes
Large kidney organizations such as American Society of Nephrology, Kidney Care Partners, National Kidney Foundation, Renal Physicians Association and more showed support for Cervantes’ mission by urging all state Medicaid directors to modify state emergency Medicaid policy to include “outpatient and home dialysis and directed living donor kidney transplants as covered services.”
In the letter, the organizations detailed steps that each state can take to create change.
Similarly, Cervantes and a team presented a policy brief and economic analysis to the Colorado Medicare agency that led to an expansion of home dialysis in January 2022. Now, undocumented immigrants with ESKD can reapply for emergency Medicare on an annual basis instead of a monthly basis. Cervantes suggests that this will result in a positive change for undocumented kidney patients.
Looking to the future
Efforts are underway across the country to expand all health access for undocumented immigrants, and one recent success was the passing of Cover all Coloradans (HB22-1289).
“This basically creates a state Medicaid program for undocumented immigrants. It's the first one ever,” Cervantes said. “Undocumented immigrants under the age of 18 and postpartum persons for at least a year postpartum will now have access to our state Medicaid.”
“Our work does not stop here,” Cervantes said. “We are now working on community-based interventions to improve the wellbeing of U.S. citizens and undocumented immigrants that receive standard-of-care dialysis. We're also working on a proposal to improve transitions to recommended kidney replacement therapy for all people. We are all continuing to build on this work so that we can eliminate disparities.”
Reference:
Support letter for dialysis for undocumented people. support_letter_for_dialysis_for_undocumented_people_20210929.pdf (kidney.org). Published Sept. 29, 2021. Accessed Aug. 22, 2022.
Collapse
Cervantes L. 2022 Bill Peckham lecture: Dignity for all: Dialyzing the undocumented. Presented at: IDEAS; Aug. 15-16, 2022; Seattle (hybrid meeting).
Read more about
Click Here to Manage Email Alerts