Advocacy

The CHPIC project aims to leverage advocacy at the state and federal levels to foster legislative sensitivity to immigrant issues and concerns. The promotion of change at a systemic level complements outreach efforts. Specifically, CHPIC has conducted advocacy on immigrant health insurance concerns i.e. confidentiality, and implications for legalization and citizenship.

Public charge is a term used by the Immigration and Naturalization Services (INS) to describe persons who cannot support themselves and who depend on public benefits for their support. Widespread confusion over public charge had long deterred many eligible people from enrolling in social services programs. CHPIC has effectively advocated to bring public charge issues to the forefront of the immigration agenda, influencing the release of guidance surrounding this issue from the White House in May 1999. The guidance declared that the use of Medicaid, CHP, or other health services by immigrants or their families will not affect their immigration status.

CHPIC has successfully advocated with the New York State Department of Health (NYSDOH) for changes in the unified CHP/Medicaid application to provide greater confidentiality protections for immigrants, and to ensure that the form is sensitive to cultural and immigration issues.

Although the public charge issue has been resolved, some insurance concerns still persist, such as sponsor deeming for Medicaid. If an immigrant family has been sponsored into the U.S. after December 19, 1997, its sponsor's income can be 'deemed' available to the immigrant family when it applies for Medicaid, and will be considered to determine whether the family members meet Medicaid's financial eligibility criteria. If family members were sponsored into the US under the new affidavit of support (the I-864), they may be asked to disclose why their sponsor cannot continue to support them. Furthermore, for families sponsored under the new affidavit of support (I-864), the sponsor is responsible for the repayment of Medicaid dollars used by the family. CHPIC is continuing to advocate at the federal and state levels to obtain resolution for the sponsor deeming issue.

Materials Development

At the beginning of the CHPIC project, the only CHP educational materials available were NYSDOH CHP brochures and health plan brochures. These did not specifically address immigrant issues, nor were they in immigrants' languages. CHPIC developed CHP/Medicaid immigrant-specific brochures through an extensive community-based process: a team of concerned organizations was formed to develop the brochure blueprint and content; the brochure was translated and back-translated into several languages (Chinese, Spanish, Bengali, Haitian Creole); and focus groups were conducted with the community at various points during brochure development. This has been a unique and important contribution to the process of ensuring access to health care for all children in New York.

Outreach and Education

The CHPIC project has conducted intensive outreach to non-English proficient immigrant communities in Queens directly and through partnerships with organizations and schools. Education about insurance, managed care, and CHP/Medicaid has been conducted at non-healthcare sites, such as consulates and religious institutions, English as Second Language (ESL) classes, grocery stores, banks, and beauty salons.

Computerized Eligibility Screening Tool (CEST)

Initial CHPIC enrollment activities revealed that CHP/Medicaid eligibility calculations done by hand had several problems. They were tedious, time-consuming, and prone to human errors. This led us to design and develop CEST, a tool to enhance efficiency in facilitated enrollment, accelerate learning for facilitated enrollers, and reduce errors, aiding in quality management/assurance.

Other Program Activities

CHPIC has conducted several complementary program activities to contribute to increasing CHP/Medicaid access for immigrant children.

A health plan survey was conducted to assess ease of access, and immigrant-friendliness of the plans. A feedback mechanism was established with the health plans. The Queens Borough President's Office and CHPIC together convened a meeting of advocates for children and health, and the health plan representatives, to discuss the findings of this survey. This dialogue paved the way for a new alliance, 'Partnership of Advocates for Children and Health Plans' (PACH). PACH has successfully collaborated within its members and in independent networks to bring to the forefront practical issues in immigrant enrollment and education.

CHPIC designed a course for students at John Bowne High School in Flushing, Queens, to learn about the healthcare system and managed care. Through a research-design class, a survey was conducted at the school to determine the health insurance status of the students and, if uninsured, to facilitate their enrollment.

CHPIC recently concluded a research project in conjunction with the New York University Master of Public Health Program (NYU-MPH), 'Assessing Community Health Needs For Child Health Services'. This project focused on the need for, access to, and utilization of, child health services in the community, specifically related to the impact of CHP. MPH students reflecting the diverse profile of immigrants in New York City developed and conducted needs assessments in a number of selected immigrant communities. The project assessed the extent to which immigrant communities access CHP, and the facilitators of, and impediments to, access.