María had only been in the United States for about a year when the pandemic hit. She had entered the country without documentation and settled in Brooklyn, finding some work under the table preparing tamales and doing food prep at a restaurant. It was a brief period of relative calm. By late April, she was out of a job and experiencing the symptoms she’d seen on the news: loss of smell and taste, dizziness, diarrhea, persistent pain in the lungs, loss of balance. “I didn’t go to a doctor because I don’t have insurance,” she told me. “I didn’t have the money to pay.”
She tried to wait out her symptoms, but her condition eventually deteriorated to the point that she needed to go to the hospital. When she arrived, she was relieved to learn that her Covid-19 testing and initial treatment would be covered by Emergency Medicaid, a federal program that can extend Medicaid coverage to otherwise uninsured individuals if they have an acute medical emergency. While running other tests, medical staff also informed her that she had developed diabetes. It was concerning news. A chronic illness was something she hadn’t planned for, and the medical staff she encountered were concerned about what it would mean for her recovery.
Now, almost four months later, María is one of the many thousands of Covid “long haulers”—patients who have officially recovered from exposure to the virus but are still navigating ongoing health issues. She’s also lost her emergency insurance—which is only designed to cover immediately life-threatening situations—so she’s buying insulin and other medication from a local clinic. Money is tight though, and she’s been worried that she won’t be able to pay for it much longer. She recently paid $80 for medication for acute gastritis and lung inflammation, while the rent bills keep piling up. As an undocumented immigrant, she was not eligible for any federal relief programs, and the food she gets from a local aid organization only goes so far. Last week, María started working again, this time cleaning houses. “I feel so much pain in my lungs as I’m cleaning,” she said. Still, she doesn’t see an alternative.
She’s not alone in that predicament. Many states have clarified that testing and treatment of an active Covid infection must be available to all and can be covered with Emergency Medicaid, but there’s been little discussion about what happens afterward. Under federal law, hospitals and medical providers in general must tend to people facing immediately life-threatening conditions but are under no obligation to keep providing care to an uninsured patient who is not in a state of emergency, even if the lack of treatment will trigger just such a situation. That describes María and other insurance-ineligible immigrants hoping to recover from the long-ranging health catastrophe that is Covid-19. Without long-term aid from the state, though, they are essentially left on their own.
The effort to make health care affordable and accessible for immigrants without status has been active and shifting for decades. Undocumented people were explicitly excluded from the marketplaces created as part of the 2010 Affordable Care Act, and activists were outraged when even recipients of the Deferred Action for Childhood Arrivals program were locked out of coverage. Currently, people without legal status remain ineligible for standard Medicaid, the Children’s Health Insurance Program, and the federally funded health insurance marketplaces. In certain emergency circumstances, they can qualify for Emergency Medicaid, though as cases like María’s make clear, the program is inflexible and largely exists as a temporary bandage.