Municipal IDs help prevent medical mishaps, provide access to care

Houston-based Memorial Hermann was recently under fire after clinical staff called police to report an undocumented immigrant who presented a fake ID along with her valid private insurance card at a clinic within the system.

The health system said staff were unaware of Blanca Borrego's residency status and expressed regret over her arrest. It said it is re-evaluating its processes following this “unique event” that had “nothing to do with immigration or residency status.”

But the incident puts the spotlight on the challenges of providers who care for the undocumented, 60% of whom don't have insurance, according to the Healthy Americas Institute at the University of Southern California's Keck School of Medicine, a research center focused on improving health in Hispanic communities.

Not all providers ask for identification when patients check in, but many do; it's often required by manuals created by payers, said Laura Palmer, a senior fellow at the Englewood, Colo.-based Medical Group Management Association. Emergency departments, on the other hand, must evaluate and stabilize all patients who come through their doors, regardless of their ability to produce identification.

Dr. David Ansell, senior vice president for system integration at Rush University Medical Center in Chicago, has been a strong advocate for undocumented immigrants' healthcare. He said Rush staff generally asks patients for some form of ID to identify allergies and pre-existing conditions. They're less concerned about ID validity and more concerned that the patient's photo identification matches their medical record, he said.

“We just want to properly identify someone, not properly identify their identification,” Ansell said.

To that end, a few U.S. cities have provided municipal IDs to undocumented immigrants and others, independent of state and federal agencies, which may inquire about legal status. Though their uses differ across the country, the IDs can often be used to access health and social services, open bank accounts and prove identity during interactions with local law enforcement.

The move has been politically charged, since many argue it allows the undocumented to enjoy some U.S. benefits.

IDNYC, the free identification card New York City launched in January, provides residents with prescription-drug discounts, among other services. Mayor Bill de Blasio's administration has provided significant outreach and education about the ID, said Nisha Agarwal, commissioner for the mayor's office of immigrant affairs in New York. “I think the theory behind the ID card is that New Yorkers are better off with government ID than without it,” Agarwal said.

So far, 530,000 people have signed up for the program. Prior to the municipal ID program, the not-for-profit New York Immigration Coalition often worked with foreign officials to provide undocumented individuals with IDs from their native countries' consulates, said Claudia Calhoon, the coalition's director of health advocacy.

New York City Health and Hospitals Corp., which runs the city's 11 public hospitals and various clinics, does not require any ID, nor does it inquire about immigration status, Agarwal said. In 2011, HHC also wrote an open letter to immigrants that was translated into 12 languages, explaining that they should not be afraid to see HHC providers. The system promised to keep their legal status confidential and treat immigrants regardless of their ability to pay.

Many advocates point to community and migrant health centers as a safe place for undocumented immigrants to access care because many centers don't ask for an official ID.

Particularly in migrant health centers, legal identification often isn't a factor because undocumented agricultural workers rarely have insurance, so there is less concern about identity fraud, said Bobbi Ryder, president and CEO of the National Center for Farmworker Health. But some health centers take photos of their patients when creating their medical record to verify their identity for future visits, she said.

A spokeswoman for the National Association of Community Health Centers, which represents 9,200 facilities in the U.S., said its goal is to provide preventive care over expensive and often unnecessary emergency care.

“Everyone benefits when there are no barriers to affordable and successful preventive healthcare,” she said.

The Affordable Care Act does not provide insurance to undocumented immigrants, and experts have urged subsidies for often young and healthy immigrants as a way to boost the insurance exchange market.

Community health centers and other like-minded not-for-profit health organizations say they need an open-door message.

“As a clinician, I'm not in the law enforcement business,” said Karen Mountain, a nurse practitioner and CEO of the Migrant Clinicians Network. “I'm in the business of trying to help people and save lives, and I can't do that as effectively if people are too afraid to seek help.”

Clarification, September 28, 2015:

Memorial Hermann did not call police to report that Borrego was an undocumented immigrant, but rather called state and local authorities to verify her ID because they believed it was fake. As stated in the story, the health system's staff were unaware of her residency status.