States Can Reduce Barriers to COVID-19 Vaccines and Treatment, Especially for Immigrants

Reports of people being denied coronavirus vaccines due to immigration status — when everyone is eligible for them, for free, as the Biden Administration has stressed — underscore the need for continued state outreach to providers and potential recipients to minimize barriers to getting vaccinated and help bring the pandemic to an end.

Efforts underway in some states and localities provide a model for others. States can also tap available federal resources, including the American Rescue Plan’s, to ensure that vaccines are provided regardless of a person’s immigration or insurance status and to reduce barriers to getting COVID-19 testing and treatment.

People don’t need to provide information about their immigration status or supply a Social Security number (SSN) or identification (other than name and date of birth) in order to get a vaccine. Some state governors and health departments have already taken extra steps to make the universal availability of vaccines clear to the public and to those administering vaccinations:

• Illinois notified Medicaid providers that COVID-19 vaccines must be provided at no cost to all Medicaid enrollees and to people who are uninsured, regardless of immigration status. The state also makes it clear on its vaccination locations page (available in seven languages) that providers can’t ask people receiving vaccines for documentation of immigration status. Massachusetts includes similar information on its vaccination FAQ page (available in 11 languages), which also clarifies that vaccines are available even if an individual doesn’t have identification. Language accessibility is a key feature of these outreach efforts.
• The Nevada governor issued a press release clarifying that the state wouldn’t give the federal government personally identifiable data that it collects in its vaccination efforts, to assuage concerns that immigration enforcement officials would use the data.
• Seattle dedicated a section of its vaccination website to a Q&A for immigrants. The website (available in seven languages) clarifies that COVID-19 testing and vaccination don’t count in a “public charge” assessment (a test considering whether people applying to enter the country or change their immigration status within it will become primarily dependent on the government for subsistence). The city’s website also cites the Biden Administration’s statement that immigration enforcement activities will not be conducted at vaccination sites.

States and localities also have federal resources available to them for testing, vaccination, and treatment efforts. The Families First Act let states provide COVID-19 testing through Medicaid for certain uninsured people, and the American Rescue Plan expanded the services covered to include vaccinations and treatment for COVID-19 and related conditions for people who are otherwise uninsured, regardless of income. People must attest that they live in the state and generally must provide an SSN. The federal government is paying for the full costs of services for this group, as well for any related administrative expenses states may incur, for example to update eligibility systems. (Someone without an SSN would still get vaccines or treatment but the provider may need to apply for reimbursement through another federal program, described below.)

This Medicaid option may also provide a pathway to payment for emergency services for uninsured people who would be eligible under the option but for their immigration status. (For example, payment could be made for COVID-19-related emergency care provided to uninsured immigrants with income over Medicaid eligibility levels.)

Federal funding is also available through the Health Resources and Services Administration COVID-19 Uninsured Program to reimburse health care providers for testing, vaccinations, and treatment services delivered to uninsured people, regardless of immigration status. However, this funding is limited, and the Department of Health and Human Services has discretion over how much funding to make available for these claims. The program has other limitations: providers and patients often don’t know it exists, and providers don’t have to participate in it. In tandem with implementing the Medicaid COVID-19 option, states should work to ensure health care providers know about this reimbursement option and provide more information to the public about how to identify participating providers.

The median length of stay for people hospitalized due to COVID-19 is 10-13 days and people with “long-haul” COVID-19 can face months of ongoing medical visits and high medical bills. The Medicaid option provides a more reliable source of coverage for these critical services and will be available for more than a year after the public health emergency ends. Fifteen states have taken up the Medicaid option so far, and all of them did so before the Rescue Plan expanded it to cover vaccinations and treatment. More states should take up this option now, which will help ensure that far more people — regardless of their immigration or insurance status — can get the COVID-19 prevention and treatment services they need.