Category Archives: immigrant health

NYS Department of Health, New York Lawyers for the Public Interest, and the New York Immigration Coalition Announce Improved Language Access for Limited English Proficient New Yorkers Using the Health Plan Marketplace

Recent Changes to the Health Plan Marketplace and Commitment to Working with Advocates Will Improve Access to Health Insurance for Thousands of Limited English Proficient New Yorkers

Albany, NY, July 17, 2014 – The New York State Department of Health, New York Lawyers for the Public Interest (NYLPI), a leading civil rights advocate for marginalized New Yorkers, and the New York Immigration Coalition (NYIC) reaffirmed the State’s ongoing commitment to improving language access and immigrant inclusion on NY State of Health, New York’s Health Exchange.

Building on the success of the Health Plan Marketplace’s first enrollment period, New York State plans to work in collaboration with NYLPI, the NYIC, and other immigrant health advocates to identify and resolve potential language barriers in accessing the Marketplace for thousands of limited English proficient (LEP) and immigrant New Yorkers.

“We appreciate the collaboration with the New York Lawyers for the Public Interest and the New York Immigration Coalition. Working together we have made a series of improvements to help ensure that LEP New Yorkers can easily access affordable, comprehensive health insurance through NY State of Health. We look forward to our continued collaboration as we move into the next open enrollment period,” said Donna Frescatore, Executive Director of NY State of Health.

Among the changes the State has made since it opened on October 1, 2013, are:

• Improved accessibility of translated materials on the Marketplace website;
• Increased capacity of representatives in the customer assistance Help Line to better assist LEP consumers in multiple languages;
• Translated print versions of the application in multiple languages; and
• Assistance for LEP consumers who may have encountered language access barriers during the first enrollment period to complete the enrollment process.

A Spanish version of the website and online application will be available for the next enrollment period, which begins on November 15, 2014. NY State of Health is also in the process of translating notices into Spanish and additional languages. It will continue to work closely with immigrant health advocates and community-based organizations to reach immigrant and LEP communities, and identify and remedy any remaining access barriers so that all New Yorkers, regardless of language, have access to health insurance.

“We are encouraged by the real commitments that the State has made in response to the serious language access challenges of the first enrollment period,” said Shena Elrington, Director of the Health Justice Program at New York Lawyers for the Public Interest. “Providing immigrants and LEP New Yorkers access to health insurance is not only fair, but also fiscally responsible. Enrolling LEP New Yorkers in health insurance will improve their access to healthcare, and will help reduce the cost of healthcare for everyone. We look forward to partnering with the State to continue finding solutions to improve access for LEP New Yorkers and closely monitor the results.”

During the first enrollment period, over 900,000 New Yorkers enrolled in health insurance through the Marketplace—a tremendous victory. Many LEP and immigrant New Yorkers, however, still lack coverage. Prior to the launch of the first enrollment period, the Urban Institute estimated that 36 percent of potential enrollees would be LEP by the end of 2016. According to recent data released by the New York State Department of Health, 15 percent of enrollees during the first enrollment period self-reported that they prefer to speak a language other than English, which suggests that more needs to be done to make the Marketplace accessible to LEP New Yorkers.

“The New York Immigration Coalition is pleased that the State has provided important racial, ethnic, and preferred language information in its report on 2013-2014 Open Enrollment,” said Steven Choi, Executive Director of the New York Immigration Coalition (NYIC). “Our work with New York’s immigrant communities, however, shows that much work remains to ensure that immigrants can access the health care they need. We look forward to working with our members, allies, and the State to support an even more successful 2014-2015 open enrollment period.”

About New York Lawyers for the Public Interest
New York Lawyers for the Public Interest (NYLPI) advances equality and civil rights, with a focus on health justice, disability rights and environmental justice, through the power of community lawyering and partnerships with the private bar. Through community lawyering, NYLPI puts its legal, policy and community organizing expertise at the service of New York City communities and individuals.

Contact for New York Lawyers for the Public Interest: Stephanie Ramirez: 212-784-5714

About the New York Immigration Coalition
The New York Immigration Coalition is an umbrella policy and advocacy organization for nearly 200 groups in New York State that work with immigrants and refugees. The NYIC aims to achieve a fairer and more just society that values the contributions of immigrants and extends opportunity to all by promoting immigrants’ full civic participation, fostering their leadership, and providing a unified voice and a vehicle for collective action for New York’s diverse immigrant communities.

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Community and Advocacy Groups Commend Nassau County Executive Orders Guaranteeing Translation and Interpretation Services to Nassau Residents

See below—and congrats to Shena, Jenn, and Kate for their hard work!

Mineola, NY – In an important step towards ensuring good government in Nassau County, County Executive Ed Mangano signed a second of two Executive Orders today guaranteeing translation and interpretation services to all limited-English proficient (LEP) residents in their interactions with County Government. Recent emergency and relief efforts have brought into stark relief the importance of the county agencies being able to communicate effectively and efficiently with all Nassau County residents, including the more than 130,000 county residents with limited ability to read, write, or speak English.

The two Nassau County Executive Orders (numbers 67 and 72) align Nassau County with Suffolk County and New York State’s similar executive orders in 2011 and 2012 that guaranteed such language assistance services, and make Nassau one of the first suburban counties in the United States to enact a comprehensive language access policy.  These Orders will bring significant public safety gains to the county and improve all agencies’ ability to interact with Nassau’s diverse population.  Under the provisions of the Order, all county agencies will, among other things, be required to:

  • Translate essential public documents and forms into the top six languages spoken by LEP residents of Nassau County—namely, Spanish, Chinese, Italian, Persian, Korean, and French Creole
  • Provide interpretation services to all LEP Nassau residents;
  • Designate a language access coordinator and draft plans for complying with this Executive Order in the next 120 days; and
  • Refrain from using language access services use as a basis for inquiring about, or sharing, immigration status.

Representatives of various organizations that have worked with the County to ensure improved language access services and achieve these Executive Orders cheered the signing and expressed their commitment to working with the County to ensure effective implementation:

Maria Cordoba, a member of Make the Road New York and Westbury resident, said, “I recently went to the County Department of Social Services, and finding out that no one in the staff spoke Spanish, I had to leave without being served. Make the Road New York is excited about these two orders and the commitment they demonstrate to limited-English proficient residents.”

Cheryl Keshner, coordinator of Long Island Language Advocates Coalition and senior paralegal at the Empire Justice Center, stated: “We applaud the signing of these executive orders. As evidenced by Hurricane Sandy, it is essential that all members of our community have equal and timely access to government services, especially during times of crisis.”

Daniel Altschuler, Coordinator of the Long Island Civic Engagement Table, affirmed “These two Executive Orders together are critical for ensuring good government in Nassau County. We are thrilled that Nassau will now become one of the first suburban counties in the United States to guarantee language access in county agencies, and we look forward to continuing to work with the County administration to ensure effective implementation.”

Shena Elrington, Director of Health Justice at New York Lawyers for the Public Interest, said: “The signing of these two executive orders marks a civil rights victory for limited English proficient residents of Nassau County, who will now be able to meaningfully access government services. These EOs reflect a commitment to ensuring access for every resident, regardless of the language he or she speaks.”

“Today Nassau County joins a growing movement in New York and across the country to break down language barriers between immigrant communities and their local governments,” said Nisha Agarwal, Deputy Director at the Center for Popular Democracy. “These executive orders will make it possible for residents with limited English proficiency to access the services they need to take care of themselves and their families, and will help create a healthier, safer, more economically robust Nassau county for all.”

“Today, Nassau County takes an important step forward in ensuring equal access to critical services such as police and emergency assistance, medical care, and important information such as public health and safety notices,” said Jason Starr, Director of the Nassau County Chapter of the New York Civil Liberties Union.  “These orders celebrate both the linguistic and cultural diversity that make our community special and the spirit of tolerance and diversity embodied in the Constitution.”

Martha Maffei, Executive Director at Services for the Advancement of Women (SEPA Mujer) stated “In my daily work with immigrant women escaping domestic abuse, language access is crucial for women who are seeking services for themselves, as well as for their families. I congratulate Nassau County for providing the tool that victims of domestic violence need to look forward in their lives.”

“As Nassau County becomes more and more diverse, these Executive Orders will help ensure that all of our residents have access to important services, and can participate in community life,” said Anita Halasz, Organizer with Long Island Jobs with Justice.

Delbys Torres, member organizer for La Fuente and resident of Freeport said, “We applaud Nassau County for committing to provide access to language services to thousands of residents in all county interactions, not just in a select few. We encourage them to continue to find ways of ensuring that Nassau County is a place who provides equal opportunity and access to services regardless of language barriers. It is a great day when government goes beyond what is legal under the law, but what is just and critical to ensure that our government is truly democratic and open to all.”

“These orders will assure that all parents are better informed about available services and, in turn, how to help their children succeed,” said Johanna Rotta, Coordinator of Community Assets at the Early Years Institute.

“The Nassau County Language Access Executive Orders will help Limited-English Proficient consumers with disabilities to have a better quality of life, to live more independently and to participate more in their community,” said Grisselle Rivera-Mucciolo, Director of Hispanic Outreach at the Long Island Center for Independent Living.

Read more here. The official press release can be found here.

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New York Lawyers for the Public Interest and the Center for Social Justice at Seton Hall University School of Law Release Report Documenting Hundreds of Cases of Coerced Medical Repatriation of Undocumented Immigrants by U.S. Hospitals

Medical repatriations of undocumented immigrants likely to rise as result of federal funding reductions to safety net hospitals under Affordable Care Act

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New York, NY, and Newark, New Jersey, December 17, 2012 − Today, the Center for Social Justice (CSJ) at Seton Hall University School of Law and New York Lawyers for the Public Interest (NYLPI) released a report documenting an alarming number of cases in which U.S. hospitals have forcibly repatriated vulnerable undocumented patients, who are ineligible for public insurance as a result of their immigration status, in an effort to cut costs. This practice is inherently risky and often results in significant deterioration of a patient’s health, or even death.  The report asserts that such actions are in violation of basic human rights, in particular the right to due process and the right to life.

According to the report, the U.S. is responsible for this situation by failing to appropriately reform immigration and health care laws and protect those within its borders from human rights abuses. The report argues that medical deportations will likely increase as safety net hospitals, which provide the majority of care to undocumented and un- or underinsured patients, encounter tremendous financial pressure resulting from dramatic funding cutbacks under the Affordable Care Act.

The report cites more than 800 cases of attempted or actual medical deportations across the country in recent years, including: a nineteen-year-old girl who died shortly after being wheeled out of a hospital back entrance typically used for garbage disposal and transferred to Mexico; a car accident victim who died shortly after being left on the tarmac at an airport in Guatemala; and a young man with catastrophic brain injury who remains bed-ridden and suffering from constant seizures after being forcibly deported to his elderly mother’s hilltop home in Guatemala.

According to Lori A. Nessel, a Professor at Seton Hall University School of Law and Director of the School’s Center for Social Justice, “When immigrants are in need of ongoing medical care, they find themselves at the crossroads of two systems that are in dire need of reform—health care and immigration law. Aside from emergency care, hospitals are not reimbursed by the government for providing ongoing treatment for uninsured immigrant patients.  Therefore, many hospitals are engaging in de facto deportations of immigrant patients without any governmental oversight or accountability.  This type of situation is ripe for abuse.”

“Any efforts at comprehensive immigration reform must take into account the reality that there are millions of immigrants with long-standing ties to this country who are not eligible for health insurance.  Because health reform has excluded these immigrants from its reach, they remain uninsured and at a heightened risk of medical deportation,” added Shena Elrington, Director of the Health Justice Program at NYLPI. “Absent legislative or regulatory change, the number of forced or coerced medical repatriations is likely to grow as hospitals face mounting financial pressures and reduced Charity Care and federal contributions.”

Rachel Lopez, an Assistant Clinical Professor with CSJ stated, “The U.S. is bound to protect immigrants’ rights to due process under both international law and the U.S. Constitution.  Hospitals are becoming immigration agents and taking matters into their own hands.  It is incumbent on the government to stop the disturbing practice of medical deportation and to ensure that all persons within the country are treated with basic dignity.”

More information about this issue can be found at medicalrepatriation.wordpress.com, a NYLPI- and CSJ-run website that monitors news and advocacy developments on the topic of medical deportation.

About New York Lawyers for the Public Interest

New York Lawyers for the Public Interest (NYLPI) advances equality and civil rights, with a focus on health justice, disability rights and environmental justice, through the power of community lawyering and partnerships with the private bar. Through community lawyering, NYLPI puts its legal, policy and community organizing expertise at the service of New York City communities and individuals.

About the Center for Social Justice at Seton Hall University School of Law

The Center for Social Justice (CSJ) is one of the nation’s strongest pro bono and clinical programs, empowering students to gain critical, hands-on experience by providing pro bono legal services for economically disadvantaged residents in the region. The cases on which students work span the range from the local to global. Providing educational equity for urban students, litigating on behalf of the victims of real estate fraud, protecting the human rights of immigrants, and obtaining asylum for those fleeing persecution are just some of the issues that CSJ faculty and students team up to address.

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Media Contacts:

Lori A. Nessel, Professor of Law and Director, Center for Social Justice, Seton Hall University School of Law, Lori.Nessel@shu.edu, 973-642-8708

Stephanie Ramirez, New York Lawyers for the Public Interest, sramirez@groupgordon.com, 212-784-5704

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Filed under federal, immigrant health, immigrant rights, insurance, know your rights, medical deportation

Suffolk County Language Access Executive Order Signed!

by Lindsey Hennawi, Program Assistant

Great news! On November 14th, 2012, Suffolk County Executive Steve Ballone signed an executive order requiring county government agencies to translate vital public documents into the top six languages spoken by limited English proficient (LEP) residents of Suffolk County and to provide interpretation services for all LEP residents as well.

Twenty percent of Suffolk County’s 1.5 million residents are LEP. Now, residents whose primary languages are Italian, Mandarin, Spanish, Polish, French Creole, and Portuguese will be able to access local government offices and communicate with officials. This means victims of domestic violence and hate crimes can access police protection. Residents affected by Superstorm Sandy can receive much needed information about recovery efforts. Support services such as unemployment insurance and public benefits are now also accessible to LEP residents. Thanks to this executive order, an individual’s language will no longer be a barrier to participation in government services or access to important resources.

The order is descended from similar legislation, including President Clinton’s 2000 executive order that mandated all agencies receiving federal funding develop language access plans in order to comply with the 1964 Civil Rights Act’s prohibition of discrimination based on national origin; Mayor Bloomberg’s Executive Order 120, signed in 2008, that bans city agencies from discriminating against residents based on their primary language or national origin; and Governor Cuomo’s 2011 Executive Order 26 that does the same for executive state agencies.

One of the first of its kind in a suburban county in the United States, Mr. Ballone’s executive order comes on the heels of the previous Suffolk County executive, Steve Levy, who in his tenure utilized county police as immigration agents, criminalized Latino day laborers, and marginalized Latino-majority neighborhoods, earning the county a reputation for anti-immigrant resentment and violence.

Suffolk County’s executive order is a result of the advocacy of the organizations with which NYLPI partnered on this campaign, including the Long Island Civic Engagement Table, the Long Island Language Advocates Coalition, Make the Road New York, the Center for Popular Democracy, and other groups that have tirelessly promoted immigrants’ rights in Suffolk County for years. Since 2009, NYLPI has advocated for language access orders on the city, state, and county level, and is currently working to develop materials to help other advocates replicate these efforts.

We are thrilled Suffolk County has taken this critical step toward advancing the civil rights of LEP individuals and making New York a more inclusive home for all its diverse residents. Congratulations to all of the advocates involved and thank you, Steve Ballone, for your work toward equality and justice on behalf of LEP residents! May yours be one of many county orders to come.

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Filed under immigrant health, immigrant rights, know your rights, language access, legislation, people of color

The Affordable Care Act and Deferred Action for Childhood Arrivals: Immigrant Exclusion in Health Reform

by Lindsey Hennawi, Program Assistant

It’s tough to be hard on President Obama just one month away from the presidential election.

After all, the Patient Protection and Affordable Care Act, an unprecedented piece of health care legislation, has been lauded by health justice advocates across the country for its promise to provide uninsured and underinsured Americans with options for health coverage which were previously unavailable to them. And the recently implemented federal policy known as Deferred Action for Childhood Arrivals (DACA) allows would-be DREAMers—undocumented youth who were brought to the US as children and who would be granted a path to citizenship under the as of yet un-passed Development, Relief, and Education for Alien Minors Act—to apply for work authorization and live without fear of being deported.

While these measures are historic, they also both fall short. The strength of the DACA program as a means to advance the rights and status of undocumented immigrants was undermined by a barely publicized announcement from the White House. According to the new rule, DACA individuals will be excluded from health coverage under the Affordable Care Act. In the past, people granted deferred action status were considered “lawfully present” undocumented immigrants and were thus eligible to participate in federal benefits programs. This new policy, however, explicitly exempts those who qualify for DACA relief from participating in these programs.

While some states have systems in place whereby lawfully present undocumented immigrants are still eligible for public health insurance from state pools of funding, this option is not universally available. Without the federal guarantee that lawfully present undocumented immigrants can benefit from the new Exchanges and Medicaid, these individuals will have to rely on whatever standards their state imposes, which can vary widely and may disproportionately impact certain immigrant communities. Some states have already started to deny benefits to DACA beneficiaries. Notorious anti-immigrant Arizona Governor Jan Brewer, for example, has illegally ordered state agencies to deny drivers’ licenses and other state benefits to DACA grantees. Apparently inspired, governors in Mississippi, Nebraska, and Texas have made similar declarations.

As a result of this federal exclusion, hundreds of thousands of undocumented youth who no longer have to worry about being deported still have to worry about how to access health care—an issue President Obama himself has described as central to the very success and character of our democracy.

There are a lot of good, practical reasons why DACA individuals should not be denied benefits under health care reform. The Affordable Care Act, with its pledge to insure the 30 million undocumented American citizens, completely excluded undocumented immigrants. The ACA will gradually reduce federal funding  allocated to compensate hospitals for the care they provide to uninsured and underinsured  patients, and the loss of this funding may threaten these hospitals’ ability to treat undocumented immigrants. The Exchanges, which will serve as a conduit through which people can purchase health insurance under the Affordable Care Act, could benefit from the addition of young, healthy people (such as many DACA individuals) paying into the pool in order to spread risk. And without regular access to affordable primary and preventive care, we will see an increase in negative health outcomes and costs that may ultimately burden the system.

Without inclusive, federal protections for health care access, undocumented immigrants will always be subject to denials of access to care, and the president’s landmark health care reform will fall short of achieving its lofty and sorely needed goal. If President Obama really wants to work toward improving immigrant rights and health—or even just to preserve the American democracy in which he believes—he needs to reconsider and reverse his latest decision. It’s just the right thing to do.

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The Battle Isn’t Over: What’s Next for the SafeRx Campaign

Knowing how to take prescription medications safely is incredibly important—especially for people who are limited English proficient (LEP) or have other difficulties understanding prescription medication labels.  New York recently passed landmark SafeRx legislation that will greatly increase many New Yorkers’ access to prescription medication. Under SafeRx, prescription pads will have to reflect a patient’s language preference and medication labels will become more patient-friendly. Pharmacies will be required to provide translation and interpretation services to LEP consumers. But while the passage of SafeRx represents a huge victory, we still have more work to do.

The law will go into full effect in late March of 2013. The New York State Board of Pharmacy (SBOP) is currently in the process of drafting recommendations for the implementation of the legislation. Unfortunately, the SBOP has failed to include stakeholders—advocates and LEP consumers—in the process. The SBOP has yet to schedule even one formal public hearing at which advocates and consumers can provide input on how to best implement the new law. Only one informal meeting has been mentioned, but not scheduled—and it’s in Buffalo. Not exactly an easy trip to make for many people around the state.

In response to the limited opportunities for stakeholder engagement, members of the SafeRx Coalition have published a report which discusses several key recommendations for the implementation of SafeRx legislation. (You can also read the accompanying cover letter to the SBOP here.) Through our recommendations, we hope to balance the interests of consumers and the pharmacy industry alike, while still meeting the health needs of New Yorkers.

Here’s a quick rundown of our recommendations:

Determine Pharmacy Primary Languages Fairly
Rather than selecting languages based on whether or not 1% of the general population speaks a given language, SBOP should require translation services in the top seven languages spoken throughout the state. This approach ensures that a uniform standard is applied statewide.

Standardize Prescription Labels
Prescription labels should be patient-centered. Labels should have clear directions, written in simple and large fonts.

Notify Patients of Their Rights
A Patient Bill of Rights should be translated into the selected languages and shared with consumers on pharmacy websites, in stores, and through other outreach.

Include Mail Order Pharmacies
Those count, too! Resources should be dedicated to assessing the language access needs of consumers who use mail order pharmacies and the services that these pharmacies currently provide. In fact, many mail order pharmacies actually have already begun providing language services.

Eliminate the Waiver Option
As the legislation stands now, pharmacies have the ability to opt-out of the requirement to provide language assistance services. But the whole point of the SafeRx campaign is that pharmacies have a federal obligation to do so. Pharmacies shouldn’t be given the ability to dodge their legal responsibilities.

Promote Liability & Accountability
SBOP should implement a plan to monitor and assess pharmacies’ compliance with the law.

Modify Prescription Pads
The NYS prescription pad should be revised to reflect if a patient is LEP and, if so, what the primary language spoken is.

If implemented correctly, SafeRx could improve business for pharmacies by improving customer service and consumer loyalty. For the healthcare system as a whole, SafeRx could dramatically reduce the 700,000 emergency room visits and 100,000 hospitalizations that occur every year when patients misunderstand how to take prescription meds [i]—saving the healthcare system over 3 billion dollars per year overall. [ii]  

With millions of New Yorkers who stand to benefit and millions of dollars to be saved, there’s no reason for the SBOP not to get on board with our recommendations.  And with the clock ticking toward when the legislation will take effect, the time to do so is now.


[i] Daniel Budnitz, et al., National Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events, Journal of the American Medical Association (JAMA), 2006; 296 (15):1858-1866.

[ii] William Shrank, et al., Educating Patients About Their Medications: The Potential and Limitations of Written Drug Information, Health Affairs, 2007; 26 (3):731-40.

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Filed under immigrant health, immigrant rights, language access, legislation

Segregated Health Care & the Latino Communitiy

Last week, we met with the New York State Assembly/Senate Puerto Rican and Hispanic Task Force to discuss the issue of segregated care in New York private teaching hospitals and our Health Equity Bill (A07699/S5785).

We brought a small but mighty group of advocates, doctors, and community residents to present before the Task Force on this important issue. According to 2009 United Hospital Fund data, 61.2% of Latinos in New York are on Medicaid or uninsured – meaning that the steering of patients based on insurance type has a particularly strong impact on the Latino community. Access to quality-health care is already difficult for Latinos – language/cultural barriers, above-average poverty rates, restrictions on health care for immigrants, etc. – so the addition of unfair hospital policies, like segregated health care, which have no medical, financial, or moral grounds should not be allowed to continue in New York.

Our bill will make it illegal to separate patients based on insurance type so that all patients are treated with the same care, in the same setting, and with the same respect once they enter a hospital.

Special thanks to our partners, Bronx Health REACH, and bill sponsors, Assemblymember Nelson Castro and Senator Gustavo Rivera for joining us at the Task Force meeting.

Below, you can watch our presentation:

NYS Assembly/Senate Puerto Rican & Hispanic Task Force Meeting 02.29.12 from Somos New York

To view our powerpoint presentation from the Task Force meeting, click here.

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March 6, 2012 · 5:56 pm