Juan and Leticia, a young, married couple illegal to the United States, have been sleeping well lately.
Their baby boy, born just two weeks ago, rarely cries at night. On this recent day, for the first time since the boy was born, the couple is meeting with a nurse and Spanish translator as part of a Lawrence program that is growing in popularity, as is Lawrence’s Hispanic population.
Nancy Jorn, director of medical health field services at the Lawrence-Douglas County Health Department, heads the program, which is part of their Pregnancy and Parenting Services. The program is a collaboration effort between the Lawrence-Douglas County Health Department, local physicians and the Lawrence Memorial Hospital. Its goal is to provide free prenatal care and delivery to undocumented and uninsured women.
Since the program began five years ago, the number of families treated each year has increased from four in 2003 to 24 last year. The health department expects as many as 40 families to be treated in 2006, said Jorn. She said she thinks the growth is due to a general growth in the Hispanic population in Lawrence.
“The challenge is, many undocumented immigrant women don’t have access to the care they need because they are not eligible for government programs and don’t have the funds to pay upfront,” Jorn said.
The health department identifies the women who need care and then offers support with nurses and provides “wrap around services,” which include continuing education and counseling with housing, transportation, paperwork and child care.
It then refers the families to Lawrence physicians, who provide free prenatal care to the women on a rotating basis and deliver the baby at Lawrence Memorial Hospital.
Soon after the birth, the mother begins to file paperwork for emergency Medicaid, which is a federal program that provides reimbursements for child delivery to any mother who falls below a specific income level. Undocumented immigrants aren’t required to provide documentation or sign a declaration of their immigration if they meet the eligibility requirements.
Although emergency Medicaid covers the delivery fee, it does not reimburse prenatal care.
Without insurance, Jorn said, paying the $4,000 package fee, which includes prenatal care and delivery, is difficult for undocumented families. Yet without prenatal care, a baby runs the risk of complications and health problems, which, in the end, can cause life-long consequences.
“Our goal was to avoid having women come without prenatal care because it’s bad for the mom, for the baby and for all of us who pay the long-term cost,” Jorn said.
Jorn said the Health Department advertises their program throughout their building with bilingual posters and literature, and she hopes that through literature and word of mouth, more members of the undocumented community will become aware that the program is available.
Juan, 33, and Leticia, 25, who asked for their first names to be altered, live in a small, dark, second-floor apartment lit by a large window that lets in stripes of sunshine from thin, white blinds. On the wall hangs a portrait of La Virgen de Guadalupe, a symbol of motherhood and Mexican heritage, and next to it hangs a miniature, fringed Mexican flag. The checkered sofa that sits against the wall is adorned with small, white stuffed animals, and in the corner of the room sits a plastic car seat.
Leticia rocks slowly in a blue recliner adjacent to the sofa, where her husband and their English interpreter are seated. Meanwhile, the baby sleeps quietly in his crib in the next room.
Diane Pope, a nurse from the health department, leans forward slightly as she asks the couple how the baby has been sleeping and eating lately. After each phrase, she waits for the interpreter seated across from her to translate.
Juan and Leticia say that they haven’t had any problems yet. The baby wakes up two to three times a night, Leticia said, but as soon as she feeds him he goes right back to sleep.
“He just knows his parents feel comfortable caring for him and that helps him to be a happier, healthier baby,” Pope says.
After the couple light-heartedly shares stories about their baby, Pope helps them to fill out the baby’s insurance applications paperwork for emergency Medicaid. If their application is accepted, their physician will be fully reimbursed for the delivery cost.
Sometimes, Jorn said, there are barriers that keep physicians from getting reimbursed for the delivery. If the family fails to provide sufficient documentation that proves their level of income, for example, they cannot be accepted for emergency Medicaid.
“We always tell patients that if they aren’t approved, they may be required to pay,” Jorn said.
Since they arrived from Mexico two years ago, Juan and Leticia haven’t made a single visit to the doctor’s office, nor have they needed one. But when the couple found out Leticia was pregnant, a friend referred them to the Lawrence-Douglas County Health Department for prenatal care.
“If it weren’t for this baby, we would never have gone to a doctor,” Juan says. “We felt we wouldn’t have any support. But knowing she was pregnant, we knew we had to do something to get the care we needed.”
Prenatal care is not the only health care issue for the Hispanic population, however. According to the National Center for Health Statistics, the leading causes of death in the Hispanic population are heart disease and cancer. In addition, 20.4% of people diagnosed with AIDS in 2004 were Hispanic, making them the racial group most affected by the virus after blacks and whites.
Despite health problems, immigrants spend significantly less than U.S. citizens on health care. According to a study conducted by Dr. Sarita Mohanty for the American Journal of Public Health in 2006, immigrants spend 55% less per capita on health care than U.S.-born persons.
A possible cause for undocumented immigrants’ relatively low health care expenditures, wrote Peter J. Cunningham in the Health Affairs Medical Journal in 2006, is fear of being asked for documentation.
However, public hospitals generally do not collect information on their patient’s immigration status. At Lawrence Memorial Hospital, for instance, emergency room patients are treated in order of the criticality of their condition. The clerks ask for names, insurance information, addresses and social security numbers, but some patients do not provide all of the information.
“We try to make as complete of a record as possible, but if you don’t have some of the information, it doesn’t mean you won’t be treated or that you’ll have to wait longer,” said community relations worker Belinda Rehmer. “We treat anyone who walks through these doors the best we can.”
For child deliveries, which are generally not treated in the emergency room, the women are also treated regardless of immigration or insurance status. Once the baby is born, hospital and state case managers visit the patients to determine if they are eligible for emergency Medicaid reimbursements.
Unlike his parents, Juan and Leticia’s baby will not have to worry about being un-insured. Like all other babies born in the U.S., he is a citizen regardless of the legal status of his parents, and is thus eligible for government insurance programs.
Any child born in Kansas who is at or below 200% of the federal poverty level qualifies for HealthWave, which is part of a federal and state partnership called State Children Health Insurance Program created for uninsured children. The program covers physical, dental and mental health services for the children until they are 19 years old.
As she left the small apartment, Pope said she felt it was rewarding to see the families get the medical care they need for themselves and their children.
“I think the program gives to this population the type of medical care that is assured to citizens in the United States, so they are more likely to have a lot healthier pregnancy and healthier baby,” Pope said.