Immigrants and Cancer Care: Navigating an Unfamiliar System

Before you work out what you are entitled to, find out what is available near you now.

Community health centers. The Health Resources and Services Administration funds these health centers. They are required to serve everyone in their community. They must also discount charges on a sliding scale based on your income and family size. They do not turn people away for lack of insurance. They can do primary care, screening, referrals and follow-up. They can be the steady base underneath a cancer plan run somewhere else. Find one at findahealthcenter.hrsa.gov. Or call HRSA on 1-877-464-4772, Monday to Friday, 8am to 8pm ET.

Emergency departments. Federal law covers hospital emergency departments that take Medicare. They must screen anyone who comes in. They must also stabilize an emergency medical condition, regardless of your ability to pay. This is a floor, not a cancer plan. But it is a real floor.

Emergency Medicaid. Federal Medicaid money is available for services "necessary to treat an emergency medical condition." It covers people who meet a state's other Medicaid rules but not its immigration-status rules. The regulation defines an emergency medical condition as one with acute symptoms severe enough, including severe pain, that going without immediate care could reasonably be expected to place health in serious jeopardy or cause serious impairment or dysfunction of a bodily organ or part. States differ considerably in how they apply this to cancer. Some states use their own funds to cover more. Ask the hospital's financial counselor. Ask your state Medicaid office directly. Do not assume the answer.

Non-profit hospitals have to meet requirements under section 501(r) of the tax code to keep their tax exemption. One of those is a written financial assistance policy. It has to say who is eligible, and whether help is free or discounted. It has to say how amounts are calculated and how to apply. It also has to say what the hospital may do if you do not pay. Hospitals must widely publicize the policy, including on the website and on paper in the facility. They must also translate it into the primary language of each limited-English group that makes up the lesser of 1,000 people or 5 percent of the community they serve.

Two other 501(r) rules matter to you. People eligible for assistance cannot be charged more than the amounts generally billed to insured patients. That covers emergency and other medically necessary care. And a hospital has to make reasonable efforts to find out whether you qualify before it takes extraordinary collection actions against you.

So the practical script is short. Ask for "the financial assistance policy and the plain language summary." Ask how long after a bill you can still apply. Ask what documents they accept if you do not have pay stubs. Apply in writing, and keep a copy. Section 501(r) does not cover for-profit and public hospitals. But many states have their own charity care rules, so ask anyway.

Lawfully present immigrants can buy coverage through the Marketplace. Some are eligible for Medicaid or CHIP. That depends on your category, your state, and how long you have been here. The rules are genuinely complicated and change by state. HealthCare.gov, 1-800-318-2596, answers questions in many languages. It can also connect you to a free local assister who will sit with you and the application.

Bring a folder to every appointment, and keep the originals. Include the pathology report, imaging reports and discs, and the list of medicines and doses you take. Include allergies, and the dates of any treatment already given. Were you diagnosed or treated in another country? Bring what you have, even if it is not in English. Ask whether the hospital can have it translated. Slides and blocks can sometimes be requested from a foreign laboratory and re-read here. That can save weeks and a repeat biopsy.

Immigration law is outside what a cancer information site can responsibly discuss. The details depend on facts about your own case. A hospital social worker or patient navigator can refer you to a legal aid organization that does this work for free. Ask that person directly. Do not pay anyone who offers to help with a hospital charity care or Medicaid application. Those applications are always free to submit.

If privacy is on your mind, ask to speak to the hospital's privacy officer. Ask plainly what the hospital's policy is on who sees your information and when. You are allowed to ask that question before you fill in a form.

The National Cancer Institute's information service is 1-800-4-CANCER. It answers questions about cancer, treatment and clinical trials in English and Spanish, Monday to Friday, 9am to 9pm ET. The Cancer Support Community helpline is 888-793-9355. It has bilingual navigators and interpretation in more than 200 languages. It can look up local transport, lodging and financial programs for you. Dialing 211 reaches a local referral line for food, housing, utilities and transport.

• eCFR — 45 CFR 92.201, Meaningful access for individuals with limited English proficiency
• eCFR — 42 CFR 440.255, Limited services available to certain aliens
• IRS — Financial Assistance Policy and Emergency Medical Care Policy, Section 501(r)(4)
• CMS — Emergency Health Services for Undocumented Aliens
• Medicaid.gov — Eligibility Policy
• HRSA — Find a Health Center