Before she was a doctor, Maria Saavedra had a very part-time job as a medical interpreter.
Saavedra came to the U.S. at age 12, with her family of Colombian immigrants. As she was adjusting to American life herself, Saavedra would tag along to her mother’s doctor’s appointments so she could translate. Her mother only spoke Spanish and needed to learn how to manage her diabetes.
That language barrier to health care is one that Saavedra is still helping people overcome, now as a bilingual doctor practicing in Bloomington-Normal.
“A lot can be lost in translation,” said Saavedra. “There’s a cultural component to things, too. Being able to speak your native language when you’re talking to your doctor makes a huge difference as far as being able to meet the needs of the patient, and for the patient to feel like they’re getting what they need out of that encounter.”
Saavedra has a front-row seat to one of the most pressing issues in health care — how to care for millions of noncitizen immigrants who live and work in the U.S., but have few health care options. Illinois has been one of the few states willing to subsidize it, through dual Medicaid-lookalike programs for low-income immigrant adults (ages 42 to 64) and another for immigrant seniors (65+).
But the unexpectedly high cost of that program raised concerns, leading Gov. JB Pritzker’s administration to stop enrolling new people into the program for immigrant adults after just one year, as of Saturday. Existing enrollees can stay in, and the one for seniors can take new patients.
“It really is unfortunate for people who are between 42 and 64, who are not going to have the opportunity to enroll in the program,” said Sarah Mellor, social services director at the Normal-based Immigration Project. “Because they do contribute. Maybe people work. They pay taxes. But then they’re not eligible for those safety-net programs that are only really open to citizens or people who’ve been lawful permanent residents for over five years.”
Bloomington-Normal impact
The impact of the state’s backtrack remains to be seen. What’s clear is that immigrants in McLean County have come to rely on this short-lived expanded access to health care.
In McLean County alone, 202 adult immigrants and 65 senior immigrants are signed up for those Medicaid lookalike programs, according to data provided by the Illinois Department of Healthcare and Family Services. Statewide, there are 49,983 adults and 14,701 seniors enrolled. The program for seniors launched in 2020, and the one for adults began in July 2022.
Dr. Saavedra said she saw a noticeable increase in immigrant patients at her office, Carle Family Medicine on Franklin Avenue, as a result of these programs.
About 40% of Saavedra’s patients are on Medicaid that is for low-income Illinoisans. So, whether it’s an immigrant or an American-born patient, she treats a lot of patients for whom she’s the first primary-care doctor they’ve ever seen.
It takes time to build a relationship like that, Saavedra said, and to educate patients about how primary-care doctors are a first line of defense and often a referral to specialists.
“Yes, you can come in if you have a genital concern. Sometimes they’re apprehensive about things like that,” she said. “(It’s) building that rapport. Yes, if you have a medical concern, you should disclose it. And that’s not something you can get from just one visit.”
Free clinic referrals
Some of Saavedra’s immigrant patients have been sent to her by the Community Health Care Clinic (CHCC) in Normal. That’s a free clinic that serves the uninsured.
The clinic screens patients to see if they’re eligible for a public insurance program, like Illinois’ for noncitizens. If they are, the clinic works diligently to make a “warm handoff” to a local doctor who takes that insurance, making that critical first appointment, providing them with last-visit notes, and a list of medications they’re on, said CHCC executive director Mike Romagnoli.
“Working from the inside gives our patients a leg up, by making it really smooth,” he said.
Where it can get choppy for noncitizens is that they can be skeptical of new state-sponsored programs like the one offered in Illinois, Romagnoli said. Some of that dates back to the Trump administration’s “public charge” rule that made it harder to get green cards if applicants use public benefits. The Biden administration stopped enforcing that rule in 2021.
“It’s a very, very new thing for a lot of our patients, especially if you’re undocumented. You do your best to fly under the radar. And poking your head out of the ground for a state program is very scary,” Romagnoli said.
Saavedra is an attractive option for CHCC’s handoffs, in part, because she speaks Spanish.
About 88% of CHCC’s patients speak Spanish, and 96% are nonwhite, Romagnoli said. The clinic has six bilingual staffers and a team of bilingual volunteers.
“I’ve got nine Spanish-speakers in the building today,” he said during an interview in early June. “Both hospitals (in Bloomington-Normal) combined don’t have that. We are very uniquely equipped to take care of them. Whereas most other offices are not.”
Immigration Project signups
Others have found their way into Illinois’ health care programs for noncitizens through the Immigration Project. They get screened for eligibility as part of the Immigration Project’s comprehensive case management that helps newly-arrived immigrants or those in crisis, such as fleeing domestic violence, according to Sarah Mellor, the social services director.
"Very few of our clients qualify to purchase healthcare on the marketplace."Sarah Mellor, Immigration Project in Normal
“For a lot of people that meant it’s the first time they’ve been able to access health care outside of the emergency room since arriving to the United States,” Mellor said. “That’s a big deal for a lot of folks, to be able to have regular mammograms or regular checkups and all that kind of preventative care.”
There were around 7,000 foreign-born noncitizens living in McLean County as of 2021, according to the U.S. Census Bureau. Put another way, that’s more than the combined populations of everyone living in Heyworth, Downs and Lexington.
Noncitizens have very few options for health insurance, even if they’re on that famously lengthy path toward legal status, Mellor said. Someone with an expired or no work permit can’t access employer-provided health care, she said. Undocumented immigrants aren’t eligible to buy health coverage from the HealthCare.gov marketplace, aka Obamacare.
“Very few of our clients qualify to purchase health care on the marketplace,” said Mellor, who recognizes the state budget is not unlimited. But she said it’s short-sighted to pull back on the health benefits program for noncitizens before it starts to pay financial dividends.
Low-cost preventive care is all about long-term benefit.
“When you’ve only have had health care for one year, and you just got it, the costs are gonna shoot up, because you’re suddenly gonna go get that mammogram you haven’t had in 20 years even though you’ve needed it,” Mellor said. “I don’t think one year is enough to allow it to work.”
