Implications of Health Reform and Managed care for Refugees and Immigrants in Kentucky

Newly resettled refugees and immigrants living in Kentucky face significant barriers to care and lack sufficient health insurance coverage. Although many families are eligible for Medicaid, single adults without dependents and undocumented immigrants typically rely on catastrophic coverage or pay for services out-of-pocket. A lack of reimbursement for language services, limited coverage for preventive and ancillary services, and little experience among health care providers in serving a multi-cultural population have created barriers to access and a reliance on safety-net providers. Efforts to address these barriers to care in recent years have included the development of a state refugee health program and collaboration among a number of state and local partners to advocate for and develop the capacity of health systems to provide language access, culturally sensitive care, and patient navigation. Medicaid managed care organizations, hospitals and a growing number of primary care providers are integrating these services into their systems due to accreditation requirements. With Medicaid expansion and the Kentucky Health Benefits Exchange on the horizon, many more low income refugees and documented immigrants will qualify for coverage in 2014, increasing access to care for those who were uninsured or underinsured. However, with many funding sources for uncompensated care expected to decrease under health reform, resources for language services, refugee screenings, and services provided to undocumented immigrants will continue to be barriers to care that must be addressed.