Where Health and Immigration Reforms Intersect: The Role of County Governments in Designing and Delivering Health Services to Immigrants

Since the 1990's,new population trends in immigrant and refugee migration have affected non-traditional gateway states, such as Georgia, Minnesota, Nevada, and North Carolina.  During this same time, we have seen national policy disinvest in federally funded health care for immigrants and devolve that authority and responsibility to states and local governments.  For instance the 2010 Patient Protection and Affordable Care Act provides a pathway to insurance coverage for more than thirty million Americans, but undocumented immigrants and legally documented immigrants who reside in the U.S. for less than five years are ineligible for Medicaid and excluded from purchasing any type of coverage through the MarketPlace.  Additionally, the lack of a national comprehensive immigration reform plan has encouraged states and localities to take immigrant related matters into their own hands. The health care coverage gap may largely be populated by working-poor immigrants now, yet guidance and best practices for designing effective and inclusive healthcare systems - and appropriately allocating public resources for this purpose - are hard to find. As a result, local governments are facing new challenges in trying to address the public health and welfare needs of their entire communities and taxpayer base, regardless of immigration status. This case study of Bernalillo County, New Mexico provides a deeper understanding of the response of counties to immigrants regarding health and welfare, and the timely opportunity for new approaches in designing the safety-net system for medically underserved immigrant families.