Washington State's Insurance Marketplace Now Open to Undocumented People

by Agueda Pacheco Flores

Undocumented immigrants have been ineligible for state health insurance, but now Washington has opened its health insurance market to potentially more than 105,000 undocumented people.

Earlier this month, Washington's insurance market, Healthplanfinder, which allows residents to buy affordable health insurance, opened to immigrants regardless of their legal status. The move is possible thanks to a 1332 Innovation Waiver filed by Gov. Jay Inslee with the federal government in late 2022.

According to the Migration Policy Institute, approximately 249,000 undocumented people live in Washington, including about 119,000 undocumented residents without health insurance coverage. The State estimates that approximately 105,000 people, currently ineligible due to federal restrictions, will be able to purchase coverage on Washington Healthplanfinder in 2024.

"A 1332 Waiver, named for Section 1332 of the Affordable Care Act (ACA), is permission from the federal government for a state to develop an innovative approach to providing health insurance coverage," according to the 1332 Innovation Waiver document. It says the waiver "aims to improve health equity by expanding access to insurance for people who are undocumented, who are more than five times more likely to be uninsured than U.S. citizens."

Brisa Guajardo is a community outreach manager with Community Health Plan Washington. She works directly with the Latino community, educating them about the new change in policy.

"The main concern and worry to this population is how this is going to impact future immigration status," she said, adding that people were concerned about the Department of Homeland Security's "public charge rule" and that it's her job to "reassure them it's not going to impact anything in the future." The "public charge rule" makes certain noncitizens ineligible to apply for a visa or a status adjustment if they are likely to become primarily dependent on government assistance.

Undocumented immigrants have until Jan. 15, 2024, to apply. Guajardo says additional financial support is available for people who can't afford any insurance, but those funds are limited, which is why she is urging Latinos in the community to act fast.

Prior to the waiver being approved, undocumented immigrants facing costly medical treatments or emergencies had few options. They could find community health centers that offered discounts, apply for emergency medicaid, or simply fall into debt.

"Outside of that, options were very limited," said Guajardo. "I've seen individuals actually not taking care of themselves. People with chronic conditions lack health insurance coverage and wait until it's too late or it's gotten really bad to get care, and I think this is really going to change the outcome of many to be able to seek preventive care without having to worry about high cost bills."

Dr. Shoshana Aleinikoff is the specialty director of refugee and immigrant health for HealthPoint in Des Moines. She says this eligibility change to the health market is a game changer for many of her patients. One root cause of the health disparities often seen in low-income Latino communities, she says — especially for those who are disproportionately diagnosed with diabetes — is their lack of access to care due to the inability to afford it.

"Even the lowest sliding scale is cost prohibitive," she said.

Aleinikoff says she doesn't want to worry about whether her patients can afford to be seen; she wants to focus on the medicine and on providing care.

"I've had an opportunity to talk to some of my patients that I've been seeing for some years and able to tell them they now potentially qualify for state insurance, and seeing the look on their face — it makes a world of difference."

📸 Featured Image: Photo via Gods_Kings/Shutterstock.com, edited by the Emerald team.