This issue brief from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) describes promising practices for increasing immigrant access to health and human services programs. The issue brief was prepared by the Urban Institute under a contract from ASPE.
The issue brief’s findings and recommendations are based on interviews and site visits with 120 professionals across 67 different health and human service organizations in Maryland, Massachusetts, North Carolina, and Texas.
The most consistent theme to arise from the site visits was the crucial role of community-based organizations (CBOs) in addressing barriers related to the complicated application process, as well as issues of language, literacy, fear, and mistrust. All four states had established partnerships with local CBOs to help reach immigrant populations in need of health and human services. CBOs have access to social networks that enable them to better reach immigrant families, who often feel more comfortable in community-based settings than in government-identified offices, so that they can serve as liaisons between state agencies and immigrant populations.
Many stakeholders also discussed the need to integrate and streamline applications and benefits for low-income families generally. However, such integration efforts could have the perverse effect of reducing immigrant access; for example, if a common application requests adult Social Security numbers because one program requires it, immigrants might be discouraged from applying for the other programs that do not. On the other hand, streamlining efforts that reduce burden and eliminate the need to appear at an office could have a particularly positive effect on immigrants, given their work and transportation barriers. For example, passive redetermination allows recertification under certain circumstances, if clients do not correct or change the information on file that is sent to them.
Language barriers are major issues for immigrants, and all states have made progress in language access. In all four states, materials, applications, and assistance are widely available in English and Spanish, and government offices contract with various interpreter services to increase their ability to serve all clients. Each state uses an telephonic language line to use when bilingual or multilingual staff are not available. These lines provide interpretation services in a number of languages and dialects so that staff, clients, and interpreters can have three-way calls.
The issue brief also discusses recruitment, training, and support for state and local agency staff. Staff might not know how to interpret complex and/or changing federal or state laws, they might be unfamiliar with the documents immigrants submit, and they might have little awareness of cultural issues that could create distance between themselves and their clients.
Immigrant families face a complex set of barriers to accessing health and human services, including some that face all low-income families and others that are either more intense among, or unique to immigrant families. This issue brief identifies and describes some promising practices that can overcome these barriers.