Refugees here face new worry
Health benefits end as Texas withdraws
Elizabeth Reyes awoke early on Feb. 1 to make the crosstown trek from her home in north Houston to Asiatown so she could be at the clinic just after the doors opened at 7:30 a.m.
The 5-foot-2 Cuban grandmother peered over the tall reception counter, straining for the familiar in a city she does not know, in a country where she had arrived only 45 days before.
“¿No hay alguna manera que podria ayudarme?” she asked. Is there any way you can help me?
Reyes just wanted to see a doctor. But behind her simple question lies a deeper one as America grapples with who should be allowed in and how much is owed to them once they get here.
Days earlier, President Donald Trump had thrown U.S. refugee policy into turmoil with an executive order barring entrance into the country by all refugees for 120 days and those from Syria indefinitely. That order has stalled in the courts, but the president has vowed to issue a new executive action any day.
Yet Texas had already begun
quietly unspooling its own policy on refugees.
On Jan. 31, the state stopped administering the federal money that pays for a host of social service and assistance programs for refugees, including eight months of health coverage through the Refugee Medical Assistance program and the Medicaid program for unaccompanied refugee minors.
Although refugees have been promised seamless coverage through a thirdparty administrator, that did little to calm the confusion that gripped the clinic as January ended and February began. Dozens of people without appointments jammed the waiting room. Many clutched letters from the state saying their existing coverage was ending.
Maria Rodriguez was working the front desk at Hope Clinic, one of Houston’s busiest community health centers serving the city’s vast refugee community. She saw the fear in Reyes’ eyes and promised to try to squeeze her in.
Rodriguez began the intake, sorting through the 53-year-old woman’s history of ailments. High blood pressure. High cholesterol. Pre-diabetes.
“Do you have any medicine?” “No.” “Do you have Medicaid?” Reyes paused. “Yo no se,” she answered. I don’t know.
She had applied as instructed when she arrived from Havana, but time ran out before her eligibility was determined.
It was the culmination of events set in motion four months earlier, when Gov. Greg Abbott pulled Texas out of the federal refugee resettlement program because he was not satisfied that the Syrian refugees headed this way had been vetted for safety.
Abbott informed the federal Office of Refugee Resettlement on Sept. 30 that Texas’ Health and Human Services Commission would no longer shepherd the $120 million in federal funds going to refugees, including an estimated $62 million for health screening and medical services.
“Despite multiple requests by the state of Texas, the federal government lacks the capability or the will to distinguish the dangerous from the harmless, and Texas will not be an accomplice to such a dereliction of duty to the American people,” the governor said in a statement at the time.
The governor’s office did not comment for this story.
In the last fiscal year, Texas resettled more than 7,800 refugees, secondmost in the nation after California, according to the U.S. State Department. That does not include thousands of Cubans, Haitians and others with special status who also get legup benefits like refugees.
Houston alone resettled 2,695 refugees, not including Cubans, the government statistics show. That’s most in Texas and among the most in the nation.
“We are a country of immigrants and refugees. There is a will to continue our heritage both in Texas and in Houston,” said Ali Al Sudani, director of refugee services at Interfaith Ministries of Greater Houston, who came to this country from Iraq in 2009 and gained citizenship in 2014.
“We have a strong legal framework for refugees when they arrive and a path to citizenship,” he said.
The tradition of welcoming and helping refugees is woven into American history. The Displaced Persons Act of 1948 ultimately allowed 400,000 Europeans to enter the United States from their war-torn nations.
The modern-day framework for refugee policy comes from the 1980 U.S. Refugee Admissions Program, which not only standardized the definition of a refugee but also directed the federal government to provide assistance as lives were restarted.
Over time, the generosity of the health coverage has shrunk. For example, in the 1980s, refugees were allowed three years of medical coverage.
The currently provided eight months is enough time, the theory goes, to get someone up to date on immunizations and stabilize or treat any lingering or chronic conditions. After that, they will be able to buy their own coverage or get a job that offers it.
Some refugees also could qualify for Texas’ traditional Medicaid, although the threshold is tough. Texas is tied with Alabama as having the strictest qualification criteria in the nation.
Abbott’s decision last fall to pull out of the Office of Refugee Resettlement program grabbed national headlines but was, in fact, mostly symbolic. It did not actually stop refugees from being resettled in Texas, nor did it turn off the federal money to help them.
It did, however, start a 120-day clock during which time the ORR scrambled to secure an outside third party to take over the state’s role and administer federal refugee funds so benefits would not be disrupted.
Different cities in Texas use different organizations to administer the funds. In Houston, all services but health care fall to the YMCA of Greater Houston, according to the federal Administration for Children and Families, which oversees the ORR.
The health care piece for adults went to a national nonprofit, the U.S. Committee for Refugees and Immigrants, which was selected in December.
That group then began working with Indianabased Point Comfort Underwriters, which is not a traditional insurer but can process refugee medical claims.
Aletter dated Jan. 17 was sent to refugees from Texas Health and Human Services, saying “your medical benefits will end Jan. 31, 2017” and noting that recipients “are not entitled to appeal.”
Six days later, another letter, this one from USCRI, was sent to refugees referring to the state notification. It, too, said existing coverage would end Jan. 31 but added “that does not mean you will lose your medical benefits.” That letter said USCRI was partnering with Point Comfort.
But those on the front lines said they had no idea what was going on.
“Our patients were panicked,” said Dr. Andrea Caracostis, CEO of Hope Clinic. About 20 percent of the 130 patients seen at community clinic each day are refugees. Her staff was equally frantic, not sure how to advise them since they knew little about the replacement coverage that was supposed to kick in.
“We would try to write prescriptions and order X-rays, but none of the providers had ever heard of Point Comfort,” said Kara Green, a nurse practitioner at Hope. “They still haven’t.”
Reyes, the Cuban grandmother, was prescribed $130 in medication at the end of her visit. But it was unclear if a pharmacist would accept Point Comfort. She paid for it out of pocket, taking it out of her already tight grocery budget.
Caracostis has been trying to contact Houston providers to explain the situation and reassure them they will be paid, just not by the state.
Betsy Brougher, president of Point Comfort, acknowledges the transition was rushed.
“There’s been a lot of anxiety because the switch-over has been crazy,” she said.
“The important thing it that no medical service has been disrupted and there’s been no loss of benefits,” she said, predicting that over time things will settle down.
Meanwhile, another clock is ticking in Washington, D.C.
Congress in December voted that all government spending would be funded by continuing resolution scheduled to run out at the end of April. Many fear the Office of Refugee Resettlement could be a likely target for steep budget cuts considering the rhetoric surrounding refugees.
The Obama administration had authorized 110,000 refugees to enter the country. Trump has proposed slicing that number to 50,000.
All questions about the fate of the ORR were directed to the White House, which did not respond.
The fast-moving events are confusing and more than a little troubling to Hussein Alaawad. A medical school graduate in Baghdad, the 29-year-old went through four years of waiting and questioning before he was allowed into the U.S.
His plane touched down in Houston on Oct. 24, his previous life condensed into two suitcases and a carry-on bag. Clothes, a fistful of photos, a Play Station 3. He also packed the brightly colored bracelet his friends had given him with handwritten slogans. One said “Dream Big.”
He fled in part after being threatened with death in Iraq because when he was only a volunteer at the hospital he could not treat a militia member’s child who later died. “You’ll be sorry,” he was warned.
So he went to Jordan and waited. The U.S. government questioned him closely, then questioned him again and again.
Once in Houston, he was treated for a potentially serious skin condition, and he tested positive for latent tuberculous. Then he got the letter in January saying his Refugee Medical Assistance was ending.
An appointment with a skin specialist, the one he had waited six weeks for, had to be canceled. He could not afford to pay out of pocket and was unsure when the new coverage would start. He was also running low on his medication to fend off tuberculous. He cannot afford the $102 price to refill it.
These days, he spends his time looking for work and studying to become a doctor in the U.S. Someday he’d like to own a house, maybe have a wife and kids. In a year, he can apply for a green card.
His family back home is afraid for him. One of the first things they told him to do was trim his beard so he would not stand out.
He’d like to visit them but fears if he leaves he will not be able to re-enter.
Still, he likes his life in his tidy one-bedroom apartment in Pearland. He has a girlfriend he met online and a car that has seen better days. Even with the turmoil of recent weeks, he is grateful to be in America, where he sees all things possible.
“No regrets,” he says, “but worries.”