Our state's new immigrant children's program, currently with one hundred participants, means Hawaii can be closer to 100% of our keiki and opio enrolled in health insurance! Here are some resources and information to help outreach and enrollment: 1. Children's Defense Fund's "Sign Them Up!" Newsletter The Fall 2000 edition has excellent information on the following topics: *Outreach Through Community Partnerships *Clarifying Immigration Law for Medicaid/State CHIP *Dispelling Myths about Public Charge *Projects Working Effectively to Sign Up Immigrant Children Go to Archive: Sign Them Up! Newsletters. 2. Public Charge Flyers The U.S. Immigration and Naturalization Services posted public charge clarification information in English, Spanish, Chinese, Korean, Thai, Cambodian, and Vietnamese. Call their national customer service hotline center at 1-800-375-5283 for more details.. 3. Racial and Ethnic Differences in Children's Access to Care The disadvantage that some Hispanic children experience in their access to health care may be related to having parents with limited English skills and insufficient knowledge about the health care system, according to a new study from the Agency for Healthcare Research and Quality. The study, published in the November 2000 issue of the American Journal of Public Health, concluded that interpreters or bilingual providers and office staff may be needed to help reduce disparities in children's access to care. http://www.ahrq.gov/news/press/pr2000/weinickpr.htm 4. Building Bridges: Overcoming the Barriers to Enrolling Immigrants and Refugees in Massachusetts Health Insurance Programs Benjamin Cook, Health Care for All, Covering Kids Massachusetts, reports on the findings of a qualitative study using key informant interviews and immigrant/refugee focus groups. The study identifies barriers to enrolling immigrants and refugees in health programs but also opportunities already in place that can be used to enroll this population. The October 2000 publication is available online in pdf format at http://www.hcfama.org/hcfa_contents.php3?fldID=99 or call Health Care for All in Massachusetts at 617-350-7279. 5. New Report Focuses on Immigrants and Barriers to Health Care Access To obtain adequate health care, immigrants need to know how to access care and communicate with providers to "understand their diagnosis and treatment," a study by Global Strategy Group reports. Prepared for the Kaiser Commission on Medicaid and the Uninsured, the study convened a series of ten focus groups of immigrants in four cities-Miami, New York City, Los Angeles/Orange County and San Antonio-to ascertain their knowledge and perception of public programs including Medicaid, CHIP, TANF, and Food Stamps. The resulting report, titled "Immigrants' Access to Health Care After Welfare Reform: Findings from Focus Groups in Four Cities," found that immigrant populations face issues similar to other low-income families, but had additional barriers to access related to "language, culture, and recent immigration policy." a. Misunderstandings Many immigrants were unaware of or held "serious misunderstandings" about how recent policy changes, including the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (welfare reform), impacted their ability to access and keep Medicaid coverage and some were fearful that seeking benefits could affect their immigration status. Under welfare reform, new legal immigrants are treated differently from existing immigrants and citizens in determining eligibility for public benefits and many focus group participants expressed frustration that "despite working and paying taxes, they were often unable to obtain...Medicaid coverage." Many also thought citizens and some immigrant groups received preferential treatment in obtaining public or private coverage. In addition, Medicaid's "difficul[t] and length[y]" enrollment process was often the biggest concern voiced by focus group participants. Nevertheless, many believed Medicaid was a good program. Other participants said they were not offered health insurance by employers even though their families included a full-time worker, but could not afford private coverage. Finally, the report noted that the American health system is very different from those in many immigrants' native countries, and that several participants did not understand health insurance, "especially...the concept of cost sharing." b. Access Issues Many immigrants said they recognize the importance of check-ups, but they often forgo or postpone care because of costs. While citing inadequate payment from Medicaid or other government programs, immigrants also said long waits, transportation, and work commitments were barriers to access. One Cuban immigrant in Miami said, "I would have to leave work so I could take the kids, and I don't make money to do that. I only get three sick days a year." Language and cultural differences often kept immigrants from seeking care as well. Therefore, many immigrants rely on home remedies or delay care until they visit their native country. Those who do access the health care system tend to seek care from clinics and private doctors, as they consider hospitals "notorious for long waiting periods [and] high costs." But immigrants with longer tenure in the United States found the system easier as they have more experience than newer immigrants. The United States is a very different world for many immigrants, the report said, and confusion over eligibility policies, language difficulties, discrimination, and administrative hurdles all contribute to immigrants faring poorly in regard to health care access. "As policymakers discuss the nation's growing number of uninsured and issues of access and quality, the plight of the noncitizen U.S. population will need to be addressed," the report concludes. The report is available on the Kaiser Family Foundation web site at http://www.kff.org/uninsured/1608-index.cfm.