North Carolina immigrants report language, discrimination as barriers to health care

Immigrants living in North Carolina face challenges such as language barriers, complex eligibility rules and discriminatory treatment when interacting with government agencies, leaving many people excluded from welfare programs, according to a new study by the Washington-based Urban Institute and UNC- a. Chapel Hill.

About one in 12 North Carolinians are immigrants. In Mecklenburg County, that number rises to nearly one in six people.

Their experiences with the health care system and government agencies, such as the Department of Health and Human Services, can vary greatly depending on their background and their location.

Urban Institute Senior Fellow Hamutal Bernstein led a statewide assessment of how well immigrants can access safety net programs, such as SNAP and Medicaid.

Nearly half of noncitizen immigrants in the states do not have health insurance, compared to about 9% of U.S.-born citizens. They are also insured at a lower rate than immigrant residents nationwide.

We saw real variation in resources across counties, Bernstein said. They found that program administration and policy interpretation differed by district.

The report notes that North Carolina is one of 10 states that administers programs like SNAP and Medicaid through a decentralized system. This means that county governments, not state agencies, run the programs.

If there are ways that there can be more sharing of knowledge, resources and information between counties, or if state health and human services agencies can facilitate cooperation between counties or the sharing of resources between counties, that could be helpful, Bernstein said.

Researchers interviewed 42 North Carolina stakeholders from departments such as DHHS. They also conducted focus groups in four counties with residents who spoke Spanish, Swahili, or Hmong. They found that language access was a challenge for all three groups, but especially for non-Spanish speaking immigrants.

“One of the things that surprised us was talking to stakeholders, including HHS agencies, but honestly, across the board, just not knowing what the language needs is beyond Spanish,” she said. You can’t assume that if you give it in Spanish, you’re covering the language access needs of a diverse immigrant population.

In Mecklenburg County, for example, nearly 40% of immigrant adults with limited English proficiency speak a language other than Spanish. The top languages ​​spoken by North Carolina immigrants are Spanish, Chinese, Vietnamese, French, and Arabic.

The researchers conducted four focus groups with members of immigrant families. This included two sessions in Spanish, one in Swahili and one in Hmong.

Spanish speakers

More than half of North Carolina’s immigrants speak Spanish, and about 40% of the state’s immigrant population was born in Latin America. This is also a diverse group, with many people coming from families with mixed immigration status.

Their main barriers to accessing security programs included concerns about past or changed immigration policies, documentation requirements and a lack of interpreters and Spanish-speaking staff in HHS offices, the report said.

Bernstein noted that Spanish-speaking participants felt increased fear in counties where sheriffs partnered with federal Immigration and Customs Enforcement.

Spanish speakers also commented on discrimination, which was a concern for all three language groups.

They reported having to take an entire day to visit the office, arrive early and wait several hours before being served, the report said.

Two participants linked the lack of Spanish-speaking staff to poor treatment and discrimination. Another said she felt the color of her skin was a barrier to getting good service at the office.

Swahili speakers

All participants in this study group were newly arrived refugees from the Democratic Republic of the Congo. They lived in the United States between two months and four years. Bernstein explained that their situation is different from that of many other immigrant groups.

Refugees are specifically helped to enroll in safety net programs once they resettle, Bernstein explained. They get help early on, but may drop out and face barriers to staying enrolled.

They also faced challenges in accessing the language.

No one has ever seen written materials in Swahili at their county HHS agency. They reported receiving all correspondence from HHS only in English and Spanish, even when their HHS workers knew they did not speak those languages, the study said.

They also reported a lack of use of professional interpretation services when calling the HHS office and confusion in finding and navigating government buildings due to the language barrier.

Hmong speakers

Hmong families represent a more established immigrant group in North Carolina. Many fled Southeast Asia after the Vietnam War, and Hmong families in North Carolina often span three generations, the report said.

Many of the focus group participants were second-generation Hmong who are helping their parents navigate the health care system. Some were concerned about how living in multi-generational households might affect income-earning conditions. Many also took on the role of interpreters.

Participants reported a lack of Hmong translated materials, saying they provide their parents with a translation when communicating with HHS district offices, the study said. Most tried to help their parents through the process by translating information and filling out forms on their behalf. But they lacked full Hmong fluency and were worried they would inadvertently misinterpret the information their parents shared.

Other findings

A study found that children in North Carolina with an immigrant parent are more likely to live in a low-income household. Statewide, more than a quarter of children from low-income families had at least one immigrant parent. In Mecklenburg County, they make up nearly half of that population.

Bernstein says it sends a message about the importance of investing in immigrant families: If you want to help low-income children and families, you need to understand that reaching out to immigrant families is important.

The Urban Institute has released an interactive data tool that provides county-level data on North Carolina’s immigrant communities and health insurance rates.