Assisters' Experiences of Hospital Screenings for Emergency Medicaid: A Qualitative Study in Colorado

Abstract: Because federal law excludes undocumented immigrants from Medicaid, Emergency Medicaid (EM) can play an important role in reducing their out-of-pocket medical expenses after an emergency. Although hospital financial assistance staff are vital to informing immigrants of EM's availability and ensuring their enrollment, no prior study has examined their EM screening practices. We conducted qualitative interviews with nonprofit hospital financial assistance staff and "assisters"—public agency staff who screen patients for assistance—in four regions of Colorado. Assisters reported three patterns through which hospital staff neglected to screen immigrants for EM: they diverted potentially eligible immigrants to assister agencies, failed to mention assistance, or qualified immigrants for hospital discounts instead. Assisters reported five explanations for hospital screening failures: understaffing, not viewing EM as their responsibility, pre-screening, a lack of interpreters, and phone mishaps. This study identifies opportunities to improve EM screening to benefit undocumented immigrants, hospitals, and states alike.