By Nicole Rodriguez-Robbins
Finger Lakes Community Health serves over 17,000 patients in upstate New York. Established in 1989 as a Migrant Health Clinic, they became designated as a federally Qualified Health Center (FQHC) in 2009 and have experienced tremendous growth as an organization in a few short years. Finger Lakes currently operates sites in Penn Yan, Port Byron, Bath, Dundee, Keuka, Sodus and Geneva, N.Y. and is in the process of opening three new locations in King Ferry, Ovid, and Newark. As Finger Lakes has grown as an organization, they have learned how to adapt to the unique challenges associated with treating a diverse patient population in a rural setting.
On a snowy February day, I visited the Center’s Geneva site. The road to the Geneva clinic is dominated by a flat, open landscape and crosses the Montezuma Wildlife Refuge before passing a collection of small farms, many of them run by the Mennonite and Amish communities. The clinic is located in a non-descript strip mall building that is easily overlooked. The facility is small and somewhat cramped but manages to incorporate primary care, dental health and behavioral health services under one roof. For the population surrounding Geneva, a mix of migrant seasonal workers, Amish and Mennonite families, and others who earn their living primarily from farming, Finger Lakes is their only access point to health care. Mary Zelazny, CEO at Finger Lakes, explained that while several private providers practice in the area, most are unwilling to accept patients who are covered by Medicaid or Medicare, or are uninsured. These providers are also often both unwilling and unequipped to treat migrant patients, who have specific linguistic and cultural needs.
Finger Lakes opened their Geneva site after the local Planned Parenthood clinic closed its doors several years ago. Since opening, the Center’s patient numbers have doubled. They are currently in the process of expanding into the next door offices, where they plan to open a pharmacy and add additional examination rooms to accommodate more patients. During my tour of the clinic, Mary showed me their state of the art “Telehealth” program, which is used for communicating remotely with providers at different sites and to specialists in other parts of the state. There is very limited public transportation in the Finger Lakes region and driving long distances between sites can be particularly challenging during the winter months. An invaluable piece of equipment at Finger Lakes is “Ruby,” a robot equipped with video monitoring capabilities and a joystick so it can be moved remotely throughout the clinic as needed. Ruby allows providers to treat patients at different sites and can also be used for language interpretation when a bilingual staff person is not available at a certain location. With this technology, providers can connect those patients who often live in isolated rural areas with off-site specialists, without making them travel prohibitive distances. Patients can receive retinopathy screenings as part of management of diabetes, as well as dental consults and behavioral health treatment. Mary explained that the trauma and isolation of immigration and the effects of separation from their families and communities put migrant patients at high risk for depression and other mental illness. There is a large need for behavioral health clinicians who are often hard to come by in rural areas. The telehealth technology has given clinicians and social workers the ability to connect patients to mental health providers through online video conferencing. Case workers and clinicians who have the linguistic and cultural competency to diagnose behavioral health-related conditions are then able to make a direct connection between a patient and mental health provider. This technology also affords patients a sense of anonymity by giving them access to providers who are outside of their tight-knit community where cultural taboos around mental health treatment might prevent them from seeking treatment.
Despite a surrounding community and political climate that is overwhelmingly anti- immigrant and largely hostile, and the legal limitations of caring for an undocumented population, Finger Lakes is dedicated to serving the migrant community with the best possible care. The center has built trusting relationships with the migrant population over the years through concerted outreach efforts and linguistically and culturally appropriate care. The staff has a clear understanding of the health hazards associated with agricultural work and the daily risk migrants face. They have employed creative solutions to meet the unique challenges of treating an uninsured, transient and unstable population. Through use of cutting-edge technology as part of their telehealth program, and concerted outreach to the migrant camps, they are able to provide patients the necessary health care services and ensure they receive proper follow-up treatment.
The Affordable Care Act’s principal aims are to achieve equity in the health care system, improve health outcomes, and lower health care costs. While the ACA doesn’t expand coverage to undocumented immigrants, the state has does have some degree of flexibility in determining eligibility for certain legal immigration statuses through the Health Benefit Exchanges. According to a new report from the New York Immigration Coalition and Empire Justice Center, 2.1 million non-citizen immigrants currently reside in New York State. This includes 625,000 persons who are undocumented and as such, are barred under the ACA from any types of public benefits and ineligible to purchase directly coverage through the health insurance exchanges. This still leaves 1.4 million lawfully-residing immigrants in New York, and N.Y. State, which has historically offered a broad scope of benefits, has the opportunity to maximize coverage for these residents under the Exchange. Presently, New York provides Medicaid coverage to those immigrants classified as PRUCOL (Persons Residing Under Color of Law, or those in process of applying for asylum, status adjustment, or who have been granted a deferred action). The definition of PROCUL is more expansive than the ACA definition of “lawfully present” immigrants and continuing to extend coverage under the PRUCOL definition will ensure access for additional immigrants. Further, although DREAM Act youth are not eligible for coverage under the ACA, New York State also has opportunity to include this group by extending the PRUCOL definition. The New York Immigration Coalition recommends that the state review options for an insurance product for undocumented immigrants.
It is up to the state to form health care exchanges which can broaden the participation of immigrant populations. It is logical that giving all immigrants’ access to care, including preventative services, is for the public good and generates an overall cost savings for individuals and the state. While universal health care coverage and access is not yet a reality, community-based providers like Finger Lakes will continue serve the needs of disenfranchised immigrant patient populations in an effort to close the gap in health disparities.