Providing care to Undocumented immigrants
STUDENT EXAMPLE CASE PLEASE DO NOT DISTRIBUTE
Problem Statement
Mr. Villalobos, a 37-year-old, Spanish-speaking migrant worker from Central Mexico.
No health insurance. Has a daughter with chronic illness he pays out of pocket to treat.
No previous health issues, develops sudden congestive heart failure/cardiomegaly.
Provided emergency care in hospital, stabilized and prescribed medication.
After being discharged, followed up with a Migrant Health Center and the attending physician decided he needed care outside of the Health Centers resources.
Mr. Villalobos needs a heart valve replacement, but cannot afford the surgery due to his lack of health insurance and eligibility for Medicaid.
This begs the question
Is the healthcare system denying the life-saving procedure to Mr. Villalobos due to his lack of medical insurance a justifiable ethical decision in the case of providing care to undocumented immigrants in the United States?
Landscape Assessment
What we do know:
Mr. Villalobos does not have health insurance
He does not have any prior medical history
He is relatively fit and healthy
He has been in the United States for less than a year (some months)
He works 10 to 12 hours a day in local mushroom houses
Has a wife and five children
Has confirmed congestive heart failure/Cardiomegaly (enlarged heart)
He has been prescribed medications to prevent clotting and control his heart rate
Presents symptoms with minimal exertion despite being on medication
Needs a heart valve replacement for condition to improve
Landscape Assessment (cont.)
What we dont know:
Mr. Villaloboss daughters condition (We dont know how much he is paying out of pocket)
Age of Mr. Villaloboss children
Details about Mr. Villaloboss wife
Mr. Villaloboss familys feelings about the situation
Mr. Villaloboss family medical history
Mr. Villaloboss income
If Mr. Villalobos has any friends/family that live in the United States that could potentially help him
If Mr. Villalobos is able to continue receiving his life-saving medications for his heart failure
Landscape Assessment (cont.)
Assumptions:
Mr. Villalobos has not tried to apply for any type of insurance or healthcare coverage
Mr. Villalobos has paid for his daughters medical care out of pocket
Mr. Villalobos wants to have the heart valve replacement done
Mr. Villaloboss family supports the surgery being done
Mr. Villalobos does not qualify for Medicaid
Mr. Villalobos is not healthy enough to return to Mexico for treatment
Mr. Villalobos is not healthy enough to continue working at this job
Mr. Villalobos does not have any friends or family in the United States in a position to help him
Related Laws and Policies
Pennsylvania’s Medical Assistance program
Under the Pennsylvania Health Law Project
Has some limitations, but exceptions for certain people to qualify
The Affordable Care Act (2012)
Holds limitations for undocumented individuals, such as ACA subsidies, CHIP, and Medicaid Limitations
Illegal Immigration Reform and Immigrant Responsibility Act (1996)
Undocumented individuals present in United States for 180 days but less than 365 days must remain outside of United States for 3 years unless granted a pardon
Increases deportation risks
What is Pennsylvania’s medical assistance program?
The MA program is Pennsylvanias version of Medicaid.
Individuals can only qualify if theyre Lawfully present or of qualified immigration status that have already lived in the United States for five years.
In this case, Mr. Villalobos does not qualify, has only been in the United States a few months, and his condition would not allow him to live for five additional years untreated.
Though he is able to receive emergency MA as he did initially, he does not qualify for this particular program.
Stakeholder Analysis
Mr. Villalobos
Needs to have good health to support his family
Does not want to put his life at risk by not receiving care
Mr. Villaloboss wife
Stayed with the 5 children in Central Mexico
Mr. Villaloboss treatment could impact her
Mr. Villaloboss Family (especially chronically ill daughter)
Requires support from Mr. Villalobos
Medical care providers
Recognize Mr. Villalobos needs heart valve replacement, but are conflicted with limited resources
Federal Healthcare system
Limitations on ACA and other related laws and policies
Values Assessment
Autonomy
Mr. Villalobos should not be denied the opportunity to make a life-saving decision for himself, and should not have the decision made for him due to lack of resources/insurance.
Equity and Social Justice
Mr. Villalobos should have the same opportunity for healthcare as everyone else.
Distributive Justice
Mr. Villalobos should be able to get the heart valve replacement surgery if resources are available in the United States.
Criteria: From perspective of Mr. Villalobos
Harm
Which option will reduce overall harm the most?
Which option will improve Mr. Villalobos health-related issues?
Which option will improve Mr. Villaloboss financial harm the most?
Efficiency
Which option saves the most money?
Which option would be efficient in helping Mr. Villalobos keep his job?
Quality of Life
Which option would make Mr. Villalobos feel the best in terms of physical health?
Which option will allow Mr. Villalobos to live a long, happy, healthy life?
Which option would allow Mr. Villalobos to help his familys quality of life?
Option 1: Status Quo
Mr. Villalobos doesnt act on getting the heart valve replacement surgery
He continues working despite being symptomatic
He continues making money to support his family
Quality of life remains on a steady decline
High risk for major organ failure and death in a short amount of time
Option 2: Apply for General Assistance Related MA
Pennsylvania adopted a Medicaid expansion in 2015
Despite Mr. Villalobos not qualifying for Medicaid, he does qualify for benefits from the expansion.
Does not require the five year waiting period, unlike the MA program
He could receive his medication that stabilizes his condition.
He falls into the category of General Care Medical Assistance:
Adults with Temporary Disabilities (GA-related NMP) Adults with low enough income and resources may qualify for this category if a doctor completes an Employability Assessment Form (PA 1663) and indicates the applicant has a temporary disability which impacts their ability to work. (Casserly, D., & PHLP, 2017)
Option 3: Receive EMA to cover ongoing care
In 2004, DHS issued Operations Memorandum # 040301 clarifying that CAOs (County Assistance Officers) have the authority to approve Emergency medical assistance for emergency ongoing care, and this is still in effect today
Does not need to disclose immigration status or qualify for Medicaid to qualify for EMA ongoing treatment
This includes:
Stating the need for treatment is immediate, and that without treatment/surgery his life is at risk.
Doctor must write EMC letter of seriousness of condition resulting from lack of proper treatment.
Must include in letter expensive medical emergencies that will arise without treatment.
Summary of Ethical Options
Value Status Quo Apply for general MA Apply for EMA for ongoing care
Harm – – + ++
Efficiency – – +
Quality of life – + ++
2
0
5
Recommendation
Option 3: Receive EMA to cover ongoing care
This option would give Mr. Villalobos the highest potential to get the heart valve replacement surgery
Improves his quality of life the most in the long term.
Most efficient for his financial status, and allows him to return to work without suffering from symptoms.
He may still have to take medication, but he wont be symptomatic with minimal exertion and he will be able to continue his work and have an overall improved condition.
What happens if Mr. Villalobos still doesnt receive any medical care despite his qualifications?
If Mr. Villalobos doesnt get coverage and goes untreated, his condition will reach emergency care status regardless. Getting covered by ongoing MA would be the best preventative measure to avoid this from happening, but he will still end up getting emergency medical care in the end. Thus, option 3 is still the most ideal option.
References
Casserly, D., & PHLP. (2017). Health Care for Immigrants: A Manual for Advocates in Pennsylvania. Retrieved from http://www.phlp.org/wp-content/uploads/2016/05/Immigrant-Health-Care-Manual-For-Advocates-05.2016.pdf
Ku, L., & Jewers, M. (2015, August 12). Health Care for Immigrant Families: Current Policies and Issues. Retrieved from https://www.migrationpolicy.org/research/health-care-immigrant-families-current-policies-and-issues
Zong, J., Zong, J. B., Batalova, J., & Hallock, J. (2018, February 27). Frequently Requested Statistics on Immigrants and Immigration in the United States. Retrieved from https://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states#HealthInsurance
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Ethicalexample1.pptx
Home>English homework help>p point
Providing care to Undocumented immigrants
STUDENT EXAMPLE CASE PLEASE DO NOT DISTRIBUTE
Problem Statement
Mr. Villalobos, a 37-year-old, Spanish-speaking migrant worker from Central Mexico.
No health insurance. Has a daughter with chronic illness he pays out of pocket to treat.
No previous health issues, develops sudden congestive heart failure/cardiomegaly.
Provided emergency care in hospital, stabilized and prescribed medication.
After being discharged, followed up with a Migrant Health Center and the attending physician decided he needed care outside of the Health Centers resources.
Mr. Villalobos needs a heart valve replacement, but cannot afford the surgery due to his lack of health insurance and eligibility for Medicaid.
This begs the question
Is the healthcare system denying the life-saving procedure to Mr. Villalobos due to his lack of medical insurance a justifiable ethical decision in the case of providing care to undocumented immigrants in the United States?
Landscape Assessment
What we do know:
Mr. Villalobos does not have health insurance
He does not have any prior medical history
He is relatively fit and healthy
He has been in the United States for less than a year (some months)
He works 10 to 12 hours a day in local mushroom houses
Has a wife and five children
Has confirmed congestive heart failure/Cardiomegaly (enlarged heart)
He has been prescribed medications to prevent clotting and control his heart rate
Presents symptoms with minimal exertion despite being on medication
Needs a heart valve replacement for condition to improve
Landscape Assessment (cont.)
What we dont know:
Mr. Villaloboss daughters condition (We dont know how much he is paying out of pocket)
Age of Mr. Villaloboss children
Details about Mr. Villaloboss wife
Mr. Villaloboss familys feelings about the situation
Mr. Villaloboss family medical history
Mr. Villaloboss income
If Mr. Villalobos has any friends/family that live in the United States that could potentially help him
If Mr. Villalobos is able to continue receiving his life-saving medications for his heart failure
Landscape Assessment (cont.)
Assumptions:
Mr. Villalobos has not tried to apply for any type of insurance or healthcare coverage
Mr. Villalobos has paid for his daughters medical care out of pocket
Mr. Villalobos wants to have the heart valve replacement done
Mr. Villaloboss family supports the surgery being done
Mr. Villalobos does not qualify for Medicaid
Mr. Villalobos is not healthy enough to return to Mexico for treatment
Mr. Villalobos is not healthy enough to continue working at this job
Mr. Villalobos does not have any friends or family in the United States in a position to help him
Related Laws and Policies
Pennsylvania’s Medical Assistance program
Under the Pennsylvania Health Law Project
Has some limitations, but exceptions for certain people to qualify
The Affordable Care Act (2012)
Holds limitations for undocumented individuals, such as ACA subsidies, CHIP, and Medicaid Limitations
Illegal Immigration Reform and Immigrant Responsibility Act (1996)
Undocumented individuals present in United States for 180 days but less than 365 days must remain outside of United States for 3 years unless granted a pardon
Increases deportation risks
What is Pennsylvania’s medical assistance program?
The MA program is Pennsylvanias version of Medicaid.
Individuals can only qualify if theyre Lawfully present or of qualified immigration status that have already lived in the United States for five years.
In this case, Mr. Villalobos does not qualify, has only been in the United States a few months, and his condition would not allow him to live for five additional years untreated.
Though he is able to receive emergency MA as he did initially, he does not qualify for this particular program.
Stakeholder Analysis
Mr. Villalobos
Needs to have good health to support his family
Does not want to put his life at risk by not receiving care
Mr. Villaloboss wife
Stayed with the 5 children in Central Mexico
Mr. Villaloboss treatment could impact her
Mr. Villaloboss Family (especially chronically ill daughter)
Requires support from Mr. Villalobos
Medical care providers
Recognize Mr. Villalobos needs heart valve replacement, but are conflicted with limited resources
Federal Healthcare system
Limitations on ACA and other related laws and policies
Values Assessment
Autonomy
Mr. Villalobos should not be denied the opportunity to make a life-saving decision for himself, and should not have the decision made for him due to lack of resources/insurance.
Equity and Social Justice
Mr. Villalobos should have the same opportunity for healthcare as everyone else.
Distributive Justice
Mr. Villalobos should be able to get the heart valve replacement surgery if resources are available in the United States.
Criteria: From perspective of Mr. Villalobos
Harm
Which option will reduce overall harm the most?
Which option will improve Mr. Villalobos health-related issues?
Which option will improve Mr. Villaloboss financial harm the most?
Efficiency
Which option saves the most money?
Which option would be efficient in helping Mr. Villalobos keep his job?
Quality of Life
Which option would make Mr. Villalobos feel the best in terms of physical health?
Which option will allow Mr. Villalobos to live a long, happy, healthy life?
Which option would allow Mr. Villalobos to help his familys quality of life?
Option 1: Status Quo
Mr. Villalobos doesnt act on getting the heart valve replacement surgery
He continues working despite being symptomatic
He continues making money to support his family
Quality of life remains on a steady decline
High risk for major organ failure and death in a short amount of time
Option 2: Apply for General Assistance Related MA
Pennsylvania adopted a Medicaid expansion in 2015
Despite Mr. Villalobos not qualifying for Medicaid, he does qualify for benefits from the expansion.
Does not require the five year waiting period, unlike the MA program
He could receive his medication that stabilizes his condition.
He falls into the category of General Care Medical Assistance:
Adults with Temporary Disabilities (GA-related NMP) Adults with low enough income and resources may qualify for this category if a doctor completes an Employability Assessment Form (PA 1663) and indicates the applicant has a temporary disability which impacts their ability to work. (Casserly, D., & PHLP, 2017)
Option 3: Receive EMA to cover ongoing care
In 2004, DHS issued Operations Memorandum # 040301 clarifying that CAOs (County Assistance Officers) have the authority to approve Emergency medical assistance for emergency ongoing care, and this is still in effect today
Does not need to disclose immigration status or qualify for Medicaid to qualify for EMA ongoing treatment
This includes:
Stating the need for treatment is immediate, and that without treatment/surgery his life is at risk.
Doctor must write EMC letter of seriousness of condition resulting from lack of proper treatment.
Must include in letter expensive medical emergencies that will arise without treatment.
Summary of Ethical Options
Value Status Quo Apply for general MA Apply for EMA for ongoing care
Harm – – + ++
Efficiency – – +
Quality of life – + ++
2
0
5
Recommendation
Option 3: Receive EMA to cover ongoing care
This option would give Mr. Villalobos the highest potential to get the heart valve replacement surgery
Improves his quality of life the most in the long term.
Most efficient for his financial status, and allows him to return to work without suffering from symptoms.
He may still have to take medication, but he wont be symptomatic with minimal exertion and he will be able to continue his work and have an overall improved condition.
What happens if Mr. Villalobos still doesnt receive any medical care despite his qualifications?
If Mr. Villalobos doesnt get coverage and goes untreated, his condition will reach emergency care status regardless. Getting covered by ongoing MA would be the best preventative measure to avoid this from happening, but he will still end up getting emergency medical care in the end. Thus, option 3 is still the most ideal option.
References
Casserly, D., & PHLP. (2017). Health Care for Immigrants: A Manual for Advocates in Pennsylvania. Retrieved from http://www.phlp.org/wp-content/uploads/2016/05/Immigrant-Health-Care-Manual-For-Advocates-05.2016.pdf
Ku, L., & Jewers, M. (2015, August 12). Health Care for Immigrant Families: Current Policies and Issues. Retrieved from https://www.migrationpolicy.org/research/health-care-immigrant-families-current-policies-and-issues
Zong, J., Zong, J. B., Batalova, J., & Hallock, J. (2018, February 27). Frequently Requested Statistics on Immigrants and Immigration in the United States. Retrieved from https://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states#HealthInsurance
Discussion
Applied Sciences
Architecture and Design
Biology
Business & Finance
Chemistry
Computer Science
Geography
Geology
Education
Engineering
English
Environmental science
Spanish
Government
History
Human Resource Management
Information Systems
Law
Literature
Mathematics
Nursing
Physics
Political Science
Psychology
Reading
Science
Social Science
Home
Blog
Archive
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Reviews
Contact
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