Growing number of states provide coverage for outpatient hemodialysis for undocumented immigrants

Abstract: https://www.acpjournals.org/doi/10.7326/M23-0202

Editorial: https://www.acpjournals.org/doi/10.7326/M23-0838

URL goes live when the embargo lifts

A brief research report has found that, due to increased advocacy and awareness of outcomes, a growing number of states have implemented policies that provide statewide coverage for undocumented persons with kidney failure to receive outpatient hemodialysis. The report is published in Annals of Internal Medicine.

Currently, undocumented immigrants cannot receive federal health insurance and most state Medicaid programs. In many states, undocumented immigrants with kidney failure rely on emergency hemodialysis (dialysis only after presenting critically ill to an emergency department) as mandated by the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals to provide emergency care regardless of ability to pay. Emergency hemodialysis is associated with a 14-fold higher mortality rate at 5 years and increased psychosocial burden for patients, caregivers, and clinicians. In 2019, only 12 states and the District of Columbia provided statewide coverage of outpatient hemodialysis by including kidney failure as a qualifying condition under Emergency Medicaid.

Researchers from the University of Colorado and University of California San Francisco assessed policy between March and October 2022 by 1) review of state Medicaid and Emergency Medicaid policy manuals for covered diagnosis codes “kidney failure,” “dialysis,” and “transplantation” and inclusion of undocumented immigrants and 2) brief interviews with clinicians with experience working with undocumented immigrants in every state. The authors found that as of 2022, twenty states and Washington, DC provide statewide coverage for standard outpatient hemodialysis for undocumented immigrants. Seventeen of those states provide outpatient hemodialysis through Emergency Medicaid, the remainder through Medicaid or state insurance pools. Five states also provide coverage for kidney transplantation. According to the authors, the expansion of dialysis coverage may be due to increasing awareness of poor outcomes with emergency hemodialysis and heightened advocacy efforts.

An accompanying editorial by authors from Harvard Medical School highlights the significant burden of lack of access to kidney replacement therapy care faced by undocumented residents experiencing kidney failure. The authors call for a humane national solution to abandon emergency dialysis as the only option for undocumented immigrants and instead pursue a move toward covering outpatient dialysis in all 50 states. They also call on legislators and policymakers to support a pathway for non-U.S. citizens living in the United States, including undocumented immigrants, to be able to purchase affordable insurance.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with corresponding author Katherine Rizzolo, MD, please email [email protected].