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Immigrants with Mental Illness to Lose Health Services

By Nhien Nguyen | International Examiner
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In 1994, Faridah Hanim and her family emigrated from Malaysia to Seattle. Though she left her country, she did not leave behind the mental illness that would affect her for the rest of her life.

Within a year of living in the United States, she was hospitalized for an episode of manic depression.

Like many new immigrants, Hanim had trouble navigating the health care system. She desperately needed a psychiatrist and a prescription for her illness, which is marked by extreme changes in mood, thought, energy and behavior. But because she was not a citizen, she did not qualify for Medicaid funds.

Hanim was eventually referred to Asian Counseling & Referral Service, an agency that serves the Asian Pacific American community with culturally- and linguistically-sensitive mental health services. There, as a Non-Medicaid client, she found a doctor and appropriate medication at a sliding scale rate relative to her income.

“I like going to ACRS,” said Hanim. “They understand my culture and it’s easier to talk [to them].”

Non-Medicaid clients are no or low-income disabled persons who don’t qualify for Medicaid for a variety of reasons, including first onset of psychiatric problems, no history of hospitalization, income level and immigration status.

Over the years, Medicaid and Non-Medicaid funding has shrunk, making it increasingly difficult for agencies to serve the growing number of uninsured clients with mental health needs.

In 1996, after the passage of the federal welfare reform, immigrants and refugees were barred from Medicaid eligibility. States like Washington get around this by using Medicaid savings for people who didn’t qualify but were in dire need of services.

In July these funds will be cut. The federal government has banned states from using Medicaid funds for disabled people who are not on Medicaid. Thousands of disabled people will be left without mental health services.

Agencies serving Asian and Latino populations have a higher proportion of Non-Medicaid clients. Historically, about 15 percent of ACRS clients and 25 to 30 percent of Consejo Latino clients were Non-Medicaid, compared to only three to 10 percent of patients in mainstream agencies.

Non-Medicaid clients like Amy, who did not wish to use her real name because of the small Burmese community in Seattle, would suffer from these changes. At age 23, Amy has bipolar disorder (also called manic depression), and pays a small co-pay of $10 for her counseling visits to ACRS. She pays for her own medication, though her doctor prescribes a generic, less expensive version.

ACRS helped Amy with funding her mental health services – the service is practically footing her medical bill – and case manager Winnie Tsai prescribed appropriate medication for her. Under the care of a previous family doctor, Amy was misdiagnosed with depression and given Prozac, a drug that potentially worsens the condition of those with bipolar disorder.

Those who support cuts to Non-Medicaid argue that only citizens should be eligible for federal and state medical assistance funds.

But ACRS Behavioral Health Director Yoon Joo Han says that many of her clients face barriers to becoming citizens. “With language and cultural barriers on top of a mental illness,” she says, “the road to citizenship can be much more challenging.”

Even if Amy, who came to the United States almost four years ago, were to become a citizen, she would still not qualify for Medicaid. Because she is still able to work, she is disqualified from the funds.

If ACRS could no longer afford to pay for her, Amy says she would have to quit pursuing her degree in nursing, and increase her work hours from 15 hours a week to full-time. Then, she could likely afford mainstream, psychiatric care, though working more hours could make her condition worse.

“ACRS helped me a lot,” said Amy, who is beginning to learn more about her illness. “They give me good medication, good advice, and good doctors.”

“Counseling helps me because I don’t talk about everything with family,” she said.

In times of a state budget crisis, Non-Medicaid funds are often the first to be cut. But, Han says that investing in Non-Medicaid now will prevent future spending, and in the end, cost the state less.

According to the Center for Mental Health Law in Washington D.C., curtailing access to mental health care could have the unintended consequences of increasing overall government spending and leading to poorer health, and even death.

Cuts in Medicaid and Non-Medicaid may also cause a swelling in the number of homeless people and criminals with mental illnesses.

As recent immigrants who cannot speak English, Sarifah Thi and her mother Jainop Thi are afraid that when the budget cuts go into effect they will not be able to afford to see their case manager, who provides sample medications for free.

They are both under the care of Cambodian case manager Kirk Tan for schizophrenia and depression, respectively.

“There is no place for me,” Sarifah said. “I don’t know what would happen to me without ACRS.”

With the new restrictions, the state will lose nearly $41 million in federal funding per year and King County will lose about $10 million per year, according to ACRS.

To continue serving the mental health needs of API immigrants, several hundred ACRS clients will join other Asian Americans to rally for funds for Non-Medicaid clients. On Asian Pacific American Legislative Day set for Feb. 17, the community will ask the state to make up the shortfall for Non-Medicaid funding.

“People are suffering silently,” said ACRS Behavioral Health Director Yoon Joo Han. “Families and communities are suffering, too.”