USCRI: U.S. Committee for Refugees and Immigrants

Study of Domestic Capacity to Provide Medical Care for Vulnerable Refugees
Promoting Refugee Health and Well-Being

A survey and policy study examining medical case management and healthcare accessibility for refugees

Refugees who are resettled in the United States face many challenges that are part of building their new lives in a new country. Some of these refugees arrive with significant medical conditions which require additional support from Resettlement Agencies to coordinate and assist with access to health care as well as auxiliary services such as accessible housing, transportation, and benefits. 

The resettlement of refugees with significant medical conditions is challenging for Resettlement Agencies as a result of the need for more intense case and medical management. Agencies have responded to this challenge by developing innovative models that maximize available resources and incorporate private donations, federal grants and volunteerism.

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Purpose of the study

The Study of Domestic Capacity to Provide Medical Care for Vulnerable Refugees, funded by the Bureau of Population, Refugee, and Migration, provides policy recommendations based on an assessment of refugees’ medical needs, services provided, and cost of care during the initial 90-day Reception and Placement period.  This multi-disciplinary study assesses the capability, impact, and service models implemented in resettlement communities to resettle medically vulnerable refugees during the 30 to 90 days after arrival in the U.S.

Partner agencies' participation

The research was implemented at five resettlement sites:

  • International Institute of New England, Boston, MA
  • International Institute of Minnesota, Saint Paul, MN
  • YMCA International Services, Houston, TX
  • College of Southern Idaho Refugee Service Center, Twin Falls, ID
  • Nationalities Service Center, Philadelphia, PA

These sites were selected for their diversity of health programming. Factors considered when identifying the sites included: overall refugee arrival numbers into the state, rate of participation in the Refugee Medical Assistance (RMA) program, the State’s participation in the Wilson-Fish Program, the State’s engagement in the Medicaid Expansion program, and the current capability of the agency to provide medical case management to newly resettled refugees.

Communities’ participation

Local Resettlement Agencies work closely with local stakeholders and service providers to help clients transition successfully to their new lives in the United States. To gain a deeper understanding of the agencies’ capacity to resettle medical cases, the project included interviewing key resettlement personnel with knowledge of the process involved in locating appropriate services and resources for cases with severe medical conditions. The interviews were conducted with key resettlement personnel including medical case personnel at the five selected sites, state officials involved in refugee issues (specifically the State Refugee Health Coordinators and State Refugee Coordinators), and other local Resettlement Agency affiliates.

Findings, conclusions, recommendations

Through this study, the U.S. Committee for Refugees and Immigrants provides research findings based on qualitative and quantitative data that are used to support policy recommendations. Data generated by this project in the five study sites shows a need for additional post-arrival support for the medically vulnerable, particularly for those with mental health conditions and mobility issues, as well as for those requiring hospitalization shortly after arrival. The recommendations generated by this report offer options for providing this additional support, as well as some critical health-related issues to consider in the resettlement of these refugees.

The findings and conclusions of this study are organized considering the following four study areas:

  1. To analyze the challenge of providing care when resettling medically vulnerable refugees;
  2. To assess the impact of the Affordable Care Act and efforts to expand Medicaid coverage on medically vulnerable refugees;
  3. To evaluate the various resettlement models utilized at the five research project sites and highlight models that reduce the challenge of providing care in resettling medically vulnerable refugees; and
  4. To provide relevant policy recommendations.

Explore USCRI’s findings and recommendations

Download the full report (121 pages)

Download a quick view (23 pages)

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