Exhausted in his mother’s arms, 6-year-old Joniel (not his real name) scratched the numerous insect bites covering his legs. Mother and son sat in an exam room, waiting for his first medical evaluation since arriving in the United States.
Joniel’s family had come to the emergency department for anti-itch cream and — as is increasingly the case — help finding housing. Displaced from their homeland of Haiti, the family had lived temporarily in South America before making the grueling journey to Boston. They had arrived just 16 hours earlier.
After doctors learned Joniel’s medical history and ran laboratory testing, the results unexpectedly showed signs of an autoimmune disorder that, without proper steroid treatments, can be life-threatening. Thankfully, he came to the hospital in time to be quickly stabilized, and two weeks later, was medically ready for discharge.
But things were about to get more complicated for Joniel and his family. With nowhere to go, and because his immigration status limited his access to safety-net medical services, such as outpatient specialty care and certain medications, doctors were not able to discharge him. He — and his family — remained in the hospital.
Joniel’s family is among a growing number of migrants in Boston who have fled increasing socioeconomic and political turmoil in their home countries. Their predicament highlights two critical needs — for housing and medical attention — that often intersect in hospital emergency rooms. Families are forced to address each of these necessities through a convoluted and frustrating system that makes getting both a place to live and health care exceedingly difficult.
A surge of migrants from Haiti, a country rocked by political and natural upheaval, underscores the need for urgent action. While rates of Haitian entrants at the US-Mexico border have dramatically increased in recent years, there has been limited federal infrastructure set in place to welcome and transition them. According to 2022 data from one local hospital’s pediatric emergency room, 80 percent of its families experiencing homelessness were Haitian asylum seekers. Overall, 42 percent of presenting families had come to that pediatric ER within 30 days of entering the United States.
As pediatricians in Boston, we see this crisis firsthand. ERs have become places of respite for migrants who have made arduous journeys, sometimes lasting months and even years, in search of refuge. Families with nowhere to turn seek out ERs as a safe space, but also because of the knowledgeable social workers who can help in the search for housing.
Meanwhile, an increasing number of children are arriving here with acute, life-threatening medical needs that require inpatient admission, or with chronic conditions requiring long-term follow-up.
Under these circumstances, Massachusetts has responded by launching a number of welcome centers for new migrant families. These sites appropriately redirect families from congested medical centers toward housing accommodations and help enroll them in benefits such as health insurance.
Massachusetts Medicaid, specifically a program called MassHealth Limited, offers health insurance to noncitizens. But it does not cover outpatient specialty care, essential medications such as asthma inhalers or insulin, physical or occupational therapy, nor transportation to medical appointments — services that would otherwise be accessible under the full coverage plan, MassHealth Standard.
Under a humanitarian parole program launched by the Biden administration, up to 30,000 people from Haiti, Cuba, Nicaragua, and Venezuela are being allowed to enter the United States each month, though the measure is being challenged in court. Most Haitian migrants can qualify for MassHealth Standard, but only with required documentation that includes proof of residency and immigration status. Joniel’s family needed housing, but unfortunately, the overburdened public housing system made it challenging to receive shelter placement near a medical center that accepted his insurance.
The state government has been working to expedite temporary housing placements, but these are often located outside the Greater Boston area, where few clinics accept MassHealth Limited. Families must travel hours on public transportation to access primary care, which becomes burdensome for frequent visits required for newborns or those with complex medical conditions.
Without established housing, Joniel’s family had difficulty upgrading his insurance to get the care he needed. If not for the excessively complicated systems related to immigration status, he could have accessed these services more readily. Given these barriers, Joniel remained hospitalized, living with his family in a 140-square-foot hospital room for weeks.
As pediatricians, our training has prepared us to care for sick children, but nothing prepared us for this. Inadequate health care coverage and strained public housing infrastructure are preventing us from treating our most vulnerable.
An issue of this magnitude requires a multistep approach to address both medical and housing necessities.
For starters, we need policy makers and citizens to support the Cover All Kids bill, which would extend full health insurance access in Massachusetts regardless of immigration status. It would let children access preventative care beyond specific hospitals and community health centers, preventing a prolonged hospitalization like Joniel’s. Several states have already expanded such comprehensive Medicaid services.
In addition, state lawmakers should support Governor Maura Healey’s recent supplemental budget filing of $250 million to assist in statewide emergency shelter needs.
After a monthlong hospitalization with substantial advocacy from the hospital team, Joniel ultimately received housing in Boston and was able to access hospital services that accepted MassHealth Limited. While we were able to provide medical care for this family, there is no guarantee that others won’t slip through the cracks of our fraught system. We need to support each and every family that arrives, hoping to start anew.
Rita Wang, Amundam Mancho, Jeffrey Edwards are pediatricians in Boston. Follow them on social media @ritaywang_, @AmundamsAnatomy, and @Djeffreedom. Send comments to email@example.com.