Undocumented Coloradans score a victory for reproductive rights with Medicaid policy

By Alexandra Cummings

Aug 6, 2021 | Health | 0 comments

//Gina Millan, a Community Organizer at Colorado Organization for Latina Opportunity and Reproductive Rights, at her office in downtown Denver on Aug. 2. Photo By Polina Saran | polinasaran@gmail.com

Editor’s note: Two sources in this story are referred to by pseudonyms to protect their identities. Spanish to English translators were used for all three sources. This article translated into Spanish by Amelia Petrini can be found here

On July 6, with the stroke of a pen, Colorado Gov. Jared Polis signed Senate Bill 21-9 into law. The bill marked a significant shift in the state’s Medicaid policy by providing undocumented people with free access to reproductive resources, including birth control.

“This bill will help ensure that young women don’t have to give up their dreams and suffer as I did,” said Maria, an undocumented immigrant who moved to Colorado 20 years ago with her children. 

Sponsored by Sen. Sonya Jaquez Lewis and Rep. Yadira Caraveo, this bill was also the product of the hard work of local organizations, including the Colorado Organization of Latina Opportunity and Reproductive Rights, or COLOR. The courage of individuals like Maria, who were willing to speak openly about the impact this bill would have, was also imperative to the bill’s progress.

The bill goes into effect Jan. 1, 2022, and services will be offered through the state’s existing Medicaid structure. Currently, undocumented folks cannot access the healthcare program and do not receive benefits in Colorado. This bill works to utilize Health First Colorado, the official name for the state’s Medicaid program, to provide reproductive care, since federal funds cannot be used to support undocumented people.

Colorado is the third state in the country that will allocate funds through Medicaid to make contraceptive resources available to state residents, regardless of citizenship or immigration status. Oregon passed a similar law targeted toward undocumented immigrants in 2017, and Washington state followed two years later.

When sharing her experience as an undocumented immigrant in Colorado, Maria expressed a feeling of defeat and fear. From the difficulties of finding a job to grappling with the stigma of being considered a “free-loader” due to her citizenship status, the barriers she has faced here in Colorado often feel more amplified than when she lived in California. 

While Colorado still has work to do when it comes to the rights of the undocumented, Maria now feels a sense of hope and believes SB 21-9 will alleviate some of the stress her community feels.

“Young girls deserve a chance to live before deciding to be parents, an opportunity I was never afforded,” Maria said.

Colorado has a history of working with different communities in regard to reproductive health access. For example, the Colorado Family Planning Initiative has helped decrease teen pregnancy across the state through free contraceptives and access to clinics. However, because this program is funded through Medicaid, undocumented teens can’t access these benefits. In 2019, 1437 of 2368 teen births were attributed to Latinas. Teen pregnancies within the Latino community double that of their white counterparts. 

The Latino community makes up 21.8% of the Colorado population, with much of the state’s undocumented population originating from Central and South American countries. The bill notes that 27% of Latino people in Colorado are uninsured—making them the state’s highest uninsured population. Without insurance, birth control pills can cost up to $600 per year. More permanent solutions like implants and intrauterine devices can be between $800-1000, according to the National Women’s Health Network.

Contrary to widespread stereotypes, undocumented immigrants are not living in the United States free of charge. Gina Millan, a contract community organizer at COLOR, moved to Colorado from Mexico to escape violence and is no stranger to the misconceptions about undocumented communities.

“We pay taxes; we work hard, and we do it all knowing we won’t be getting the same access to things that documented Americans will,” Millian said. 

Research reviewed by the nonpartisan Congressional Budget Office indicates that between 50% and 75% of unauthorized immigrants pay federal, state and local taxes. In fact, they are estimated to pay about $7 billion per year into Social Security, even though they currently do not benefit from the program.

In a health system dominated by employer-based coverage, the Latino community lacks health insurance primarily because they are more likely to be working for employers that do not offer coverage or are not covered by their firm’s health plan. Although private insurance is available, family plans that often cost well over $1000 a month aren’t feasible with low-paying positions. 

“We can’t afford birth control without insurance, especially when we’re already working multiple jobs just to put food on the table,” said Elena, an undocumented immigrant living in rural Colorado who testified before Colorado elected officials when this bill was brought to the floor. 

Elena, who not only financially provides for her family here in Colorado but also sends money back to her loved ones in Mexico, could feel a weight lifted when she heard the bill passed.

“It’s important because, as a mother to daughters, I can now show them that they don’t have to be afraid,” Elena said. “They will have the ability to make decisions over their own body and the trajectory of their futures.”

Undocumented and immigrant people face a multitude of barriers to accessing contraception and reproductive care when compared to U.S.-born citizens. According to the American College of Obstetricians and Gynecologists, 71% of this population reported having no health insurance coverage in 2011.

On top of a lack of insurance, proximity to resources also plays a role in the inability to access birth control. According to data from Power To Decide, more than 300,000 Coloradans live in contraceptive deserts, which means county residents lack reasonable access to a health center that offers the full range of contraceptive methods. Many contraceptive deserts in Colorado are found in rural areas, adding a physical barrier to care on top of documentation status. 

“I live in a town that is very small, and we have to travel over an hour to a location that offers healthcare,” Elena said. “With the price of gas and low pay, it’s just not feasible, especially when I have to pay for the contraceptives once I get there.”

COLOR, a nonprofit organization that works to ensure that Latino individuals and their families can access opportunities and resources for the health of mind, body and spirit, has led the charge for Senate Bill 21-9 since the fall of 2020. 

“This bill has been a long time coming,” said Katherine Riley, policy manager at COLOR. “We tried to pass a more comprehensive bill that would have expanded Medicaid to cover a wide range of reproductive health services, including prenatal/postpartum care and sexually transmitted infection counseling for our undocumented community. The bill was never introduced, and after COVID held us back in 2020, we decided to bring just a piece of that original legislation forward this year.”

The Medicaid expansion was initially intended to be a three-to-five-year plan, but COLOR was pleasantly surprised to see the bill pass in just a year. Riley credits the quick success of their work to COLOR’s former director, Karla Gonzales Garcia. As an immigrant herself, she ensured the bill was positioned properly in the healthcare sector. With her guidance, COLOR was able to build strong relationships with organizations and legislators. 

Although COLOR is celebrating their success, their work is not done. With programs supporting a wide variety of Latino groups, COLOR continues to break down barriers. They have programs designed specifically for youth, including their group Latinas Increasing Political Strength and a Youth of COLOR fellowship program. They’re also leading programs aimed at parents, including a helpline geared toward pregnancy and postpartum support.

COLOR hopes that bills like SB 21-9 will serve as a stepping stone toward eventually offering the full range of resources and opportunities that had been part of their original bill a few years ago.

“For us, this work is not about the fact that most immigrants do pay taxes and greatly contribute to their communities,” Riley said. “It’s about human rights. These are people living in our communities that should be treated with respect and dignity.”

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