Arlette Lozano came to this country 18 years ago from Mexico at age 8 when her mother sent her and her 3-year-old brother across the border with the help of a coyote — someone paid to smuggle people across the border.
There wasn't enough money for their mother to travel with them, so the children came alone to meet an aunt living in East Los Angeles. "It was very scary," Lozano recalls. "I remember my mom telling me not to fall asleep because they can kidnap us."
Lozano, now a 26-year-old student at UCLA with a double major in global studies and anthropology, grew up in Fullerton with her brother and mother, who eventually made her way to the U.S.
Despite distant memories of the dangerous trek she and her brother took years ago, she says she knows no other life than the one she's lived here in America.
Yet, without legal immigration status, her family has been shut out of many benefits available to U.S. citizens, including access to health insurance. "It's always been a concern," Lozano says of living without coverage.
Undocumented immigrants have limited access to health insurance and medical care, a fact the Affordable Care Act does little to change. Though it increases access to Medicaid and private health insurance, the law bars millions of undocumented immigrants, including an estimated 1 million Californians, from these programs.
"Undocumented immigrants continue to be outside the coverage expansions under the Affordable Care Act," says Steve Zuckerman, with the Urban Institute, a Washington think tank.
Even when aware of the programs and services that are available to them, people can be apprehensive about trying to take advantage of them.
Many undocumented immigrants "say fear of deportation for themselves or family members is a barrier in terms of signing up for coverage and accessing healthcare services," says Laurel Lucia, policy analyst at the UC Berkeley Center for Labor Research and Education.
Lucia points out that U.S. Immigration and Customs Enforcement has established that any information submitted by immigrants — both documented and undocumented — for Medicaid or private insurance will not be used to enforce immigration law against those applying or their family members.
Despite the barriers, there are options for immigrants in Lozano's position to find health insurance and medical treatment. Here are some suggestions.
Student health plans. Many colleges and universities require students to either buy their school's health insurance policy or show proof of other coverage. Immigration status is generally not questioned when students apply, and the plans are affordable.
UCLA enforces such a requirement, and so for the first time in her life Lozano has health insurance. But she worries that once she completes her education she'll no longer have access to coverage.
"I'm very, very concerned about when I graduate school," she says.
Employer-based health insurance. Upon graduation, if Lozano lands a job that offers health insurance, she'll be able to take advantage of it. People without legal status in the U.S. are sometimes hired by companies that offer employee health benefits, and they are generally able to sign up without having to show proof of their immigration status.
Although experts acknowledge that this isn't an option for most, Zuckerman says, "There are undocumented immigrants with work-based coverage."
Private health insurance. Although this is an expensive option for many people, undocumented immigrants are also allowed to purchase private health coverage as long as they do so directly from an insurance carrier or through a broker. But they cannot shop through Covered California, the state's insurance exchange set up under the Affordable Care Act, or take advantage of tax subsidies to pay for coverage.
Medi-Cal coverage. The state provides a full range of low-cost healthcare options for poor Californians, and some of those Medi-Cal benefits are available regardless of a person's immigration status. For instance, emergency care, pregnancy-related services and, when needed, state-funded long-term care can be obtained.
In addition, a 2012 federal law provides temporary work authorization and relief from deportation to undocumented children and young adults who arrived in the U.S. before turning 16. It's part of the Deferred Action for Childhood Arrivals law, known as DACA. Undocumented immigrants who qualify — mostly people younger than 31 who attend school — are eligible.
The Affordable Care Act bars undocumented immigrants from access to Medicaid, but California allows those with DACA status to sign up for Medi-Cal.
"In California if you meet income requirements, DACA-eligible youth are covered by Medi-Cal," says Steven Lopez, health policy expert at the National Council of La Raza, a Washington-based Latino advocacy group. A recent University of California study estimated that roughly 125,000 Californians qualify for this help.
Community health centers. Funded in part by federal grant money, roughly 1,200 health centers operate around the country. These federally qualified centers provide primary healthcare, dental, mental health and pharmacy services. They treat all comers without concern for immigration status or ability to pay for care.
These clinics "have been a critical role in providing that safety net level of care and will continue to do so especially for those who remain uninsured because of their immigration status or other reasons," Lopez says.
There are also many low-cost and free community clinics that provide services on a sliding scale.
State-based health programs. Unlike most states, California makes a number of health programs available to low-income residents regardless of immigration status. Services vary by county.
Healthy Way L.A. Unmatched. This program provides primary care for uninsured patients, including immigrants without legal status. Many counties also offer special health programs and services for children. Local county health departments can provide residents with detailed information.
In addition, Kaiser Permanente offers a Child Health Program for uninsured California children younger than 19 who don't have access to Medi-Cal or other coverage, regardless of immigration status. Coverage costs between zero and $20 per child per month.
Lozano is grateful to have coverage but is so accustomed to avoiding doctors that she's uneasy about using her benefits.
"There is still shame when I go to the doctor or dentist," she says. "I have to tell them I've never been there before. To explain why is very nerve-racking."
You can find a Federally Qualified Health Center by searching the U.S. Health Resources and Services Administration website: findahealthcenter.hrsa.gov/help.
To find local community health centers, search the Community Clinic Assn. of Los Angeles County website: http://www.ccalac.org.
To find information about Healthy Way L.A. Unmatched visit the Los Angeles County Department of Health Services site: dhs.lacounty.gov.
For more information about health benefits for non-citizens: Coalition for Humane Immigrant Rights of Los Angeles: (888) 624-4752.
Zamosky is the author of a new book, "Healthcare, Insurance, and You: The Savvy Consumer's Guide."