Patients in Idaho will now have to show proof of quote “lawful presence” in the U.S. to receive state funded care. But what about those who have legal status - citizens, green card holders, asylum seekers - but don’t have paperwork readily available?
Signed into law in April, HB 135 prohibits Idaho state funds from being used to provide benefits to people who are not in the country legally. Speaking at the Central District Health Board Meeting that month, Director Russ Duke said checking people’s IDs, including the required social security card for citizens, will be challenging.
“When we go out and we provide TB medications to a person who is currently unhoused because they have active TB, they don't have a Social Security card. We will no longer potentially be able to treat that individual to control respiratory virus, for which they have no ability to manage without medication,” he said, noting that many without homes gather in public spaces like shelters and libraries.
“That's an example of why this law could be concerning, at least from a public health perspective,” he added.
Tuberculosis can require months of antibiotics and can be extremely contagious without treatment. According to the Centers for Disease Control, rates of TB are ten times higher among unhoused folks. For those experiencing homelessness, holding on to paperwork can be difficult. Cards, wallets, and small items are often lost or stolen on the streets, and it can take a while for vulnerable people to get new documents.
The law provides some exceptions. It does not require verification of “lawful presence” for programs at short term shelters that “are necessary for the protection of life or public safety.” What falls under the definition of public safety is unclear.
The law also states that “the agency or political subdivision may establish by appropriate legal procedure such rules or regulations to ensure that certain individuals lawfully present in the United States receive authorized benefits including, but not limited to, homeless state citizens.” Those rules and regulations are not defined.
Board members raised the question of how untreated diseases can affect the community at large.
“The organism doesn't really care whether you've got documentation or not. So it does put the public at risk,” noted trustee and registered nurse Betty Ann Nettleton at the meeting.
“We want to really be able to take care of all individuals because we can't control who gets contracted with what communicable disease and how that may spread out within the community,” said Beth Bolen, an administrator at the District Families and Clinic services contacted after the meeting. “So being able to take care of all individuals would be ideal.”
Bolen said the District is consulting with lawyers to make sure it complies with the law before it goes into effect on July 1, 2025.
“We're anticipating that this will have an impact on being able to serve all of the patients that we have served in the past but we are unsure of how big of a population that's going to be or if it's going to be because they have undocumented status versus they're unable to produce the documents that we need,” she said.
The District serves about 13,000 people yearly. From July 2024 to this April, the CDH provided a wide set of vaccines at no cost to 670 under or uninsured adults.
