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Immigrant Health Care: Information for Providers

Thousands of immigrants, including many seeking asylum, come to NYC each year. Health care providers must take a wide range of considerations into account when caring for people who are recent arrivals to the United States.

Below are resources and referrals for newly arrived immigrant patients, including information on how to get them the best care possible from the first visit.


Insurance

Every patient who does not have health insurance should be offered a screening for health insurance eligibility by a City enrollment counselor. Regardless of immigration status, the following programs are available for the following populations:

  • Child Health Plus (children)
  • Medicaid (pregnant people)
  • Full public health insurance (people recognized by federal immigration authorities)
  • Emergency Medicaid (those ineligible for full coverage)

For more information about helping patients find insurance, see the NYC Health Department Health Insurance Action Kit.


Immunizations

Ask your patient for their immunization records, though they may not be available. If your patient has a vaccine record from their country of origin, be sure to enter the historical doses and histories of diseases and testing into the Citywide Immunization Registry.

Children should be screened and vaccinated urgently with all needed recommended immunizations, including those required for school attendance. Both influenza and COVID-19 vaccination should be offered to everyone age 6 months and older.


Care Considerations for Newly Arrived Immigrants

Below are some health concerns that may be observed among recent arrivals to NYC and how providers should report them.

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Varicella

Varicella continues to be detected among recent arrivals who are residing in shelters and other facilities in NYC. Most cases have been among unvaccinated children, but cases have also occurred among adults. Immediately vaccinate children and adults with no or an unknown history of varicella. Report varicella cases in shelters to the NYC Health Department’s Provider Access Line at 866-692-3641. For more information, see Varicella Guidance for Providers (PDF).

Tuberculosis (TB)

Many people who recently arrived in NYC have lived in or traveled through countries with high rates of TB. Assess all people who have not been screened since arriving to NYC for latent TB and symptoms of active TB. Use a blood-based interferon-gamma release assay test for TB infection in people age 2 and older.

TB services at the NYC Health Department’s Chest Centers, including testing, chest X-rays, sputum induction and treatment, are provided at no cost to patients, regardless of their immigration status.

To refer a patient to an NYC Health Department Chest Center, call 311.

COVID-19

Make sure people are up to date with their COVID-19 vaccinations. Some people may have received initial COVID-19 vaccinations at the U.S.-Mexico border but may not have received additional immunizations in the U.S.

Offer or refer people with COVID-19 symptoms or a recent exposure for testing. Many sites offer no-cost testing regardless of immigration status. Prescribe or refer patients with COVID-19 for treatment.

Malaria

Starting in 2023, an increasing number of malaria cases in NYC have been due to infection with Plasmodium vivax (P. vivax) and associated with time spent in South and Central America. Historically most malaria diagnoses in NYC have been attributable to P. falciparum and associated with time spent in sub-Saharan Africa.

As infection with P. vivax malaria tends to result in less severe disease than with P. falciparum, patients may not seek medical attention early or at all, and providers may also miss the diagnosis. This may lead to an increase in disease severity and complications (such as cerebral malaria and acute kidney injury). Additionally, with P. vivax infections, the hypnozoite form of the malaria parasite can become dormant in the liver for months or years before relapse, which may pose challenges both for clinical diagnosis and management.

Diagnosis of malaria should routinely be considered for any person with a fever who has spent time in an area with malaria in the weeks to months preceding symptom onset (or longer for patients with relapsing infections due to P. vivax and P. ovale) and:

  • Clinically compatible symptoms, including flu-like illness, chills, headache, muscle aches, tiredness, nausea, vomiting or diarrhea, or
  • Thrombocytopenia or hemolytic anemia that cannot be attributed to another cause, regardless of symptoms.

Treatment recommendations for malaria vary by species and severity. Refer to the CDC Malaria Diagnosis and Treatment Guidelines for U.S. Clinicians for specific detailed instructions. To prevent relapse, which can occur with P. vivax and P. ovale infection, patients must be prescribed specific anti-relapse therapy.

CDC clinicians with malaria expertise are on call 24/7 to provide advice to healthcare providers on the diagnosis and treatment of malaria and can be reached through the CDC Malaria Hotline at (770) 488-7788 or (855) 856-4713 (toll free) Monday to Friday, 9 a.m. to 5 p.m. Eastern Time. After hours, on weekends, and on federal holidays, healthcare providers can call 770-488-7100 and ask to speak with the malaria clinician on call.

Providers should report malaria cases to the NYC Health Department through Reporting Central or by calling the Provider Access Line at 866-692-3641.

Malaria Prevention, Diagnosis and Treatment Resources

Measles

Measles can spread rapidly in congregate settings like shelters and residential facilities where many recent arrivals are living. Providers should be vigilant for possible cases in both children and adults. Call the NYC Health Department’s Provider Access Line at 866-692-3641 to report possible measles cases at the time of clinical suspicion and arrange for testing at the NYC Health Department’s Public Health Laboratory. Do not wait for laboratory confirmation to report possible cases.

Providers should also ensure all children are up-to-date on their vaccinations. Documented measles immunity is required for school attendance. Adults without evidence of immunity to measles should also be vaccinated as soon as possible.

For more information, visit Measles Information for Providers.


Clinical Support for Asylum Applicants

Asylum seekers and other immigrants who obtain forensic medical evaluations are more likely to be granted protection in the U.S. than those who do not. Clinicians can play a vital role in supporting asylum seekers by conducting these evaluations to document the physical and psychological consequences of any harm they have experienced. As more people seek asylum in the U.S., more trained providers are needed to meet the increasing demand for this critical service.

You can receive free training to conduct evaluations via the Asylum Medicine Training Initiative, an asynchronous platform that allows you to complete the five to seven hours of training when it is convenient for you. You can also simultaneously register with an existing volunteer asylum medicine network.


Reproductive and Family Health

Health care providers should take a comprehensive sexual history of people who recently arrived from the U.S.-Mexico border.

Pregnant People and Infants

Pregnant and birthing people who are seeking asylum and refugee status face barriers to needed prenatal care and postpartum support. Late entry or lack of prenatal care puts pregnant and birthing people at risk for maternal mortality and complications during birth.

Refer all pregnant people to Prenatal Care. In addition, consider the following referrals:

Child Health Care Services

Screen young children for developmental disabilities, and refer patients with concerning results to the Early Intervention program (newborns to 2 years of age) or the Committee on Preschool Special Education program (3 to 5 years of age) programs.

Advise families that children can get health care through public school. Students can receive prescribed medicine, skilled nursing treatments and 504 Accommodations in school by completing a medication administration form annually.

In addition to immunizations, advise patients that new students to NYC schools must meet certain medical requirements.


Other Recommended Screenings

Initial visits with immigrants should also include:


Additional Resources