How COVID complicates life for newly arrived refugees in Houston – Houston Chronicle

Before the pandemic, Huda Alhamdani, a case manager at Catholic Charities of the Archdiocese of Galveston-Houston, wrangled Medicaid coverage and food stamps for newly arrived refugees in a week.

Now, the process takes months, leaving her clients with limited healthcare options at a time when they’re most needed.

“If it’s an emergency, we just tell them to call 911, and we’ll deal with the bills later,” she said.

Health insurance delays are among the ways that COVID has complicated the stressful lives of newly arrived refugees in Houston. The virus has forced them to navigate a maze of increasingly technology-dependent providers with little knowledge of the country’s complex healthcare system, while also tending to their housing and transportation needs.

Houston each year welcomes hundreds of refugees fleeing violence or persecution in their home countries. Historical data from 1975 to 2018 show most refugees arrived in the city from Vietnam, Iraq and Cambodia. But last year’s Taliban takeover of Afghanistan triggered an influx of more than 4,000 Afghans, according to earlier reports in the Chronicle.

“When they arrive, they’ve already gone through a stressful situation, and it continues to be a struggle because adjustments take time,” said Ali Al Sudani, chief programs officer for Interfaith Ministries for Greater Houston. “So if you add COVID on top of this, of course that’s going to make it a little bit more difficult and complicated for everyone.”

When it comes to healthcare, insurance delays are the most immediate concerns for refugee families, advocates say.

The problem is twofold, said Alhamdani. First, Social Security offices have remained closed throughout the pandemic, except for limited in-person visits. Case managers endure lengthy wait times over the phone to schedule appointments so their clients can receive their Social Security cards, a necessity for a Medicaid application.

Oftentimes, Alhamdani said, she can’t reach anyone. And when she does, appointments are not available until the following month.

For the refugees who do eventually obtain their Social Security cards, case managers face another lengthy wait during the application process for Medicaid and food stamps with the Texas Health and Human Services Commission, she said. Medicaid provides health coverage for some low-income people and for people with disabilities.

Texas Health and Human Services did not respond to an inquiry about the reasons for the delays. In an emailed statement, the U.S. Social Security Administration highlighted its “commitment to operating our nation’s immigration system more efficiently” by allowing refugees to apply for a Social Security card on the same form used to apply for a work permit. But the federal agency did not elaborate on the long wait times.

Refugees do have other options for healthcare. Many qualify for temporary health insurance through the Refugee Medical Assistance program, but that funding stops after eight months. Alhamdani says she tries to reserve those benefits for people who need immediate care.

Some uninsured refugees feel stuck if they test positive for COVID. Abdullah Laqaragoli, a 21-year-old Iraqi refugee living in Houston, said he lay on the floor of his home for four days in early 2021 as the virus left him fatigued and short of breath.

“If I had healthcare, I 100 percent would have gone (to a doctor),” said Laqaragoli, who first moved to Turkey with his mother before coming to the United States in 2020. “I would have called the ambulance and had them pull me up, because I literally could not move.”

In addition to the insurance holdups, many refugees simply do not know where to go for treatment. Case managers must explain the difference between primary care and emergency care, and define terms like “out-of-pocket expenses” and “in network.” That can lead to costly bills for visits to a hospital emergency room. If refugees need treatment, the agencies often steer them to safety-net clinics for mild infections or to Ben Taub Hospital for severe illnesses. But many refugees also follow the lead of family members and neighbors who go to Hillcroft Physicians PA, a 14-room clinic in southwest Houston that serves patients in 10 languages.

During COVID surges, the clinic sees a huge influx of refugees who work and live in the surrounding area, said Dr. Forough Farizani, the medical director. The population, while largely vaccinated, is more vulnerable to the virus because many work in the service industry, she said.

At the peak of the omicron wave, the clinic saw more than 70 people a day with a variety of illnesses, stretching its staff of about six people.

“They’re very dependent on us for education,” said Farizani. “They’re not computer savvy or their English is not at the level where they can go online and find things. So they come here for everything.”

Zamir Amiri visited the clinic in late December, four months after he and his pregnant wife fled from Afghanistan and arrived in the U.S. He sought treatment for his two-year-old son, who had cold-like symptoms.

He said the clinic is his preferred choice because it’s close and because some of the staff, including Farizani, can speak a mix of Dari and Farsi.

“We all want to come here,” he said through a translator.

The Hillcroft clinic may be a convenient option, but it’s not the only provider that caters to the refugee population. Alhamdani said she often refers clients to Texas Children’s Hospital, which offers the Program for Immigrant and Refugee Child Health, an initiative that connects uninsured or underinsured refugee patients to primary care providers and specialists throughout the region.

The program’s director, Dr. Karla Fredricks, noticed many refugees lack reliable sources of information in their language about treating a COVID infection. They often rely on social media or WhatsApp, she said.

“You’ve been taught to fear it and avoid it, and now you’re new to this country and your child is sick,” she said. “So we could do a better job of (informing them) what to do if you do get sick.”

She also pointed out that the healthcare system has become increasingly technology-dependent with the rise of telemedicine. Communication between the patient and providers is largely online, and refugees sometimes lack the skills to navigate mobile apps or websites on their own.

They might not be able to access their COVID test results, for example, and therefore may not know whether they should quarantine or isolate.

“That’s just another aspect of the newly arrived experience,” she said. “They say ‘I knew who to turn to when we were back home. I just went to the next village and asked my mom.’ But when you got to the U.S., you usually don’t have that extended family support like you do back home.”

julian.gill@chron.com