Running head: DIALYSIS DIALYSIS FOR THE UNDOCUMENTED 1
Dialysis f! "he Und#u$en"ed Anne Mailh" S"% F!an#is Uni&e!si"y Clini#al A''li#a"ins( Cindy D!enning )une 1*( +,1-
DIALYSIS FOR THE UNDOCUMENTED
+ Abstract
The und#u$en"ed i$$ig!an" ''ula"in is n" eligi.le f! fede!ally funded heal"h '!g!a$s( Medi#aid and Medi#a!e% In Den&e!( "his .e#$es an issue f! "his ''ula"in /i"h end s"age !enal disease 0ESRD( a disease /hi#h !e2ui!es "h!i#e /ee3ly dialysis% 4E$e!gen" dialysis5 .e#$es "he nly /ay " !e#ei&e "his "!ea"$en"( 'sing finan#ial and e"hi#al issues( #s"ing nea!ly fu! "i$es "ha" f u"'a"ien" dialysis and "he 'a"ien" fa#ing le"hal le&els f '"assiu$( se&e!e u!e$i# #ndi"ins( and $assi&e fluid &e!lad 0Rd!igue6( +,17% Fu! s"a"es #u!!en"ly ffe! Medi#aid funding f! "hese ESRD 'a"ien"s: Calif!nia( N!"h Ca!lina( Ne/ Y!3 and 8ashing"n 0Ca$'.ell( Sanff 9 Rsne!( +,1,% O"he! s'e#ifi# #lini#s ha&e ."ained funds " #&e! "his #s" su#h as Ri&e!side Dialysis Clini# in Teas( !edu#ing e$e!gen#y de'a!"$en" .u!den 0Ragha&an 9 Shei3h;Ha$ad( +,11% In Den&e!( safe"y;ne" hs'i"als li3e Den&e! Heal"h '!&ide e$e!gen" nly dialysis /i"hu" full !ei$.u!se$en" and !is3 #lsu!e li3e
DIALYSIS FOR THE UNDOCUMENTED
=
Dialysis f! "he Und#u$en"ed Cl!ad !an3s nu$.e! 1> in "he U%S% f! nu$.e! f und#u$en"ed i$$ig!an"s% In ea!ly +,1- i" /as es"i$a"ed "ha" a ""al f 1->(,,, !esiden"s /e!e und#u$en"ed( ?7@ f /hi#h /e!e f!$ Mei# 0S"a"es /i"h $s" und#u$en"ed i$$ig!an"s and /he!e Cl!ad !an3s( +,1-% This !esul"s in a" leas" 1->(,,, !esiden"s "ha" a!e n" eligi.le f! heal"h #&e!age% This 'ses an issue f! "hse /i"h se&e!e heal"h #ndi"ins "ha" !e2ui!e !egula! $ain"enan#e su#h as ESRD( /hi#h is 1%7 "i$es highe! in His'ani#s "han /hi"es 0Ragha&an 9 Shei3h;Ha$ad( +,11% Ba"ien"s li&ing /i"h ESRD !e2ui!e "h!i#e /ee3ly u"'a"ien" dialysis in !de! " a&id #$'li#a"ins f '! !enal fil"!a"in su#h as hy'e!3ale$ia( a!!hy"h$ias( u!e$ia and &lu$e &e!lad% The #s" is a.u" ?,(,,, 'e! 'a"ien" 'e! yea! and is a se!&i#e "ha" "he Aff!da.le Ca!e A#" f +,1, e'anded " #&e! 0Rd!igue6( +,17% In Den&e!( CO und#u$en"ed i$$ig!an"s /i"h ESRD a!e n" eligi.le " !e#ei&e u"'a"ien" dialysis due " la#3 f Medi#aid #&e!age% Ins"ead( "hey #an '!esen" " "he e$e!gen#y de'a!"$en" 0ED /he!e ED '!&ide!s( hs'i"alis"s( and ne'h!lgis"s /!3 "ge"he! " de"e!$ine if "he 'a"ien" 2ualifies f! 4e$e!gen" dialysis5% If dee$ed e$e!gen"( "he 'a"ien" is ad$i""ed f! 1;= nigh"s( ! lnge!( nly " !e"u!n in =;? days " !e'ea" "he en"i!e ad$issin again% This "!ea"$en" !a'idly infla"es .y a.u" =%? "i$es f "he s"anda!d u"'a"ien" yea!ly #s"( and is #s"ing "a 'aye!s &e! +,,(,,, 'e! 'a"ien" 'e! yea! 0Ragha&an 9 Shei3h;Ha$ad( +,11% The e$e!gen" '!esen"a"in all/s f! a 4si#3e!5 'a"ien" !e2ui!ing $!e "i$e in "he hs'i"al( $!e s"aff( $!e e2ui'$en" and $!e $edi#a"in% This als 'ses an e"hi#al issue f! '!&ide!s as any f!$ f dis#!i$ina"in( in#luding agains" i$$ig!a"in s"a"us( is agains" "he a"h "ha" '!&ide!s "a3e " #a!e f! a 'a"ien"% T ha&e Medi#aid and Medi#a!e !ei$.u!se f! und#u$en"ed i$$ig!an" u"'a"ien" dialysis /uld #e!"ainly !edu#e "he #s" f dialy6ing "hese 'a"ien"s% Medi#aid and Medi#a!e a!e
DIALYSIS FOR THE UNDOCUMENTED
>
fede!al and s"a"e funded '!g!a$s "ha" !ei$.u!se #lini#s( hs'i"als ! fa#ili"ies f! heal"h se!&i#es '!&ided " 'a"ien"s 0Medi#aid( n%d%% These '!g!a$s /e!e signed in" la/ in 1-7 and #&e! indi&iduals /i"h l/ in#$e 0B!g!a$ His"!y( n%d%% In +,1>( "he!e /e!e a.u" 1 $illin 'e'le #&e!ed .y Medi#aid in Cl!ad 0D/ns( +,1>% T"al Medi#aid s'ending in Cl!ad in +,1> /as al$s" - $illin 0T"al Medi#aid S'ending( n%d%% Calif!nia( Ne/ Y!3( N!"h Ca!lina and 8ashing"n ha&e su##essfully influen#ed Medi#aid " 'ay f! u"'a"ien" dialysis f und#u$en"ed i$$ig!an"s .y 2ualifying ESRD and "he need f! dialysis as an e$e!gen" #ndi"in% Ms" f "hese s"a"es !e#gni6e "he BRUCOL 0Be!$anen" Residen"s Unde! "he Cl! f La/ designa"in /hi#h s"a"es "ha" und#u$en"ed i$$ig!an"s /h !eside in "he U%S% and d n" ha&e a !e#!d f! #n"e$'la"in f enf!#ing de'!"a"in .y "he De'a!"$en" f H$eland Se#u!i"y a!e eligi.le f! S#ial Se#u!i"y enefi"s 0ansal 9 Gs3.yni3( +,1-% The!e is #n"!&e!sy in "he "'i# f '!&iding fede!al funds " und#u$en"ed i$$ig!an"s due " "he n"in "ha" n" nly a!e "hese 'e'le in "he #un"!y illegally( .u" "hey d n" #n"!i.u"e " "he "aes "ha" all/ '!g!a$s li3e Medi#aid and Medi#a!e " eis"% The Chief A#"ua!y( a g&e!n$en"al !gani6a"inal en"i"y !es'nsi.le f! es"i$a"ing fede!al funds( es"i$a"ed "ha" a ne" f 1+ .illin /as #n"!i.u"ed " Medi#a!e .y und#u$en"ed i$$ig!an"s in +,,? /i"h $ini$al s'ending as a !esul" f la#3 f a##ess " "hese funds% I" #n#luded "ha" in +,, alne( i$$ig!an"s $ade 1>%?@ f "he #n"!i.u"ins " "he T!us" Fund and a##un"ed f! nly ?%@ f i"s e'endi"u!es% This !esul"s in a ne" su!'lus f 1=%* .illin ''sed " "he =,% .illin defi#i" f!$ Medi#a!e s'ending .y "he US;.!n% F! ea#h yea! "ha" /as e&alua"ed( i$$ig!an"s gene!a"ed a su!'lus e&e!y yea! .e"/een +,,+ " +,, !anging f!$ 11%1 .illin " 1?%+ .illin 'e! yea! 0all$an( 8lhandle!( Hi$$els"ein( !( 9 M##!$i#3( +,1=%
DIALYSIS FOR THE UNDOCUMENTED
7
In fa#"( "he!e ha&e .een se&e!al s"udies "ha" sh/ "ha" i$$ig!an"s use less heal"h #a!e se!&i#es "han U%S%;.!n #i"i6ens( and und#u$en"ed i$$ig!an"s a##un" f! nly 1%7@ f "he ""al $edi#al #s"s in "he U%S%( $s" f /hi#h a!ise f!$ e$e!gen#y de'a!"$en" &isi"s% I" is '!'sed .y "he I$$ig!a"in Bli#y Cen"e! "ha" heal"h #a!e #s"s #an .e !edu#ed &e!all /hen $!e 'e'le 'ay in" "he heal"h #a!e sys"e$% B!e&en"ing und#u$en"ed i$$ig!an"s f!$ 'u!#hasing heal"h 'lans nega"i&ely i$'a#"s "hse /h a!e 'aying in" "he sys"e$% Addi"inally( $!e $ney is .eing s'en" n &e!ifying !esiden" s"a"us /hen s$ene "!ies " 'u!#hase heal"h insu!an#e 0Ed/a!d( +,1>% In s"a"es /he!e u"'a"ien" dialysis f! "he und#u$en"ed has n" .een $ade eligi.le( #e!"ain #i"ies ha&e "a3en i" u'n "he$sel&es " !esl&e "he issue% F! ea$'le( San An"ni uses #un"y "aes " fund s#heduled u"'a"ien" dialysis a" '!i&a"e( f!;'!fi" dialysis #lini#s 0ansal 9 Gs3.yni3( +,1-% Den&e! has ? f!;'!fi" and + nn;'!fi" dialysis #en"e!s( n" in#luding Den&e! Heal"h /hi#h is a safe"y;ne" hs'i"al 0Den&e!( Cl!ad Dialysis Cen"e!s and Clini#s( n%d%% In Hus"n( Ri&e!side Dialysis Cen"e! funds u"'a"ien" dialysis f! a li$i"ed nu$.e! f 'a"ien"s% F!"y 'e!#en" is funded .y '!'e!"y "aes in Ha!!is Cun"y and "he !es" f!$ in#$e .ased sliding s#ale fees 'aid .y "he 'a"ien" 0Nuila( +,17% Cu!!en"ly( "he T!easu!y Di&isin f Den&e! s"a"es "ha" '!'e!"y "aes in Den&e! a!e a$ng "he l/es" in "he #un"!y% The funds a!e .eing u"ili6ed " $a3e i$'!&e$en"s n #i"y fa#ili"ies( funding " "he De'a!"$en" f Hu$an Se!&i#es and " "he De&el'$en"ally Disa.led Fund( funding f! aff!da.le husing and 'u!#hasing .dy;/!n #a$e!as f! Den&e!s 'li#e ffi#e!s 0Den&e! B!'e!"y Taes( Ci"y and Cun"y f Den&e!( n%d%% I" des n" #lai$ any #n"!i.u"ins "/a!ds $edi#al se!&i#es% The '!esen#e f C$$uni"y Heal"h Cen"e!s 0CHC in Cl!ad is an"he! 'in" f a##ess in add!essing "he needs f "he und#u$en"ed ESRD ''ula"in% CHCs( es"a.lished in 1*+( a!e
DIALYSIS FOR THE UNDOCUMENTED
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!e'!esen"ed .y The Cl!ad C$$uni"y Heal"h Ne"/!3 0CCHN and e$'ly &e! >(,,, Cl!adans% These fa#ili"ies se!&ed a.u" 7+-(,,, Cl!ad 'a"ien"s in +,1>( and i"s es"i$a"ed "ha" "hese #lini#s sa&e "he heal"h #a!e sys"e$ a.u" 1(=,, 'e! 'a"ien" 'e! yea!( and a.u" +> .illin na"inally 'e! yea!% Den&e! Cun"y has > CHCs "ha" '!&ide '!e&en"a"i&e se!&i#es " 'a"ien"s( in#luding und#u$en"ed i$$ig!an"s ! "hse /i"h ina.ili"y " 'ay 0Cl!ad C$$uni"y Heal"h Cen"e!s S"!eng"hening Cl!ads Heal"h and "he E#n$y( n%d%% B!e&en"a"i&e #a!e is a $ains"ay f !edu#ing &e!all heal"h#a!e #s"( and '!&iding "ha" #a!e " 'a"ien"s /i"h i$'ending 3idney disease ! de"e#"ing a" an ea!lie! s"age #uld !edu#e "he '!e&alen#e and .u!den f ESRD% I" is #lea! "ha" !esea!#h la#3s in Den&e!( and Cl!ad &e!all( n "he e#n$i# i$'a#" f "!ea"ing und#u$en"ed ESRD 'a"ien"s and /ha" slu"in /uld .e .es"% Addi"inally( "he defini"in f an 4e$e!gen" #ndi"in5 in Cl!ad shuld .e &isi"ed% Las"ly( sin#e sliding s#ale 'ay$en" '!g!a$s al!eady eis" in "he s"a"e f! und#u$en"ed i$$ig!an"s( "his /uld .e an a!ea f in"e!es" f! a slu"in " "his '!.le$ ."h f! ESRD #a!e and as a '!e&en"a"i&e $easu!e% H/e&e!( "he!e is li$i"ed da"a a&aila.le f! "his in !ega!ds " "his s'e#ifi# ''ula"in% Literature Review
Cnside!ing "ha" und#u$en"ed i$$ig!an"s .eing in "he U%S% is #n"!&e!sial " .egin /i"h( "he!e is li""le !esea!#h n h/ /e #an i$'!&e $edi#al "!ea"$en" f "hese 'a"ien"s in addi"in " $ini$al ad&#a#y f! "he issue% H/e&e!( a''!a#hes " "he "'i# in !esea!#h ha&e assessed "he $a""e! f!$ a finan#ial 'e!s'e#"i&e in addi"in " a $edi#al ne% In a +,1, !e&ie/ .y Ca$'.ell( Sanff( and Rsne! "he #s" f e$e!gen" dialysis /as assessed in #$'a!isn " s#heduled u"'a"ien" dialysis in Teas% The s"udy #$'a!ed "he "/ g!u's af"e! a 'li#y #hange "3 'la#e in 1? /he!e #e!"ain i$$ig!an"s /e!e g!andfa"he!ed in" s#heduled dialysis 0n J ++
DIALYSIS FOR THE UNDOCUMENTED
?
and 'a"ien"s '!esen"ing af"e! "he 'li#y #hange /e!e eligi.le f! e$e!gen";nly dialysis 0n J 1= 0Ca$'.ell( Sanff( and Rsne!( +,1,% The de$g!a'hi# da"a /as analy6ed . y using "he Fishe! ea#" "es"( signed !an3 "es"( and t "es"% The #s" /as analy6ed /i"h "/;sa$'le t "es"% Resul"s sh/ed "ha" "he e$e!gen#y dialysis g!u' s'en" $!e days 'e! yea! as in'a"ien" 01-+ &s 1,%1( $!e days in "he ICU 0-%1 &s 1%7>( $!e ED &isi"s 0+-%= &s 1%>( had $!e .ld "!ansfusins 0+>% &s +%+( fe/e! annual dialysis "!ea"$en"s 0* &s 17>( l/e! $easu!es f dialysis ade2ua#y 0,% K ,%,* &s 1%-> K ,%,7( and !e'!"ed a g!ea"e! le&el f 'ain /i"h l/e! 'hysi#al fun#"ining% The !egula!ly s#heduled g!u' #s" a.u" ?-(,,, 'e! 'a"ien" 'e! yea! #$'a!ed " a.u" +*7(,,, 'e! 'a"ien" 'e! yea! 0Shei3h;Ha$ad( Baiu3( 8!igh"( 9 Shande!a +,,?% An"he! s"udy .y Ragha&an and Shei3h;Ha$ad in +,11 l3ed a" "he finan#ial as'e#"s f e$e!gen" dialysis f! und#u$en"ed ESRD 'a"ien"s "h!ugh #ha!" !e&ie/ f 1*- 'a"ien"s in Hus"n( T in /hi#h >* f "hse 'a"ien"s /e!e als !and$ly sele#"ed and in"e!&ie/ed% Inf!$a"in #lle#"ed in#luded leng"h f s"ay in "he U%S%( leng"h f s"ay in Hus"n( #un"!y f !igin( #u!!en" and 'as" /!3 his"!y( highes" le&el f edu#a"in #$'le"ed( 3n/ledge f "hei! 3idney disease '!i! " i$$ig!a"ing( if dialysis /as a !easn f! "hei! i$$ig!a"in( and if "hey had g""en #a!e f! "hei! disease > $n"hs .ef!e dialysis ini"ia"in% S"a"is"i#al analysis f "he da"a /as 'e!f!$ed /i"h SAS &e!sin *%, using s"uden"s t "es" and Chi;s2ua!e% Resul"s sh/ed "ha" und#u$en"ed dialysis 'a"ien"s /e!e yunge! "han "hei! legal #un"e!'a!"s 0>+%- K 1+%- yea!s &s 7*% K 1>%= yea!s( ' ,%,1( and had less '!e&alen#e f dia.e"es $elli"us 0=7@ &s -*@( ' ,%,1% The a&e!age edu#a"in le&el #$'le"ed f! "he und#u$en"ed i$$ig!an" /as -"h g!ade /i"h 1?@ g!adua"ing high s#hl #$'a!ed " ??%+@ f 'a"ien"s f!$ "he legal $a"#hed #h!"% Only =@ f "he 'a"ien"s had 3n/ledge f "hei! disease '!i! " i$$ig!a"in( and 7>@ had .een
DIALYSIS FOR THE UNDOCUMENTED
*
e&alua"ed .y ne'h!lgy in "he > $n"hs '!i! " ini"ia"ing dialysis% Nine"y 'e!#en" f und#u$en"ed 'a"ien"s /e!e e$'lyed '!i! " dialysis and 1>@ #n"inued " /!3% A si$ila! su!&ey /as #ndu#"ed in + Ne/ Y!3 hs'i"als( a s"a"e /he!e und#u$en"ed 'a"ien"s a!e eligi.le f! u"'a"ien" dialysis% I" /as fund "ha" ?=@ f und#u$en"ed dialysis 'a"ien"s did n" !e#ei&e '!e;end;s"age #a!e( and nly >@ had .een a/a!e f "hei! disease '!i! " i$$ig!a"in% They als fund "ha" "he und#u$en"ed ESRD 'a"ien"s /e!e "/i#e as li3ely " .e e$'lyed "han legal ESRD 'a"ien"s su!&eyed in "hse + hs'i"als( a !a"e #nsis"en" /i"h "he s"a"is"i# "ha" >@ f /!3ing;age und#u$en"ed i$$ig!an" $en a!e e$'lyed( "he!ef!e #n"!i.u"ing a g!ea" deal " "hei! #$$uni"y and "he e#n$y 0Rd!igue6( +,17% y ha&ing 'a"ien"s d e$e!gen" dialysis as ''sed " s#heduled #a!e( "his i!!egula! s#hedule '!e&en"s $any f "he$ f!$ /!3ing( in "u!n affe#"ing "he l#al and na"inal e#n$y% The a!"i#le n"es "ha" "he!e a!e 1+,, Fede!ally ualified Heal"h Cen"e!s 0FHC funded .y "he Heal"h Resu!#e and Heal"h Agen#y "h!ughu" "he U%S% These a!e #en"e!s "ha" '!&ide '!i$a!y;"y'e #a!e " 'a"ien"s !ega!dless f a.ili"y " 'ay ! i$$ig!a"in s"a"us 0Rd!igue6( +,17% In Cl!ad( '!i$a!y heal"h #a!e se!&i#es " und#u$en"ed i$$ig!an"s a!e a&aila.le "h!ugh C$$uni"y Heal"h Cen"e!s 0Heal"h C&e!age O'"ins f! I$$ig!an"s in Cl!ad BDFP( n%d%% This #uld .e a 3ey "l in iden"ifying 3idney disease ea!ly and 'ssi.ly sl/ing '!g!essin " end;s"age% Gap Analysis
The #u!!en" '!a#"i#e f '!&iding dialysis " und#u$en"ed ESRD 'a"ien"s in Den&e!( CO is "h!ugh e$e!gen" dialysis% One hs'i"al "ha" "a3es n "his !es'nsi.ili"y is Den&e! Heal"h% This hs'i"al is a safe"y;ne" hs'i"al #nsis"ing f 7(,,, e$'lyees( and #lai$s "hey d n" '!&ide finan#ial assis"an#e " "he und#u$en"ed% H/e&e!( "hey /ill '!&ide "!ea"$en" " "he uninsu!ed% The ga' in "his $e"hd f "!ea"$en" lies in "he issues dis#ussed a.&e: infla"ed #s" and all/ing
DIALYSIS FOR THE UNDOCUMENTED
'a"ien"s " .e#$e le"hally ill% This hs'i"al is fa#ed /i"h '! !ei$.u!se$en" f! "hese se!&i#es( /hi#h his"!i#ally( in "he #ase f "i$es% The la!ges" hu!dle in '!&iding "he sa$e #a!e " "hese 'a"ien"s as "he! ESRD 'a"ien"s lies /i"hin eligi.ili"y " !e#ei&e u"'a"ien" dialysis% Sin#e 'aying f! "he #s" f "his "!ea"$en" u";f; '#3e" is un!ealis"i#( "hese 'a"ien"s ha&e " ha&e funding f!$ an"he! su!#e( su#h as Medi#aid( ! all/ed " !e#ei&e dialysis a" n ! l/e! #s" " Medi#aid as in "he #ase f Ri&e!side Dialysis Cen"e! in Hus"n( T% The 2ues"in "ha" a!ises /i"h "his is if "his /uld en#u!age $!e illegal .!de! #!ssing f! a##ess " $edi#al #a!e% H/e&e!( as $en"ined ea!lie!( "he $aQ!i"y f und#u$en"ed 'a"ien"s !e#ei&ing dialysis /e!e diagnsed in "he U%S% /i"hu" '!i! 3n/ledge f '! 3idney fun#"in% Addi"inally( in a g!u' f 'a"ien"s su!&eyed in Indiana( "hse /i"h e$e!gen";nly dialysis a##ess /e!e n" /illing " !el#a"e " "he! s"a"es /he!e u"'a"ien" dialysis /as '!&ided " "he und#u$en"ed due " fa$ily "ies and es"a.lished li&es 0ansal 9 Gs3.yni3( +,17% The fa#" "ha" "he $aQ!i"y f "hese 'a"ien"s a!e .eing diagnsed a" end;s"age 'ses an ''!"uni"y " u"ili6e CHCs and "he '!e&en"a"i&e #a!e "hey '!&ide " i"s fulles" '"en"ial% The !a"e a" /hi#h 'a"ien"s ha&e denied '!e;end s"age #a!e #lea!ly indi#a"es "he!e is a ga' in "hese 'a"ien"s a##essing '!e&en"a"i&e #a!e% This hinde!s "he ''!"uni"y f! ea!ly diagnsis f "he
DIALYSIS FOR THE UNDOCUMENTED
1,
disease and li3ely sl/ing '!g!essin " end;s"age% Cnside!ing "ha" "he &as" $aQ!i"y f "he und#u$en"ed i$$ig!an" ''ula"in is His'ani#( "his i$'lies "ha" "he!e is an &e!all highe! in#iden#e f ESRD in "he und#u$en"ed ''ula"in% The!ef!e( edu#a"in n "hei! in#!eased !is3 f "he disease and "he i$'!"an#e f a##essing '!e&en"a"i&e #a!e shuld .e '!&ided " "his g!u'% An"he! hu!dle "ha" is 'ssi.ly as la!ge as funding is ad&#a#y% The "'i# f i$$ig!a"in is a #n"!&e!sial ne and .$.a!ds u! 'li"i#al /!ld% Be!ha's "he $s" i$'a#"ful g!u' "ha" #an ad&#a"e f! "his ''ula"in is "he $edi#al #$$uni"y% e!linge! and Ragha&an dis#uss "he idea f ad&#a#y .y #lini#ians .y #ns#iusly !e#gni6ing '!efe!en#es ! dis#!i$ina"ins( and s"a"ing 4All hs'i"als se!&ing #$$uni"ies /i"h und#u$en"ed ''ula"ins shuld $a3e "i$e f! #andid( !efle#"i&e( and nn'uni"i&e dis#ussins f 'a"ien" #a!e #hallenges !ela"ed " 'a"ien"s und#u$en"ed s"a"us%This #uld fa#ili"a"e a##u!a"e inf!$a"in .e#$ing a&aila.le " "he! 'a!"ies "ha" #uld .e f assis"an#e in a $&e$en" f! #hange 0e!linge! 9 Ragha&an( +,1=%5 Conclusion
Ba"ien"s !e#ei&ing e$e!gen";nly dialysis ha&e lnge! hs'i"al ad$issins( $!e f!e2uen" ICU s"ays( '!e! 2uali"y f dialysis( and '!e! 2uali"y f life% The $aQ!i"y f ne'h!lgis" "h!ughu" "he na"in ag!ee "ha" "his is an une"hi#al /ay " "!ea" "hese 'a"ien"s 0Hu!ley e"% al%( +,,% In !de! f! 'a"ien"s ! #lini#s " .e a.le " ge" "he funding " '!&ide "his "!ea"$en"( "he $edi#al #$$uni"y and g&e!n$en" agen#ies /ill li3ely ha&e " /!3 "ge"he!% Be!ha's( "his /ill !e2ui!e #hanges " /ha" Cl!ad Medi#aid #nside!s 4e$e!gen"5 ! #hanging /h Medi#aid #&e!s( as in "he #ase f Calif!nia( Ne/ Y!3( N!"h Ca!lina and 8ashing"n% All#a"in f Den&e! Cun"y "aes " dialysis 'a"ien"s #uld als hel' fa#ili"a"e funding in "!ea"$en" f "hese 'a"ien"s% Las"ly( edu#a"ing "he und#u$en"ed i$$ig!an" ''ula"in a.u"
DIALYSIS FOR THE UNDOCUMENTED
11
CHCs in !de! " de"e#" 3idney disease ea!lie!( '!&iding .e""e! $anage$en" f "he disease( and sl/ing '!g!essin #uld .e i$'le$en"ed%
Refe!en#es e!linge!( N%( 9 Ragha&an( R% 0+,1=% The E"hi#s f Ad&#a#y f! Und#u$en"ed Ba"ien"s% Hastings Center Report ( >=01( 1>;1?% di:1,%1,,+has"%1+-
Ca$'.ell( <% A%( Sanff( S%( 9 Rsne!( M% H% 0+,1,% Ca!e f "he Und#u$en"ed I$$ig!an" in "he Uni"ed S"a"es 8i"h ESRD% American Journal of Kidney Diseases( 7701( 1*1;11% di:1,%1,7=Q%aQ3d%+,,%,-%,= Cl!ad C$$uni"y Heal"h Cen"e!s S"!eng"hening Cl!ads Heal"h and "he E#n$y% 0n%d%% Cl!ad C$$uni"y Heal"h Ne"/!3% h""':##hn%!g/'; #n"en"u'lads+,1-,-CCHN;EIA;.!#hu!e;/e.%'df
DIALYSIS FOR THE UNDOCUMENTED
1+
Den&e!( Cl!ad Dialysis Cen"e!s and Clini#s% 0n%d%% Re"!ie&ed )une 1+( +,1-( f!$ h""':#i"eheal"h%#$dialysis;#en"e!s#l!ad#i"iesden&e! Den&e! B!'e!"y Taes Ci"y and Cun"y f Den&e!% 0n%d%% Re"!ie&ed )une 1( +,1-( f!$ h""'s:///%den&e!g&%!g#n"en"den&e!g&en"!easu!y;di&isin'!'e!"y;"aes%h"$l D/ns( A% 0+,1>( )une *% Cl!ad Heal"h Ins"i"u"e ; Inf!$ing Bli#y% Ad&an#ing Heal"h% Re"!ie&ed )une 11( +,1-( f!$ h""':///%#l!adheal"hins"i"u"e%!g.lgde"aila; $illin;'e'le;#l!ad;hi"s;a;$edi#aid;$iles"ne Ed/a!d( )% 0+,1>% Und#u$en"ed I$$ig!an"s and A##ess " Heal"h Ca!e: Ma3ing a Case f! Bli#y Ref!$% Policy, Politics, & Nursing Practice( 1701;+( 7;1>% di:1,%11??17+?17>>1>7=+-> Heal"h C&e!age O'"ins f! I$$ig!an"s in Cl!ad BDFP% 0n%d%% Cl!ad C &e!ing ids and Fa$ily% Hu!ley( L%( e$'e( A%( C!ane( L% A%( Da&idsn( A%( B!a""e( %( Linas( S%( % % % e!l( T% 0+,,% Ca!e f Und#u$en"ed Indi&iduals 8i"h ESRD: A Na"inal Su!&ey f US Ne'h!lgis"s% American Journal of Kidney Diseases( 7=0-( >,;>% di:1,%1,7=Q%aQ3d%+,,*%1+%,+
ansal( B%( 9 Gs3.yni3( % 0+,17% Dialysis A##ess f! Und#u$en"ed I$$ig!an"s in Indiana 0Re'%% Medi#aid% 0n%d%% Re"!ie&ed )une 11( +,1-( f!$ h""'s:///%$edi#a!e%g&yu!;$edi#a!e; #s"shel';'aying;#s"s$edi#aid$edi#aid%h"$l Nuila( R% 0+,17( O#".e! 17% 8hy Ha!!is Cun"y "a3es #a!e f i"s /n ; 'a'e!s ! n 'a'e!s% Re"!ie&ed )une 1+( +,1-( f!$ h""':///%hus"n#h!ni#le%#$l#alg!ay; $a""e!sa!"i#leUnd#u$en"ed;i$$ig!an"s;The;ER;And;Ha!!is;-7=71+=%'h'
DIALYSIS FOR THE UNDOCUMENTED
1=
B!g!a$ His"!y% 0n%d%% Re"!ie&ed )une 11( +,1-( f!$ h""'s:///%$edi#aid%g&a.u"; us'!g!a$;his"!y'!g!a$;his"!y%h"$l Ragha&an( R%( 9 Shei3h;Ha$ad( D% 0+,11% Des#!i'"i&e analysis f und#u$en"ed !esiden"s /i"h ESRD in a 'u.li# hs'i"al sys"e$% Dial% T!ans'lan"% Dialysis & Transplantation( >,0+( ?*;*1% di:1,%1,,+da"%+,7=7 Rd!igue6( R% A% 0+,17% Dialysis f! Und#u$en"ed I$$ig!an"s in "he Uni"ed S"a"es% Advance in Cronic Kidney Disease( ++01( -,;-7% di:1,%1,7=Q%a#3d%+,1>%,?%,,=
Shei3h;Ha$ad( D%( Baiu3( E%( 8!igh"( A% )%( 9 Shande!a( 8% % 0+,,?( A'!il% Ca!e f! i$$ig!an"s /i"h end;s"age !enal disease in Hus"n: A #$'a!isn f "/ '!a#"i#es% Teas Medi#ine% Re"!ie&ed f!$ h""'s:///%!esea!#hga"e%ne"'u.li#a"in-==*1=Ca!ef!i$$ig!an"s/i"hend; s"age!enaldiseaseinHus"na#$'a!isnf"/'!a#"i#es% S"a"es /i"h $s" und#u$en"ed i$$ig!an"s and /he!e Cl!ad !an3s% 0+,1-% Re"!ie&ed May +( +,1-( f!$ h""':3d&!%#$+,1-,==,"he;s"a"es;/i"h;"he;$s";und#u$en"ed; i$$ig!an"s T"al Medi#aid S'ending% 0n%d%% Re"!ie&ed )une 11( +,1-( f!$ h""':3ff%!g$edi#aids"a"e; indi#a"!""al;$edi#aid;s'ending 8illia$s( M% 0+,11( Se'"e$.e! %
DIALYSIS FOR THE UNDOCUMENTED
1>