Addressing health care needs of Colorado immigrants using a community power building approach

Abstract

Objective: To assess and address through policy change the health-care needs of immigrant populations in Colorado. Data Sources: Primary data were collected in two Colorado communities from June 2019 through December 2020. Study Design: This work utilized a mixed-method, community power building approach to determine and meet health-care needs of immigrants, a marginalized population of mixed documentation status. Findings were then used to inform Emergency Medicaid (EM) expansion in Colorado. Data Collection: In-depth interviews were conducted in Spanish, English, and Somali with 47 immigrants in rural Morgan County in June–September 2019; findings were presented to the community for feedback in January–February 2020. In March–December 2020, 330 interviews were conducted in Spanish and English with 208 unique individuals in Morgan and Pueblo Counties by local community grassroots leaders via four rounds of a novel phone tree outreach method. Interviewees were identified through snowball sampling and direct outreach among individuals seeking immediate relief (i.e., food assistance). Principal Findings: Interviewees reported numerous barriers to health-care access, including discrimination and limited service hours and transportation options. Data also revealed a clear health insurance coverage gap among undocumented immigrants. These data were then presented to Colorado's Department of Health-Care Policy and Financing, ultimately contributing to securing EM expansion to this population to include COVID treatment, including respiratory therapies and outpatient follow-up appointments. Data-informed continued implementation advocacy to ensure the effectiveness of EM program expansion. Conclusions: Immigrants are particularly marginalized by the health-care system. Rapid data collection grounded in a community power-building approach produced data that directly informed state policy and an increased power base. This approach enables direct connection to immediate “downstream” needs in communities while simultaneously building collective systemic “upstream” analysis and capacity of community members and laying pathways to translation and implementation of research into policy.