Health care access, utilization, and needs in a predominantly Latino immigrant community in Providence, Rhode Island.

MOre than 46 MIllIOn peOple In the us lack health insurance, as do 140,000 Rhode Islanders (16% of the state’s population under age 65). Most of the state’s uninsured are low income working adults, and thirtyeight percent are low-income childless adults who are not currently eligible for Medicaid. The number of uninsured individuals has been rising in the region, due to decreases in employer-based coverage. National and regional statistics do not account for individuals who are uninsured because they do not yet have citizenship status and are not eligible for company-associated programs or state health insurance. State-supported health care (RIte Care) has also been eroding. Rhode Island’s fiscal woes have led to loss of coverage for low-income children and families. The biggest changes have included i) removing eligibility for children who are undocumented immigrants, ii) removing children who have legal immigrant status but have been in the US for less than five years, iii) increasing the cost of monthly premiums, and iv) reducing parent eligibility. In 2009, reauthorization of the Children’s Health Insurance Program allowed states to receive federal matching funds for covering legally present immigrant children, resulting in RI restoring coverage for this group, who had previously been funded entirely with state dollars; the ACA contains a “Maintenance of Effort” requirement that has prevented RI for implementing monthly RIte Care premium increases that were contained in SFY 2012 budget. The revocation and restoration of coverage reflects the fragility of health care coverage in a time of economic down turn and state fiscal challenges. 4 Together, these changes caused at least 1,000 adults and 3,000 children to lose coverage in 2009. In the years before health reform is implemented, it is likely that the number of uninsured in Rhode Island will continue to rise, due to the erosion of RIte Care as well as the ongoing deterioration of employer-sponsored coverage. Furthermore, experts anticipate that health care reform will not eradicate the problem of the uninsured. While the number of uninsured is expected to decrease by 32 million if health reform is implemented, gaps will remain. Free clinics are one potential solution to health care access problems in the interim before health care reform, and may provide a longer-term solution to those individuals who will still be unable to access care after reform. Clinica Esperanza/Hope Clinic (CEHC) was established in 2007 to address the health problems of the uninsured in Rhode Island. Due to the founders’ commitment to providing linguistically appropriate, culturally attuned care, CEHC initially established temporary clinics in two church basements, serving a