Juan Miranda had a problem.
He’d been hearing from friends and other members of the Latino community in North Carolina who feared they’d been exposed to the novel coronavirus but were forgoing testing at nearby CVS testing sites.
It wasn’t just that they lacked insurance -- it was that they were undocumented.
Businesses such as CVS and Walgreens have opened their doors to expand free testing in at-risk communities. But there’s a catch; for an uninsured person to receive a test, they must provide either a social security number or a state-issued identification card -- neither of which undocumented people have.
Migrant advocates worry the policy has had a chilling effect on testing within the undocumented community.
“Maybe they wouldn't get turned down if they showed up without an ID,” said Miranda who’s an organizer with Siembra North Carolina, an organization that advocates for the rights of Latinx people. “But that’s the problem: Many people are not even going.”
The state of North Carolina wants immigrants without documented status to know that isn’t the case for their new, free testing sites.
Footing the bill
COVID-19 has disproportionately impacted the Black and Latino community in North Carolina. Almost half of the confirmed cases are among Latinx people, who comprise about 10% of the state’s population. Latinx deaths are at about 10%, more in line with their population numbers here.
On the contrary, Black people account for about a quarter of the state’s cases, but they make up fully a third of the state’s COVID-19-related deaths, despite being 22% of the population.
Both are overrepresented in the essential worker population and more likely to experience worse social determinants of health due to a long history of systemic racism.
Undocumented people in the immigrant community face added challenges in health care access. They’re barred from receiving Medicaid, and unlike in several other states, if you’re undocumented in North Carolina, you can’t get a driver’s license or other state ID.
Requiring identification is a billing issue, companies said. Under the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the federal relief bill passed by Congress in March, and the subsequent Paycheck Protection Program and Health Care Enhancement Act, testing sites that provide COVID-19 testing to the uninsured can receive reimbursement for the cost from the federal government.
To file those claims through the Health Resources and Service Administration (HRSA)’s COVID-19 Uninsured Program Portal, providers need a person’s Social Security number, driver’s license or state identification number.
“If a patient clicks on ‘I don’t have medical insurance’ when making an appointment, then their social security number, driver’s license or state ID number must be provided at the test location so that CVS can submit for reimbursement through the HHS program, COVID-19 Uninsured Program Portal,” said Charlie Rice-Minoso, a communications specialist with CVS.
Walgreens made a similar statement.
“At this time COVID-19 tests are available at no cost to individuals who meet CDC guidelines to receive a test,” said Phil Caruso, media relations spokesperson at Walgreens. “We also require an ID as part of our reporting requirements to health agencies.”
From there, whether or not a person will be able to get testing is unclear.
“We ask that patients make every attempt to provide those forms of identification,” Rice-Minoso said. “And they should discuss with the CVS Pharmacy team member onsite during their testing appointment should they be unable to provide that information.”
According to Siembra NC, this has caused some undocumented immigrants who suspect they’ve come in contact with the virus to avoid testing entirely.
“With some of our members, their kids have gotten tested at CVS because they were born here or have DACA,” said Miranda. “But the parents themselves have not gotten tested.”
No cost, no IDs
Last week, the North Carolina Department of Health and Human Services (DHHS) announced it was launching 300 no-cost testing sites specifically for historically marginalized communities in the state.
Called the Community Testing in High-priority and Marginalized Populations (CHAMP) Initiative, it targets areas that currently have limited testing sites and aims to make testing available to 2.2 million Black, Latinx and American Indian people within the state.
And the state wants people to know that if an uninsured person can’t provide an ID, that’s okay.
“People are not required to have any form of state or federal ID at the CHAMP testing sites,” said Dr. Shannon Dowler, the chief medical officer with North Carolina Medicaid.
She added that she called vendors, Vidant Health and Orig3n Inc., on Monday and confirmed they are not requiring IDs after North Carolina Health News’ inquiry.
“We've really stressed this with our vendors doing the CHAMP work. They know that they were selected to provide a very specific service -- to improve testing and access to health care for marginalized populations,” said Dowler. “So there should not be a ‘gotcha’ feeling, or even that sort of higher-level, corporate feeling like you get if you go to a CVS site.
“This should feel much more like local home testing.”
Testers will still ask for an ID, said Dowler, simply as a matter of “fiscal responsibility.”
“We want to make sure we can use the dollars we have to go as far as possible -- if we can get the federal government to pay for the test, then we can use those dollars to pay for other things like housing and food support, or other items that people need,” she said. “But if someone doesn't have it, it's not a problem.“
If a person can’t provide identification, the state will pay the cost of the test.
“The patients don't pay anything at these testing sites,” she said.
To ensure that sites are providing culturally competent services, the health department has implemented a “secret shopper” program, in which DHHS employees will arrive in plainclothes to get tested and evaluate if vendors are following guidelines.
“If they're requiring IDs, which they're not allowed to, somebody is going to know and they're going to act on that right away,” said Dowler, noting that the vendor could lose funding. “So I really do believe that these vendors are working really hard to make these sites available for historically marginalized populations.
Dr. Vivian Martinez-Bianchi, director of Health Equity at Duke University’s Department of Family Medicine and a member of the vulnerable population task force for DHHS, said the state is working to build trust broadly with undocumented communities, including in the way they ask this question.
“I really think for people to trust this, the way to ask the question is: ‘Do you have an ID -- don't worry if you don't!’” she said. “It has to immediately follow.”
She said a tester may also ask for someone’s identification card to ensure correct spelling of their name, or fully record the title of a person with multiple last names.
“Testers can also say, ‘If you have an ID, it would be helpful for us to type out your name appropriately, but it's okay if you don't,’” noted Martinez-Bianchi. “I said that several times while at a site this Saturday.”
Martinez-Bianchi added that they’re working to alleviate other concerns about getting tested as an undocumented person -- particularly when it comes to collecting information.
“The other thing we’re asking for is addresses,” she said. “On Saturday, I met with a large group of community organizers. People had so many questions about who's going to see their address, asking, ‘How do I know it's not going to be given to the government to come and get us afterward?’
She said the current political climate had people afraid, and reluctant to come out for treatment or testing.
“The only way to map the disease in the community is by knowing where people live,” she added.
DHHS said they do not share addresses with the federal government -- the only people who see a person’s address are the laboratories where tests are sent, and, if a person tests positive for COVID-19, the DHHS gets notified.
“That result will go to the health department so that they can help get in touch with family members or others who may have been exposed and, if they can't separate in the home, help them find a free place to stay during that time if they need to isolate or quarantine,” said Dowler.
Reaching the undocumented community, said Martinez-Bianchi, is an issue they want to get right.
“We really want people to get tested,” she said. “We want to really make sure that we are assuring people that this is never going to be used to go get them. It's not a ‘catch you’ activity. We want to know if you caught this [COVID-19] problem because then we can help you with resources, or help you with information so that you can protect your family.”
North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.