Healthcare Access and Immigrants in the Gulf South in the Times of COVID-19

Background. The COVID-19 pandemic, Dr. Anthony Fauci clarified, “put a spotlight on” pre-existing racial/ethnic health disparities. Factors such as residential segregation, language and transportation access have been shown to predict increased risk of COVID-19 infection. Examinations of social determinants of these disparities often overlook immigrant status. Although studies document the scope of the pandemic on these pre-existing disparities, few have examined how healthcare organizations perceive demand and adapt services to address gaps in health care access. Gaps in healthcare access by immigrants are particularly notable in new destination states, like those of the Gulf South, that have an increasing new immigrant population – many of whom work “low-skilled” yet essential jobs. We examine the extent to which Gulf South healthcare providers provide services and perceive changes in their demand by immigrants during the COVID-19 pandemic.

Methods. This mixed methods study examined healthcare organizations’ provision of services to immigrants in in the context of the changing immigration policy and healthcare environment during and after the COVID-19 pandemic. We focus on providers in the Gulf South, specifically Louisiana, Mississippi and Alabama. We conducted a survey of staff at healthcare organizations (e.g., federally qualified health centers (FQHCs), migrant health clinics) from August to December 2021. Additionally, we conducted in-depth interviews with 10 individual healthcare providers. We conducted descriptive and multivariate analyses to examine providers’ perception of demand and uptake of their services by immigrants. All analyses were conducted in Stata 16.

Results: A total of 72 healthcare organizations completed surveys, the majority (about 73%) from Louisiana and over half (51%) serving immigrant clients. Of those serving immigrant clients, nearly all reported clients primarily from Latin America (e.g., Mexico, Honduras) and a few also reporting clients from Asia and the Middle East (e.g., Vietnam, Syria). Few reported an increase in cost and immigration status-related barriers since the COVID-19 pandemic (4% increased cost, 7% increased immigration-status). About 32% offered COVID-19 testing and vaccines at their site; however, of those, the majority reported under 10% of tests and vaccines (46% and 52%, respectively) to immigrant patients and another 16% and 19% reported testing or vaccinating no immigrant clients. Although the majority (65%) reported conducting community outreach about COVID-19, less than half of those (47%) conducted outreach that specifically targeted immigrant communities. Those that did not specifically target immigrants cited factors like “lack of time,” “lack of staff,” or perception that there was no immigrant population as reasons for not conducting targeted outreach.

Implications. Although the immigrant population in Gulf South states like Louisiana is small (around 4%), the population growth rate has continued expanding in the region while simultaneously stalling or declining in other states. An extant challenge prior to the COVID-19 pandemic, our findings suggest access to healthcare for immigrants in the region continued to be limited. Understanding discrepancies between provider awareness and capacity for conducting outreach to immigrant communities and population numbers could better inform how to enhance immigrant connectedness to services in new destination places like the Gulf South.