In the months since the Flint water crisis made national headlines, problems have not abated for area residents, many of whom still rely on filters and bottled water to satisfy a basic human need. Amid news of widespread rashes and hair loss, advocates interviewed by Rewire are reporting that Flint’s undocumented communities continue to go without access to testing and treatment for lead poisoning. Among other reasons, the government system the state has selected for the provision of health care—Medicaid—has made access challenging for some undocumented residents.

In light of the crisis, some advocates are collecting testimonies in hopes of qualifying area residents for visas that offer victims of crimes certain protections, including a moratorium on their deportation.

In one such testimony, a Flint resident shares that their family was drinking contaminated water for three months before being made aware of the water crisis. To this day, they say they have yet to receive any information on the consequences of lead poisoning and are still unaware of where testing can be done and whether or not it’s free.

Contacted for comment about the allegations that there has been little recourse for undocumented and mixed-status families in the area, a spokesperson from the U.S. Department of Health and Human Services (HHS) said in an emailed statement that “water filters, water cartridges, bottled water, and water testing kits are available to all residents—regardless of status—at local points of distribution in each ward around the city and identification is not required to obtain these commodities.”

The HHS spokesperson added that all of the “children enrolled in Flint area schools have and will continue to benefit from the funding provided to local schools by the U.S. Department of Agriculture to purchase and serve additional fresh fruits and vegetables which help prevent lead absorption.”

“Free Clinics Are Not Good Enough”

Flint’s water emergency began in April 2014, when state officials changed the source of the city’s water supply from Detroit’s Lake Huron to the Flint River as a cost-saving measure. The state Department of Environmental Quality has since admitted it didn’t add the necessary chemicals to prevent the Flint River water from corroding pipes, causing water contamination. Flint residents are still required to use water filters; recent testing by the U.S. Environmental Protection Agency at nearly 50 locations in the city found lead levels in filtered water below what is considered dangerous. Some homes in Flint could not be fitted with filters, so bottled water is still being used.

Flint’s mayor declared a state of emergency in December 2015, but Gov. Rick Snyder (R) did not declare one until January 2016, when he mobilized the National Guard to distribute clean water and water filters.

As Rewire reported in January 2016, some water distribution centers in Flint asked residents for government-issued IDs, creating a hurdle for many undocumented residents. Initially, these residents also were not provided information about the water crisis in languages other than English and information about lead testing to determine if they and their children had been poisoned.

In its emailed statement to Rewire, the HHS spokesperson explained that “the Michigan Department of Health and Human Services has made the state’s health information available in Spanish, Arabic, Chinese, and American Sign Language. Bilingual staff members are also available and talk regularly with residents at church events and community fairs.”

The state also received approval from the Centers for Medicare and Medicaid Services to expand its Medicaid program in March, enabling approximately 15,000 additional children and pregnant women to be eligible for Medicaid coverage. But as advocates have noted, many undocumented immigrants do not qualify for Medicaid, which requires proof of legal immigration status. Under the 1996 welfare reform law, lawfully present immigrants, such as green-card holders, cannot receive Medicaid benefits until they have been in the United States for more than five years. The same applies to the Affordable Care Act, which grants access to the insurance marketplace for lawfully present immigrants who’ve been in the country for more than five years. Those who are undocumented are ineligible for the Affordable Care Act.

“Medicaid excludes many noncitizens, and the response from the state has been to shrug and say, ‘That’s the way it is, it’s part of the federal Medicaid law,'” Susan Reed, managing attorney at the Michigan Immigrant Rights Center, told Rewire. “We’ve asked for what the comparable coverage would be for noncitizens excluded from Medicaid; there’s really been no response from anyone we’ve raised that issue with.”

Consequently, only U.S. citizens and limited categories of noncitizens are eligible for comprehensive coverage under the local program and other Medicaid programs. Noncitizens, both documented and undocumented, are eligible for Emergency Services Only Medicaid, but that program does not cover the variety of services needed by children exposed to lead-contaminated water. The coverage, for example, doesn’t include basic, primary health care.

As Rewire previously reported, there is no “safe” blood-lead concentration, and the severity of symptoms and likelihood of long-term problems increase with exposure. In young children, this can take shape as behavioral issues, reduced cognitive functioning, anemia, hypertension, and toxicity to their reproductive organs. Research from the World Health Organization also reveals that high levels of lead exposure over a prolonged time period can severely damage a child’s brain and central nervous system, causing comas and in more severe cases, death. Long-term monitoring of those most at risk of “irreversible” brain injuries or central nervous system damages wouldn’t be possible without access to insurance coverage and medical providers.

The Michigan Immigrant Rights Center told Rewire that some noncitizen children with legal immigration status may be able to access Affordable Care Act coverage, but that coverage is not comparable to the waiver-based coverage provided by the Medicaid expansion approved in March. Reed further explained that through the Children’s Health Insurance Program Reauthorization Act of 2009, Michigan could choose to remove the five-year waiting period children who hold green cards must wait before they are eligible for the full scope of Medicaid. But Michigan has not opted in.

When advocates have raised these questions to state officials, the response has been to tell undocumented and mixed-status families to go to free clinics, Reed told Rewire.

“First of all, free clinics are not good enough,” the attorney said. “Second of all, this is evidence that there is complete ignorance of what it means for mixed-status families to try to find a new route of care and establish a relationship with a new provider.”

When asked about the allegations that undocumented and mixed-status families are being denied access to care, Jennifer Eisner, the Michigan Department of Health and Human Services’ public information officer, told Rewire that “[c]ase management services for children with elevated blood lead levels, provided by the Greater Flint Health Coalition’s Children’s Healthcare Access Program, is provided to all children in Genesee County at no cost, upon consent of the parents, regardless of immigration status, Medicaid status, and income.”

In an emailed statement, Eisner also said “the Nurse Professional Fund is working with the University of Michigan nursing program to provide Spanish speaking nurses, nurse practitioners, and nursing students to serve the Spanish speaking populations in Flint. These nurses are being placed at a local [Federally Qualified Health Center] and Our Lady of Guadalupe in Genesee County.”

Eisner cited “federally qualified health centers,” or free clinics, as options for undocumented and mixed-status families, including the Hamilton Community Health Network. Eisner told Rewire this location in particular provides “health services, regardless of Medicaid eligibility and immigration status.”

Rewire called the North Pointe Clinic, part of Flint’s Hamilton Community Health Network. The clinic did say it provides lead testing and treatment to its patients, but staff “absolutely do not” treat those without a state-issued ID or social security card.

“There is nowhere that is going to do that. You most definitely got to have that [state ID],” a clinic worker at North Pointe told Rewire. “You can call other clinics to see [if that’s the case there], but you need your state ID so we know you are who you say you are. That’s just the law.”

Flint’s Genesee County Free Medical Clinic told Rewire the same thing. A clinic worker said, specifically, the clinic does provide lead testing and treatment for lead poisoning, but “you have to have an ID. You have to prove to me that you’re a Genesee County Resident.”

Reed said it has been her experience that “certain local and state entities” have no understanding or sensitivity of the realities that undocumented and mixed-status families face when accessing care.

“Asking for a state ID when an undocumented parent isn’t eligible for one, requiring social security numbers, not having staff remotely trained in the significance of not having a social security number—no one seems to feel any particular sense of responsibility for some children because of their immigration status, even though all children in Flint were poisoned,” Reed said.

Undocumented Flint Residents Fear Detainment and Deportation

Samantha Magdaleno, an organizer with One Michigan for Immigrant Rights, told Rewire that many undocumented adults haven’t been able to access testing for themselves or treatment for their family out of fear of deportation.

“There are children who were found to have very high amounts of lead [in their systems] and who do need treatment, but because of their status they haven’t been able to get treatment,” Magdaleno said. “There is a clinic outside of Flint that does provide treatment to undocumented people, but what we’re hearing from the [undocumented] residents is that you have to prove you’re a Flint resident and they’ve had trouble getting those documents and they’re afraid to leave Flint because of Border Patrol. Border Patrol has told us they’re going to stay out of Flint, but outside of Flint there is no telling what will happen.”

Reed agreed, adding that Border Patrol is fairly present in the area because Flint is close to the Point Huron International Bridge and there is a Border Patrol station nearby. The attorney said she has been to Flint City Council meetings where Border Patrol agents have said they’re trying to be sensitive to the people affected by the crisis, but they also intend to “go about their business,” which can mean a few different things. Border Patrol agents can go into a private residence 25 miles inland with a warrant; they can pull over vehicles if they have “reasonable suspicion” of an immigration violation or crime; and they can stop people and ask them questions regarding their citizenship status at checkpoints and border crossings.

“The thing we have heard again and again is that families are very afraid to move around the city outside of their usual pattern,” Reed said. “Both [Immigration and Customs Enforcement and Border Patrol] have said they’re not targeting anyone related to the water crisis and they’re just going about their business, but they’ve also said they’re enforcing the Obama administration’s priorities and anyone outside of those priorities don’t need to worry. That doesn’t translate into a message an undocumented community can put faith in.”

When asked how the fear of deportation affects their life, an undocumented Flint resident shared with One Michigan for Immigrant Rights that they only go to places that are necessary, such as the grocery store, work, and school. “[I’m] always looking behind my back and fearing that someone will stop me or any of my family members,” their testimony read.

Immigration and Customs Enforcement is the largest investigative arm of the Department of Homeland Security (DHS). Both consider their highest-priority cases to be “individuals who pose a threat to public safety, such as criminal aliens and national security threats, as well as repeat immigration law violators, and recent border entrants.” It is this last category that is the most troubling for Flint’s undocumented community.

As Bridge’s Jacob Wheeler reported in June 2015, Michigan has one of the largest long-term foster care programs in the nation for immigrant and refugee children. In 2014, nearly 200 unaccompanied children arrived in Michigan, Wheeler wrote. If those children lose their asylum cases, however, they can become immediate ICE targets under immigration enforcement policies like Operation Border Guardian, which primarily targets Central American migrants over the age of 18 who came to the United States as unaccompanied children after January 2014.

U Visas Can Provide a Sense of Safety, But No Immediate Health Care

Susan Reed told Rewire there have been countless instances in which Flint’s undocumented community have been failed by both the city and the state since the city switched its water supply. Samantha Magdaleno agrees, which is why her organization, One Michigan for Immigrant Rights, has been collecting testimonies from undocumented Flint residents, documenting their experiences in the wake of the water crisis. The goal, she said, is to help the community obtain U visas, otherwise known as the U nonimmigrant visa.

According to U.S. Citizenship and Immigration Services (USCIS), these visas “are set aside for victims of certain crimes who have suffered mental or physical abuse and are helpful to law enforcement or government officials in the investigation or prosecution of criminal activity.” While a U visa would not immediately help an undocumented Flint resident when it comes to accessing care for lead poisoning because they’d have to wait five years before being granted access to Medicaid or the Affordable Care Act, it would provide some status and safety.

One Michigan for Immigrant Rights last collected testimonies on May 22. The testimonies detail whether undocumented residents were notified of lead in the water, when they were notified, and if they’ve been able to get testing or treatment.

“What we’ve found is that a lot of folks told us they weren’t able to get treatment because they don’t have papers and they don’t have health care, so they’re not able to get treatment for lead poisoning,” Magdaleno said. “We’re trying to collect enough testimonies so we can file for a group U visa because we believe that whoever goes forward with the criminal charges [against city officials] should be able to certify these people for U visas. This wouldn’t solve all of their problems, but at least they would be able to get some kind of status so they’ll be able to get treatment in the long term, because right now, they don’t know what the long-term effects of this lead poisoning will be.”

U visas are more commonly associated with victims of violent crime, such as the Pulse nightclub shooting in Florida, but Reed said this type of visa is not exclusive to violent crimes. The attorney said that obstruction of justice and witness tampering are qualifying crimes and that “it’s very clear those are crimes that have been investigated in Flint.”

A total of nine current and former state and local officials have been charged in a continuing investigation into the water crisis. There have been charges of evidence tampering in multiple cases, and Reed says obstruction of justice charges will likely continue.

Providing Flint’s undocumented community with U visas can also be helpful to the larger community. The health information gathered as a result of the U-visa certification, Reed said, is relevant in terms of the crimes being prosecuted and any crimes being further investigated.

The attorney told Rewire that crime victims often have very little information about who committed the crime, but what they have to offer is information about what the effect has been.

“I think that’s very analogous here. You have people who have suffered severe harm—who may have suffered the most harm of anyone in the water crisis because they were so late to get good information in a language they could understand about what was actually happening,” Reed said.

“People were boiling water because that’s a natural assumption about what to do, but boiling the water actually concentrates the lead. People remaining available to a prosecutor or an investigating agency or judge to share information about the impact on their health, their development, on their children’s development, is potentially very helpful to a prosecution. If I were to be able to get U visas certified, that is certainly the argument we would be making to [U.S. Citizenship and Immigration Services],” she added.

Beyond the possibility of obtaining U visas for Flint’s undocumented community, Reed said she has “absolutely no idea” what the community will do next as it relates to obtaining treatment for lead poisoning.

“I don’t have a great answer for what’s next. I don’t have a new strategy. Things have really stalled out,” Reed said. “The state has dismissed every concern we’ve raised, shrugged it off as a federal issue, told people to go to the free clinic, and it seems like things have kind of moved on. In Flint we’re seeing a group of people whose humanity was discounted. A whole population is being seen as less worthy of protection, care, and concern. It’s really disheartening.”