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2/1/2024 Rep. Morales introduces bill to cover kidney disease treatment for all Rhode Island residents
STATE HOUSE – Rep. David Morales is introducing legislation to cover treatment for Rhode Island residents with end stage kidney disease, regardless of their immigration status.

“While it tends to be a public health issue that goes overlooked, Rhode Islanders experiencing end stage kidney disease are suffering deep pain as they often have to depend on dialysis treatment and the need of a kidney transplant in order to survive, not to mention the financial costs of accessing medical treatment. Now just imagine suffering from end stage kidney disease while also being low-income and ineligible for Medicaid coverage because of your immigration status. That is the chilling reality that feels like a death sentence for dozens of our neighbors across the state,” said Representative Morales (D-Dist. 7, Providence). “This is why I’m introducing legislation that will ensure that all Rhode Islanders suffering from end stage kidney disease receive the appropriate treatment and best health outcomes possible, regardless of their immigration status. Together, we can replicate the efforts of several other states who have already taken these steps to care for their immigrant neighbors in need.”

The bill (2024-H 7398) directs the Executive Office of Health and Human Services to provide dialysis treatment, as well as kidney transplants, to Rhode Island residents suffering from end stage kidney disease who do not qualify for full Medicaid due to their immigration status. This applies to both undocumented residents and non-citizens who qualify for Medicaid but have been present in the United States for under five years, making them only eligible for coverage of an “emergency medical condition.”

 “Expanding Medicaid coverage to undocumented immigrants with end-stage kidney disease is the correct thing to do on ethical and financial grounds,” said Dr. Eric Kerns, nephrologist at Rhode Island Hospital. “We know that kidney transplantation is superior to chronic dialysis for both quality of life and survival – the 5-year survival rate on dialysis is 42% while the rate after kidney transplantation is 83% - but under current law immigration status prevents us providing appropriate care to all our patients.”

Even community programs that attempt to alleviate this gap in coverage are limited by current federal law. Dr. Kerns works at two dialysis clinics in Rhode Island that provide care for between 20 and 30 undocumented immigrants with end-stage kidney disease. These patients apply to a financial aid program called Community Free Service run by Lifespan that provides 80% or more of the cost of dialysis, depending on income. However, because they lack insurance they are barred from pre-transplant evaluation at RIH and so cannot receive kidney transplants.

“There is an ethical argument to provide equitable care to all patients regardless of race, socioeconomic and immigration status,” said Dr. Kerns. “There is also a financial argument that kidney transplantation is cheaper than dialysis for any patient with a life expectancy exceeding 3.5 years. Several studies have shown that undocumented immigrants with end-stage kidney disease are younger and healthier than the general dialysis population, and a recent study from UC Davis demonstrated that post-transplant outcomes in 75 undocumented immigrants were superior to the center’s overall recipient pool outcomes.”

Undocumented workers pay almost six billion dollars in federal taxes each year, a number that does not include state income, property and sales taxes, which may total close to $12 billion annually. Undocumented residents do not qualify for most federal programs like Medicaid and Social Security, regardless of whether they pay taxes into these programs.

For more information, contact:
Tristan Grau, Publicist
State House Room B20
Providence, RI 02903