When the 50-year-old Brazilian painter heard the new state health reform mandates everyone to have health insurance by Dec. 31, the man - who had been uninsured for six years since he immigrated here - felt he had to do something.

When the 50-year-old Brazilian painter heard the new state health reform mandates everyone to have health insurance by Dec. 31, the man - who had been uninsured for six years since he immigrated here - felt he had to do something.


An illegal immigrant, the man couldn't do much. Though the mandate applies to everyone, including undocumented immigrants, the new law doesn't offer health insurance programs for them, other than Free Care or MassHealth Limited, for emergency services only.


The man, who identified himself by his first name's initial and last name, A. Ribeiro, thought about continuing going without insurance, but changed his mind when he learned all those uninsured by the end of 2007 could lose their personal income tax exemption for 2007, about $219. The penalty will increase in 2008.


Ribeiro, who pays taxes with an Individual Taxpayer Identification Number (ITIN) in hopes that would help him legalize his situation, signed for both Mass Health Limited and Health Safety Net Pool for low-income people, formerly known as Free Care, for himself, his wife and their three children of ages 23, 17, and 3.


"I'm much more relieved," said Ribeiro of Medford. "I take care of myself so I don't get sick, but it's better to have insurance in case something happens."


Ribeiro signed for insurance at one of four workshops sponsored by a local Brazilian civic association that brought a researcher from Boston University's School of Public Health, Dr. Milagros Abreu, to Framingham. Abreu, who has conducted similar programs for Latinos in East Boston, came on a volunteer basis, hoping she could find funding to continue the program.


The interest has been huge, said Ilma Paixao, a member of Framingham's Brazilian American Association, which spearheaded the workshops with Abreu, because "the need is so great," Paixao said.


Since the workshops began in October, Arlete Falkowski, a volunteer with the association, has taken dozens of calls from people who want to know how the health care reform would affect them.


"People know there is a deadline and a penalty," she said. "But they don't know where to apply, if they qualify or what options are out there."


In a meeting at a Brazilian church in early December, 80 people gathered to listen to Abreu, who explained in Spanish the changes brought by the new laws. A volunteer translated into Portuguese. More than 300 have attended the workshops, and about 150 have applied for health insurance, with help of Abreu's initiative, called the Latino Health Insurance Program. Among those newly insured were legal residents who didn't know they could qualify, families with children born here who were eligible for services, and some illegal immigrants who have gone uninsured for many years.


"Some have never seen a doctor in 15 or 20 years, others travel abroad to seek medical care, and some others seek care at the last minute at the emergency room," said Abreu, who works at BU's Department of Epidemiology. "Our main goal is to make sure they have access to health care where they live. We want to keep our communities healthy. It's for the benefit of everyone."


The new health care reform became law in April 2006, and state officials said it's already achieving its goal of reducing the number of uninsured people in Massachusetts. Lt. Gov Tim Murray announced last week more than 300,000 have enrolled in health insurance programs and said, "health care reform is working." According to a 2006 state survey, there were 372,000 uninsured residents, or 5 percent of the population.


How many of those were illegal immigrants, nobody knows. Confusion about the new laws is still widespread among the immigrant community. To help them, an interfaith group visited two Latino churches in Framingham, St. Tarcisius, which offers masses in Portuguese for the Brazilian community, and St. Stephen's, which offers masses in Spanish for the Hispanic population. The sessions held in September and October were well attended, said Les Holtzblatt, a Metropolitan Interfaith Congregations for Hope (MICAH) board member and Sudbury resident.


"People knew about the laws but still needed additional information," he said.


According to the new regulations, immigrants who are legal residents can apply for several programs such as Commonwealth Care, the subsidized health insurance program offered through the Commonwealth Health Insurance Connector Authority, and MassHealth Standard, the state's Medicaid program. They can also apply for Commonwealth Choice, the unsubsidized program offered though the Health Connector.


But illegal immigrants are in a bind, said advocates.


"Undocumented immigrants are stuck between a rock and a hard place," said Carly Burton, policy director at the Massachusetts Immigrant Refugee Advocacy Coalition. "They work multiple jobs, pay taxes, are not offered health insurance by their employers or by the new laws, and yet are subject to the mandate."


Still, the new laws may help more immigrants, legal and illegal, be insured, said advocates. Commonwealth Care has provided insurance to legal immigrants, who would not have had access otherwise, said Burton.


"It's making Massachusetts more healthy," she said. "But I wish there was another program that could provide insurance for undocumented immigrants."


Abreu shares the sentiment.


"The new law has a great intention of providing medical care to everyone, but it has limitations," she said.


Under the new laws, illegal immigrants can still apply for MassHealth Limited, which covers emergency services only, and Health Safety Net Pool, which is available for low-income individuals.


The new law would not affect all illegal immigrants. Those who don't file taxes won't be penalized if they don't have health insurance, but according to immigrant advocates, most illegal immigrants file income tax returns. Opponents said even if they pay taxes, illegal immigrants overuse health care services placing a burden on the public and are strongly against providing any health coverage for those who have no permission to stay in the country.


Advocates said many illegal immigrants avoid hospitals and only use them in emergency situations due to language and cultural barriers, lack of information and fear of leaving a trail that could be tracked down by immigration authorities. Illegal immigrants fear deportation the most.


Such is the case of Ribeiro, who during his six years here, never saw a doctor for fear of being deported. Only in 2002, he had to go the emergency room because he felt sick and couldn't work. He had pneumonia. Ribeiro knows many people who have never set foot in a doctor's office or an emergency room.


"Many people prefer to be sick than going to the hospital," he said. "But now I'm telling people they can apply for insurance."


Liz Mineo can be reached at 508-626-3825 or lmineo@cnc.com


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