February 19, 2015
Health Equity In Focus: Outreach and Education Come First in Bhutanese Refugee Community
By: Diverse Elders

This blog originally appeared at Community Catalyst.

by Birendra Dhakal, Bhutanese Association of Georgia and Emily Polak, Community Catalyst

Nearly a year ago, a new partnership was formed to promote outreach and enrollment opportunities for the Bhutanese community in Georgia. With help from the Diverse Elders Coalition, the Bhutanese Association of Georgia (BAG) and Georgians for a Healthy Future (GHF) collaborated to support the senior Bhutanese refugees living in Clarkston, Georgia to enroll in health coverage under the Affordable Care Act.

I caught up with Birendra Dhakal of the BAG to learn more about the partnership, and how consumers responded to the various trainings to support them in enrolling in health insurance, either through the Marketplace or in Georgia’s Medicaid program, depending upon a consumer’s financial eligibility and immigration status.

Two women stand in front of a group.

The first training took place nearly a year ago in Clarkston with about 25 members of the Association’s Citizenship class, as well as an additional number of Bhutanese community members. The training provided basic information on Georgia’s insurance marketplace, as well as a discussion about eligibility and requirements for enrollment. The Navigator conducting the training also walked attendees through HealthCare.gov, and despite the glitches that plagued last year’s open enrollment, provided reassurance to attendees that they should keep trying to enroll, with the tip to try enrollment in the evening as the website would likely be less busy. This past November, BAG and GHF conducted a similar ACA awareness training for 25 Bhutanese seniors, offering information about the need for health insurance, reenrollment procedures and assistance enrolling, should it be required. BAG translated materials about health insurance into Bhutanese as well, ensuring that the material’s translation was not only linguistically correct but also culturally relevant.

For the Bhutanese community, Birendra shared that outreach is generally done by word of mouth with a bilingual approach often proving important: Nepali is the preferred language to reach most, though English communication has worked to a lesser degree for some families. Additionally, children in Bhutanese families play an important role in interpretation and in navigating the internet for enrollment opportunities. BAG also noted that enrollment programs were most successful when held on weekends for working adults, while weekday events were particularly successful for elders from the community, so long as transportation to enrollment sites was provided.

Initially when the ACA became law, Bhutanese refugees in Georgia were euphoric. As refugees, they are eligible to receive Medicaid during the first eight months of their arrival. Following this, however, Birendra shared that they are “at the mercy of their employer” or must seek out assistance from non-profit hospitals—like Grady Hospital in Atlanta—who charge them based on income.

At this point, many people from Georgia’s Bhutanese community with citizenship are caught in the coverage gap, as they work in low paying jobs making them ineligible for tax credits because of income limitation. Additionally, even if some families are eligible to receive tax credits, Birendra commented that they “have the notion that health insurance is not something they foresee as a need as they feel that even if they are ill they will go to Grady Hospital.” It’s resulted in limited participation in enrollment within the Bhutanese community. As a result, enrollment has been largely limited to families with eligible incomes who know health insurance to be necessary.

Additionally, there’s been another barrier that BAG and GHF have been working to surmount: for many Bhutanese immigrants, there is a different perception about medical costs. Medical bankruptcy is nowhere near as prevalent in their home nation, making it more challenging to convey the significance of insurance coverage here in the United States. Despite these challenges, we tip our hats to the work that BAG and GHF are doing to provide information to the Bhutanese community, and are inspired by the partnership they’ve created, which is a direct impact of the ACA.


The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.