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Running out of Time: Unaccompanied Refugee Minors and a fight for health care

The Department of Health Care Services is one department responsible for unaccompanied refugee minors

Nor Kathem has his eye on the clock. He has set the alarm on his phone to go off when his parking meter will expire. He doesn’t want to get a parking ticket in downtown San Jose. 

Kathem has an athlete’s swagger and sense of timing. He has been a refugee in three different countries, so even though he is only 20, he knows a lot about running out of time.

“Being a refugee is a surprise,” he says. “You don't choose it. It's just a must. And there's no words that would describe being a refugee. And there's no feelings [that] would describe it.” Kathem says even though he’s moved from country to country, he’s not a nomad. He says refugees always carry a sense of exile and distance from a lost homeland.

Kathem was born in Iraq in 1995. In 2003, the United States invaded Iraq and his family was forced to go to Jordan and then Syria. In 2011, the Arab Spring erupted and his family was displaced again. This time, they ended up in America. Kathem was just 16. 

He sighs deeply as he tries to explain the feeling. 

“I have no words. It was hard. It was harsh,” Kathem says of the journey he made with his mother and two sisters. 

The family landed in Almaden, an affluent community near San Jose. Kathem worked hard to fit into his new life. He played football and even joined the wrestling team. 

But at home things weren’t easy. “My mother had PTSD, ADHD, and she had many other symptoms,” he says. 

Like his mother, he also struggled to adjust, “I had many problems,” he says. “I couldn't understand the culture, I didn't understand the people, I didn't understand the language, I had a lot of frustrations, in public and at home.”

After less than a year in the country, Kathem’s mother kicked him out of the house. At age 16, Katham became a foster youth through the Unaccompanied Refugee Minorsprogram, or URM. 

Nationwide, there are about 1300 unaccompanied minors in the URM program. About 150 are here in California. These young people are at the intersection of two already overworked systems: refugee resettlement and foster care. 

Kathem was lucky. He didn’t have to go to a group home. The parents of his wrestling coach brought him to stay with them. 

“I felt safe for the first time in my life, so it was really cool,” he said. “We would watch football, we would watch basketball and we would speak about Edgar Allen Poe.”

Katham says he felt like he was part of a family again. 

But Katham had chronic problems from his childhood on the run. Not the mental pain his mother faced, but physical ailments: a broken write, back pain, and hamstring problems. Some of his teeth were rotting from a lack of early dental care. 

“My dentist told me beforehand that if I don't find an orthodontist, I would lose four of my teeth,” he says. “I've already lost two and so I had to go in. And then I looked for some orthodontist that would cover Medi-Cal, but my Medi-Cal was off.” 

As an unaccompanied refugee minor, Katham is entitled to coverage through the state’s Medicaid program, known as Medi-Cal. He was supposed to be covered until age 26, but when he turned 18 he lost his coverage with no explanation.

Katham says he found himself in a tight spot, but he found an orthodontist who would accept out-of-pocket payments for braces. 

But Katham didn’t understand why he’d lost his insurance. He went to Bay Area Legal Aid, one of the few local nonprofits serving the low-income refugee population. They told him he was still eligible for Medi-Cal, and they petitioned the state to get his coverage back. He won. 

This is where it gets a little complicated. There are two state agencies responsible for unaccompanied refugee minors like Katham. One is the Department of Health Care Services. They appealed the ruling in an attempt to overturn the judge’s decision. 

Katham was not the only URM being dropped from Medi-Cal earlier than promised. 

“We noticed was that increasingly we were seeing the same clients over and over again with the same issues,” says Marina Pantchenko, an attorney at Bay Area Legal Aid. She says URM’s are being denied Medi-Cal coverage they are entitled to. 

“I represented a client that was a URM that ran away from home at the age of 12,” she says. The young man was found crossing the Thai border on his own. Pantchenko says once he arrived in the United States he was diagnosed with tuberculosis, yet eight months into his treatment, Medi-Cal dropped him. Bay Area Legal Aid intervened, and eventually his insurance was restored. But there was a gap in medical coverage for a patient with a highly infectious disease. 

Pantchenko says this kind of experience is traumatic. “Really quite horrific for a 12 or 13-year old entering this country and not being able to access health care coverage.” 

That coverage is used to address physical sickness and also mental and emotional needs. Pantchenko says when you are a refugee and in foster care, mental health care is often necessary.  

“These individuals face trauma in their home country,” she says. “In addition to not having a guardian or a parent to take care of them...Mental health services is absolutely critical.” 

Pantchenko says so far she has seen 10 young people who are being denied health care. But she believes it’s just the tip of the iceberg. 

She doesn’t know why. “I really don't know what internally is going on at these state agencies,” she says. “I think there's a general confusion on an administrative level about where these youth are supposed to fit in.” 

Pantchenko and Bay Area Legal Aid are suing the state. I reached out to the California Department of Health Care Services about the case. They say they are unable to comment on pending litigation, but in an email from their Office of Public Affairs they wrote: “The Federal Government has ultimate responsibility for the URM population, through the Office of Refugee Resettlement.” 

The case is pending. 

There may be some disagreement about who is responsible for these young adults. It is Pantchenko and Nor Kathem’s hope that this suit will reach into the shadows and help those who may be struggling. 

Even with all he has gone through, Kathem says he considers himself lucky. “Basically, growing up I didn't find peace with my heart, and as well as my mom, and we had to move because we had to run away. Either death or running away and we ran away all my life.” But now in America, Katham says he can decide for himself and control his own destiny.