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AJP CME: September 2017 - Challenges in Treating Undocumented Immigrants

Activity Type:

  • Journal CME

Release Date: 9/1/2017

Expiration Date: 8/31/2019

  • AMA PRA Category 1 Physician: 1
  • Participation: 1

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Abstract: In a 2016 report, the nonpartisan Pew Research Center estimated that the number of unauthorized immigrants in the United States—defined as those who entered the country without valid documentation or those who violated the terms of a lawful admission, such as staying past a visa expiration date—accounted for 11.1 million people in 2014, falling from a peak of 12.2 million in 2007. One framework to analyze the effect of immigration laws and policies on health services is to identify those restricting access to any services, those granting minimum rights to services, and those granting more than minimum rights to services. Federal laws restrict unauthorized immigrants from coverage for routine health visits through federally funded programs, such as non-emergency Medicaid, the Children’s Health Insurance Program, or the Patient Protection and Affordable Care Act. However, unauthorized immigrants can receive emergency medical services without restriction and apply for Emergency Medicaid if they qualify for low-income status. Federal restrictions also apply to unauthorized pregnant women and children, including those known as “DREAMers” who qualify for the Obama administration’s Deferred Action for Childhood Arrivals program, although children born in the United States whose parents are unauthorized immigrants are eligible for the same types of coverage as other American citizens. Despite their full exclusion, unauthorized immigrants contributed a net total of $3.5 billion to Medicare’s Hospital Insurance Trust Fund in 2011 through payroll or self-employment taxes, leading some analysts to raise questions about the ethics of excluding them.


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Educational Objective

The participant will analyze barriers (e.g., individual biases, language differences, cultural disparities, and legal issues) clinicians may encounter when providing mental health care to undocumented immigrants.

Target Audience

This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.

Estimated Time to Complete

Duration: 1 hour
Begin Date: September 1, 2017
End Date: August 31, 2019

How to Earn Credit

In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™).  A score of 60% or higher is required to receive credit.


The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The APA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Faculty and Planner Disclosures

Title: Challenges in Treating Undocumented Immigrants

Authors: Neil Krishan Aggarwal, M.D., M.A.

Affiliations: From the New York State Psychiatric Institute and Columbia University Medical Center, New York (N.K.A.).

Disclosures: Dr. Aggarwal has received an early-career investigator grant from NIMH (MH102334), royalties from the American Psychiatric Association and Columbia University Press, and speaking fees from New Jersey Culture Connections and University of Texas at Austin for conducting cultural competence training.

Discussion of unapproved or investigational use of products*: No.

*APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.

Program Planners

Robert Freedman, M.D. (Editor-in-Chief, AJP); Susan K. Schultz, M.D. (Deputy Editor, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals).

Dr. Schultz has received research support from the Alzheimer’s Disease Cooperative Study for projects conducted in partnership with Toyama Chemical Company and in partnership with Eli Lilly and Company. Dr. Freedman, Mr. Roy, and Mr. Pogachar report no financial relationships with commercial interests.

Hardware/Software Requirements

This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+. This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat, Microsoft PowerPoint, and Windows Media Player.
Optimal System Configuration:
  • Flash Player: Adobe Flash Player 10.1+ 
  • Browser: Firefox 3+, Internet Explorer 8.0+, Safari 4.0+, or Google Chrome 7.0+ 
  • Operating System: Windows XP+ or Mac OS X 10.4+ 
  • Internet Connection: 1 Mbps or higher
  • Screen Resolution: 1024 x 768 pixels.

Minimum Requirements:

  • Windows PC:500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Sound Card at least 16-bit; Macromedia Flash Player 10 or higher, audio playback with speakers for programs with video content; Firefox 1.1+, Internet Explorer 7.0+, Safari 1.0+, Google Chrome, or Opera
  • Macintosh: Mac OS X 10.3 or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit

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