In its latest annual health access report, MDM highlights the "immense difficulties" encountered by migrants to access health coverage despite being eligible for French state medical aid (AME).

During 2022, the NGO participated in ten programs with migrants in France: on the coast of Pas-de-Calais, at the French-Italian border via mobile shelter units in Ventimiglia and Briançon, in Paris and Marseille, and in Mayotte. Three specific programs were dedicated to unaccompanied minors, in particular those in appeals proceedings who are excluded from child protection systems, in Caen, Nantes and Paris.

The main activity of MDM is concentrated in its care and orientation centers (CASO). In 2022, half of the people received in these CASOs were in an irregular administrative situation.

Delays in seeking care

MDM received a little more than 4,000 undocumented patients and 2,000 asylum seekers that year.

Doctors reported that 57% of those undocumented patients had at least one chronic illness. They diagnosed a need for "urgent or fairly urgent" care for 40% of them.

Among asylum seekers, the situation is more or less similar. The proportion of asylum seekers with a chronic illness -- 55% -- is almost identical to that of undocumented patients. Doctors report an even greater need for "urgent" or "fairly urgent" medical care: 53% of the asylum seekers were in need of such care.

The MDM report underscores the barriers in seeking care for migrants. One in two undocumented patients suffers from those barriers, the NGO writes, leading to worsening health conditions.

91% of undocumented people do not have health coverage

Although 85% of undocumented people are eligible for health coverage, only 9% have an active coverage. 

As for asylum seekers, 77% of those eligible do not have active coverage. 

The lack of access to coverage they have a right to can be explained by several factors. The procedures for granting coverage are complex. A report from multiple organizations published on April 20 revealed that 64% of those polled encounter difficulties in obtaining treatment due to a lack of healthcare coverage. Among them, 7 out of 10 have given up treatment. 

"I don't understand the new procedures. I don't have the Internet, and I don't have the means to load credits on my cell phone," explained an elderly woman in this survey, stressing her need to be helped in the procedure.

Only 4% of undocumented people are housed by an organization or association for more than two weeks, MDM reports. This limits the possibilities of social and healthcare support, which are essential to help access one's rights.

As for asylum seekers, 2 out of 5 are homeless. Asylum seekers subjected to the Dublin procedure face even more barriers in access to healthcare, the NGO reports, “because they are less often housed and supported in obtaining rights.”

'Risks of care renunciation'

The immigration bill is "a source of great concern" for MDM. It will be discussed in a public session in Parliament at the beginning of November. When the text passed through Senate committees in March, an amendment brought by right-wing party members eliminating the AME was adopted.

The text is not adopted yet and nothing indicates that this amendment will remain in the final law. With every new immigration bill, the AME is subjected to parliamentary attacks. According to MDM and based on their fieldwork, “there is no evidence of rights abuse but, on the contrary, there are risks of care renunciation."

In MDM appointments in 2022, no less than 86% of patients eligible for AME had not accessed their rights.

Rights loss from one year to the next

There are many obstacles, such as a lack of information and support on the subject. "A woman in France was seeing a doctor in town for three years and always paid for her consultations and health costs. No longer having the means to do so, she came to the MDM center. No health professional had told her about AME," an MDM team reports. It was this team that had to help her put together her request.

The procedures are also becoming more and more complicated. The report lists causes for this: "(N)ear closure of CPAM reception desks, physical submission of first requests, processing time for files, increased use of dematerialization or paid telephone platforms…". As a result, people without active rights under AME forgo care twice as often as those who are covered.

In addition, the AME is only valid for a single year after which a case needs to be resubmitted for rights to be renewed. Rights are lost, from one year to the next, MDM writes. With other NGOs, the organization has been calling for years for a merger of the AME into the general social security system, for a "truly universal" healthcare protection.