The Health Regulatory Entity (ERS) has recommended the government ensure the Ministry of Health “takes the necessary measures, particularly legal-normative, to clarify the interpretation and application of the law regarding immigrants’ access to healthcare services”.
This involves “individuals without a residence permit or a certificate of residence exceeding 90 days issued by the parish council”. The ERS also emphasized the need to clarify the “financial responsibility for costs incurred by healthcare services provided to these individuals”.
The legal ambiguity stems from what ERS sees as a conflict between the National User Registry (RNU) Regulations and a 2009 circular from the Directorate-General of Health (DGS), which remains in effect despite preceding the new Health Basic Law of 2019 and associated regulations.
The RNU Regulations exempt from payment in the National Health Service (SNS) foreign nationals who, although not yet possessing a residence permit, have a parish council certificate proving residence in the country for more than 90 days for “urgent and vital care services”.
The ERS notes that the RNU Regulations do not define the extent of “urgent and vital care.” However, during the consultation process for the recommendation, the Central Administration of the Health System (ACSS) expressed the view that expenses may be charged to foreigners if the care does not fall within those listed in the DGS circular and exceeds the restrictive provision of “urgent and vital care.”
This circular, in addition to exempting payment for “urgent and vital healthcare,” makes medical assistance in the SNS free for undocumented foreigners in cases of communicable diseases posing a public health risk (such as tuberculosis or AIDS), maternal and child healthcare, including childbirth, voluntary pregnancy termination, or prenatal care, and vaccinations per the National Vaccination Program.
It also includes foreigners in family reunification situations when a household member is verified to contribute to Social Security and cases of proven social exclusion or economic need.
The issues raised by ERS are further complicated by the new Health Basic Law, which includes “migrants with or without legal status” as SNS beneficiaries.
In light of this, the ERS urges the government to provide legal clarification concerning irregular foreigners’ access to the SNS and advises the ACSS “to detail the concept of ‘urgent and vital care’ in coordination with legally competent entities.”
The ERS reiterates previous recommendations to the ACSS to implement “adequate measures for registering, processing, and monitoring real data and information on each foreign citizen accessing healthcare services in the SNS.”
It also advises the ACSS to disseminate the RNU Regulations and the primary healthcare registration regulations to SNS establishments and to ensure the “issuance and dissemination of the necessary guidelines for their complete and uniform compliance.” Additionally, the Shared Services of the Ministry of Health (SPMS) should “adapt the information systems used by establishments.”
Finally, ERS recommends the Executive Directorate of the SNS “ensure uniform action by Local Units regarding foreigners’ access to healthcare services.”
