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To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

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Advocacy & Public Policy

Addressing Access to Kidney Replacement Therapy for Undocumented Immigrants with Kidney Failure


There are an estimated 5500 to 8857 undocumented immigrants with kidney failure in the United States. Individuals with kidney failure require kidney replacement therapy (e.g. dialysis or transplantation) to live. All citizens and some permanent residents with kidney failure qualify for Medicare because of the ESRD Entitlement program, however, undocumented people are excluded from federal insurance provisions such as Medicare and provisions under the Affordable Care Act.

Due to lack health care coverage for kidney replacement therapy due to citizenship status, undocumented immigrants are only able to receive emergency dialysis treatment (dialysis only when critically ill) at local emergency departments (EDs) as mandated by the Emergency Medical Treatment and Labor Act (EMTALA).

Emergency hemodialysis is associated with many deleterious outcomes, including:


To modify the services and/or conditions provided by state Emergency Medicaid programs thereby expanding healthcare coverage of kidney replacement therapy for undocumented individuals with kidney failure.

What States Are Doing

Kidney health professionals across the United States are already taking charge to change state policy, improving access to care and reducing the strain on our health care system. Many states have state-wide provisions for maintenance dialysis for undocumented people through qualifying "kidney failure" as a covered condition under Emergency Medicaid, inclusion of undocumented people in Medicaid reform, or through state-wide high risk insurance pools.

In February 2019, the Colorado Department of Health Care Policy and Financing opted to include "ESRD" in Colorado's definition for "emergency medical condition," which expanded access to scheduled thrice-weekly hemodialysis to undocumented immigrants. Many other states have modified their Medicaid language to allow for standard dialysis, and some states have included other treatments for kidney failure, such as vascular access and home dialysis. Read more here.

Currently, 20 states and DC have statewide provisions for dialysis, and 5 states have provisions for transplant.

Kidney Replacement Therapy Insurance Coverage

The benefits to providing undocumented dialysis:

Advocacy strategy has been summarized multiple times, and may be listed in the following steps:

  1. Identify the problem as a policy problem
  2. Understand the policy and finances- how is emergency dialysis reimbursed?
  3. Consider the change you'd like to see- who needs to be convinced?
  4. Identify stakeholders- community advocacy groups, hospital leadership, media, state Medicaid agency
  5. Stakeholder engagement
  6. Utilize research to enhance messaging

ASN Action

Click here to receive more information and to join the effort.

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