In medical emergencies, people with no legal residency status can be treated in state, charitable or private hospitals.
Who is eligible for healthcare?
Recognized asylum seekers are not the only groups that are eligible for inpatient services; even people who, in accordance with AsylbLG, have had their final petition rejected and are subject to deportation, in other words, people who have no legal residence status, those who are “tolerated”, civil-war refugees and their spouses, partners and children, are entitled to health care provision. These groups have the right to access health services in accordance with AsylbLG (see § 1 AsylbLG).
Scope of provision
The scope of provision is set out in § 4 and § 6 of the Asylum Seekers Benefits Act. This law stipulates that anyone with an acute illness (or a chronic disease with an acute need of treatment) or a painful illness, as well as women in pregnancy and childbirth are entitled to healthcare (see entitlement and scope).
Hospital staff neither has a duty nor a right to report people with no legal residency status to the police or to the immigration authorities. This applies to all staff irrespective of whether they work in the medical or administrative field (clarification to the General Administrative Regulation on the Residency Act 2009).
The costs of urgent hospital treatment must be paid by the responsible social services department in accordance with § 6a AsylbLG Reimbursement of third party expenses. Until November 2015, however, § 25 SGB XII was applied in cases of people with an entitlement to benefits arising from AsylbLG.
In the case of hospital admissions, the social security office located in the area where the person in need of treatment was last habitually resident or lived during the last two months before he or she was admitted for treatment has to cover the costs (§ 10a para. 2 AsylbLG). In cases where urgent medical care is required (as in these cases), the local social welfare office must cover the costs in advance (§ 10a paragraph 2 sentence 3, § 10b para. 1 AsylbLG). This is also stipulated by social welfare law. 1 In practice, however, it is often unclear which social welfare authority is actually responsible for the costs. In order to resolve this problem, in Bremen a specific social welfare office and a dedicated person in the administration takes on the responsibility for paying the costs.
The costs of interpreting
People who are eligible for benefits in accordance with the Asylum Seekers Benefits Act can have the costs of interpreting covered by the relevant social services department if this is necessary for their treatment (§ 6 AsylbLG). Interpreting is viewed as a mandatory service that must be provided and paid for by the relevant authority 2
After treatment has been provided, the hospital sends a bill for the costs of the medical emergency to the relevant social security office (in accordance with § 25 SGB XII and § 6a AsylbLG in conjunction with §§ 4, 6 AsylbLG). Urgent cases are those that, from a medical point of view, require immediate assistance and where there is not enough time for prior contact with the organization that will have to cover the costs. 3 The personal data of the person receiving treatment is covered by patient confidentiality; confidentiality also extends to the social welfare authority (this is known as extended patient confidentiality and is stipulated by § 88 AufenthG in conjunction with 88.2.4 ff. Administrative Regulation on the Residence Act 2009). In order to assess a person’s entitlement to healthcare (in accordance with § 1 para. 5 no. 5 AsylbLG) and the possibility of gaining financing by third parties (such as through foreign health insurers), social service departments often need data from the immigration authorities. However, patient confidentiality also extends to the immigration authorities and any information needed by social services can be requested by telephone.
In practice, however, assessing the need for assistance (through the “means test” stipulated by § 7 AsylbLG. § 20 SGB X and § 24 Administrative Procedure Act) poses a challenge to hospitals and social services departments.
In a small number of municipalities, the means test has been completed using an affidavit (or a declaration, in the case of hospitals in Bremen) or a locally recognised clearinghouse, which certifies the need for assistance.
References and further reading
- Deutsche Krankenhaus Gesellschaft (2015): Das Krankenhaus als Nothelfer. Hinweise zur Umsetzung des § 25 SGB XII bzw. § 6a AsylbLG
- Informationsverbund Asyl & Migration (2013): Sascha Kellmann. Sozialrechtliche Rahmenbedingungen für besonders Schutzbedürftige