The Challenges Faced by Foreigners to Access State Medical Aid: A Report by Associations

In a report published last week, associations point to the difficulties encountered by foreigners in an irregular situation in order to benefit from their rights. Barely a majority of people eligible for it are beneficiaries.

It looks like a small Kafka-like hand that would have multiplied the laying of stones to prevent the applicant from arriving at the right place in the Château… In any case, this is the feeling that one has when one dwells on the thousand and one difficulties put in place for foreigners in an irregular situation so that they can, legally, benefit from medical aid from State (AME). And this is what emerges from a report published last week by a series of associations on access to AME (1).

“Lack of accessibility”

State Medical Aid is a system that allows foreigners in an irregular situation to benefit from health coverage. Costing around one billion euros, it allows a very fragile population a minimum access to healthcare services, with no additional costs. However, many people who would be entitled to it do not benefit from it. According to the report, only 51% of eligible people are actually covered by the AME. Already, in 2019, the government had made its access more complex, in particular by introducing a minimum period of three months of presence in an irregular situation on the territory.

Recently, on March 15, an amendment proposing the abolition of the device was even voted in the Senate. And as always, in the comments made to justify their vote, abuses by foreigners were highlighted in order to benefit from them.

However, for associations, the situation is quite different. It highlights a significant deterioration in access to AME “through an accumulation of administrative obstacles” making it very difficult to access CPAM agencies (primary health insurance fund). Here are a few of them. First, the latest reform of the AME has made it compulsory to physically deposit first applications at the counter of the primary health insurance funds (CPAM). And it’s a lottery: “Each CPAM organizes the reception of the public in its own way with a margin of autonomy, leading to a very strong disparity in access to rights depending on the departments.” arbitrarily, “limiting deposits to certain CPAM branches creates considerable difficulties by lengthening and complicating user journeys”. And even : “Without any directive in this sense, almost the majority of CPAMs in Ile-de-France require appointments to be made, by internet or by telephone, to come and file their file, and in certain departments to come and collect their card. », investigators continue. “We note many obstacles to obtaining reliable information, with a lack of accessibility and frequent changes in information concerning the places and procedures for filing AME applications, with the closing of CPAM counters, in a context dematerialization of public services, sometimes even with erroneous information transmitted by security agents at the entrance to CPAM agencies”.

“Obvious Obstruction”

The only channel for making an appointment for filing an AME request with certain departments, call 3646. However, this number is now “difficult to reach”. “According to the results of our testing, the dropout rate varies according to the departments. More than one in three calls are unsuccessful for the CPAMs of Seine-Saint-Denis and Val-de-Marne. It is common to wait between twenty and forty-five minutes depending on the departments concerned to hope that the call is actually picked up. Moreover, the answers are often confused, with “insufficient information provided concerning the legal conditions for granting rights to the AME. For example, the obligation to physically present themselves at the CPAM counter to file their first application is not mentioned in one out of three calls”.

Another blockage, the waiting times for the appointment in order to file a file: “Between January 10 and 16, it takes an average of ten days to obtain an appointment in order to file an application with the Créteil (Val-de-Marne) agency, and fifteen days for that of Sarcelles (Val -d’Oise), twenty days for that of Argenteuil (Val-d’Oise), and up to twenty-four days for that of Cergy (Val-d’Oise). In our daily support practices, we see even greater variability in the availability of appointments: from a few days to two and a half months”, notes the report. As for the refusals, they are legion. “The first reason for refusal is the incomplete file (more than one in three people), to be linked to the difficulty in obtaining quality information to build up their file”. The second pattern is more impressive. “It comes from a refusal to enter the agency opposed by the security guard at the entrance (nearly one person in five), which constitutes a particularly obvious obstruction of access to a public service. During our investigation, we also repeatedly witnessed altercations between the security guard and the people who come to the agency… In Seine-Saint-Denis, more than one in two people failed to file his case. And more than one in three people whose card was ready did not manage to collect it from the agency”.

Finally, it is as in the castle of Kafka, the applicant finds himself at the door. “Health insurance offers a totally unsuitable reception and in fact hinders access to a fundamental right for foreigners without a residence permit, while simple solutions exist!” was therefore able to affirm Fanélie Carrey-Conte, general secretary of La Cimade. “If you don’t know how to read and write French, if you don’t have an internet connection or a telephone plan to call 3646, treatment becomes an impossible mission”, lamented Florence Rigal, president of Doctors of the World.

But that is perhaps the goal sought… And this echoes recent remarks made to us by the Defender of Rights: she told us that she sometimes had the feeling that the public authorities were creating obstacles from scratch for prevent the effectiveness of certain rights.

(1) Survey carried out by telephone testing of 3646, but also with forty volunteer investigators.

(2) La Cimade, Comede, Dom’Asile, Médecins du Monde and Secours Catholique.