Refugee Health Program: Humanitarian Parolee Health Resources
As Wisconsin welcomes new humanitarian parolees to our state, it is important for providers to have the knowledge and resources to provide informed care. Since April 2022, sponsorship programs enable individuals from the countries below to come to the United States under the immigration status humanitarian parole.
- Ukraine
- Cuba
- Haiti
- Nicaragua
- Venezuela
Humanitarian parole is a discretionary benefit granted by the Department of Homeland Security (DHS) to certain noncitizens to allow them to enter and temporarily stay in the United States for specific reasons. Immigration parole is different from criminal parole. There is no relationship to the criminal justice usage of the word parole.
Humanitarian parolees from Ukraine, Cuba, Haiti, Nicaragua, and Venezuela entering through sponsorship programs must attest to receiving certain vaccinations before they travel to the United States and then go through a medical screening for tuberculosis (TB) within 90-days of their arrival. This includes a TB blood test.
The TB blood test, also called an Interferon Gamma Release Assay or IGRA, is a way to find out if you have TB germs in your body. The TB blood test can be done instead of a TB skin test (Mantoux). There are two kinds of TB blood tests: QuantiFERON®-TB or T-SPOT®TB.
Vaccine Requirements
Vaccination attestation means each person must attest to having received at least one dose of a measles, polio, and Food and Drug Administration (FDA)-approved COVID-19 vaccines. They are not required to be vaccinated against other diseases as a condition of their humanitarian parole (see USCIS Vaccination and TB Attestation for more information: U4U | CHNV)
Translated health resources and culturally informed care
- Uniting for Ukraine Vaccine Attestation: A U.S. Citizenship and Immigration Services webpage. It has information on pre-travel vaccine attestations for Ukrainians. It also lists the vaccines required for refugees within 90 days of arrival.
Translated TB resources
- Conversation guide for talking with your clients about screening for TB: Ukrainian (PDF) | Conversation guide for talking with your clients about screening for TB: Russian (PDF) | Conversation guide for talking with your clients about screening for TB: English
- TB fact sheet: Ukrainian/English (PDF) | TB fact sheet: Russian/English (PDF)
- TB flyer: Ukrainian/English | TB flyer: Russian/English (PDF)
- TB poster: Ukrainian/English | TB poster: Russian/English (PDF)
- Sample newsletter content | Ukrainian, Russian, and English
- Sample text message content | Ukrainian, Russian, and English
- Sample social media posts | Ukrainian, Russian, and English
Information on TB and vaccine attestation
- If not eligible for federal medical assistance, the Wisconsin Tuberculosis Program may be able to help. Contact your Local Health Department for more information.
- Tuberculosis (TB) Screening for People Arriving from Ukraine to Wisconsin, P-03293 (PDF): Recommendations by the Wisconsin Tuberculosis Program on tuberculosis screening for Ukrainians who are part of the Uniting for Ukraine program.
- Tuberculosis Testing for Ukrainian Arrivals and Sponsors, P-03430: An informational handout to provide Tuberculosis testing information and resources to Ukrainian arrivals and their sponsors available in English, Ukrainian, and Russian.
- Wisconsin Tuberculosis (TB) Screening Tool for Ukrainian Humanitarian Parolees (UHP) Participating in the Uniting for Ukraine Program (U4U), P-03293a, (PDF): Tool for completing components of tuberculosis screening for Ukrainians participating in the Uniting for Ukraine program.
- Uniting for Ukraine Vaccine Attestation: A U.S. Citizenship and Immigration Services webpage. It has information on pre-travel vaccine attestations for Ukrainians. It also lists the vaccines required for refugees within 90 days of arrival.
Other resources
- Uniting for Ukraine: Department of Homeland Security's webpage. It provides an overview of Uniting for Ukraine and frequently asked questions.
- Ukrainian Clinical Guidance: A publication from the Minnesota Center of Excellence in Newcomer Health. It outlines health screening recommendations for providers who work with people arriving from Ukraine.
- Psychological First Aid: A Switchboard webinar on psychological first aid in the context of the events in Ukraine. It includes the basics of psychological first aid and cultural information on Ukraine.
- Uniting for Ukraine Overview and FAQ: Department of Homeland Security's webpage that provides an overview of Uniting for Ukraine and frequently asked questions.
- Cultural Backgrounder: Refugees from Ukraine: Guide on refugees from Ukraine from the International Rescue Committee
Want to find out how you can help Ukrainian arrivals? Go to the Wisconsin Department of Children and Families website to learn more.
Only certain humanitarian parolees are eligible for Office of Refugee Resettlement (ORR) Benefits. Eligibility also depends on other rules, like income requirements. Populations from Ukraine, Cuba, and Haiti, which may be eligible for ORR Benefits include:
- Ukrainian Humanitarian Parolees (includes other people who last regularly resided in Ukraine and are arriving through the United for Ukraine Program)
- For detailed information about eligibility for refugee resettlement benefits and services and other public benefits go to ORR Benefits for Ukrainian Humanitarian Parolees.
- Cuban and Haitian Humanitarian Parolees (and others who are also considered Cuban/Haitian Entrants)
- For detailed information about eligibility for refugee resettlement benefits and services and other public benefits available go to ORR Benefits for Cuban/Haitian Entrants
Some ORR benefits and services are time limited. It is important to apply right away. Learn more about applying for ORR benefits and services.
Eligibility for BadgerCare Plus and Medicaid varies for people with humanitarian parole. Some are immediately eligible, some have a five-year waiting period, and others are not eligible. It depends on the specific type of parole, the date the individual was paroled into the U.S., and the length of parole. Eligibility also depends on other rules, like income requirements.
- Children (less than 19 years old) and pregnant people may be eligible for BadgerCare Plus or Medicaid.
- Adults, who are also eligible for ORR benefits or have been a humanitarian parolee for at least five years, may be eligible for BadgerCare Plus or Medicaid.
- Adults who are unable to get BadgerCare Plus or Medicaid can get health insurance through the Marketplace at HealthCare.gov.
- Children can also get coverage on the Marketplace if they’re not eligible for BadgerCare Plus or Medicaid because their household has too much income.
- Some humanitarian parolees may be able to get coverage for life threatening conditions through Emergency Services
How to apply for BadgerCare Plus, Medicaid or Emergency Services
You can apply for benefits and programs online, by phone, by mail, or in person at your agency. If you read or write in a language other than English or Spanish, you will need to apply by calling your agency or submitting a paper application.
- Go to the DHS ForwardHealth website for details on how to apply.
How to apply for Marketplace Health Insurance
The Marketplace has tax credits and cost sharing reductions to make coverage more affordable.
- Apply for Marketplace health insurance by going to HealthCare.gov
Need help?
Contact Covering Wisconsin, a free resource that helps connect Wisconsin residents with health insurance, including BadgerCare Plus, Medicaid, and Marketplace, as well as other programs that support health.
Humanitarian parolees can apply for work authorization and a Social Security number.
To get help obtaining work authorization or a Social Security number check out the Department of Children and Families website.
Resources for clinicians
- View the Refugee Health Program’s recent presentation “Alternative Pathways to Immigration”
- CareRef: A tool for clinicians that gives guidance on post-arrival medical screenings. It is based on the CDC Domestic Refugee Screening Guidance and the specialized needs of refugee populations. (The Wisconsin Department of Health Services highly recommends this resource.)
- Contextual Considerations for Infectious Disease Control (PDF): Information from the European Center for Disease Prevention and Control. It details public health considerations for the prevention and control of infectious diseases in the context of Russia’s aggression towards Ukraine.
- Immunity Community – Fostering COVID-19 Vaccine Confidence: A free training course for providers. It offers strategies to increase confidence in COVID-19 vaccine.
Translated health resources and culturally informed care
- Uniting for Ukraine Vaccine Attestation: A U.S. Citizenship and Immigration Services webpage. It has information on pre-travel vaccine attestations for Ukrainians. It also lists the vaccines required for refugees within 90 days of arrival.
- Plain Talk About Childhood Immunization: A 50-page booklet for parents on immunizations and their benefits, risks, and effectiveness as well as vaccine safety:
- Vaccination Record Interpretation Guide: Translation guide for school personnel, providers and other medical practitioners assessing immunization records in Ukrainian and Russian, created by the Washington State Department of Health.
- Vaccine Information Statements (VIS)
- Picking up medications: scroll through right panel once hyperlink is opened to select from 15 languages
- 3HP, 3HR, and 4R Medication Trackers and Patient Information Sheets from CDC (including translations)
- Southeastern National Tuberculosis Center TB resources
- CDC Resources in Languages Other than English: Translated resources from the CDC on various health related topics. Additional health-related resources
- Know Your Rights: Department of State Travel's pamphlet describing individual's rights while working in the United States.
- Catholic Charities Milwaukee Educational Videos: Educational videos and resources from Catholic Charities Milwaukee available in multiple languages.
These newcomers are not screened for TB prior to arrival in the United States and must attest to screening with an interferon gamma release assay (IGRA) result within 90 days after arrival. Tuberculin skin tests (TSTs) are not accepted. The Wisconsin Department of Health Services will not be able to provide local jurisdictions with information about humanitarian parolees, including TB status.
Health department personnel who provide TB testing may be the first point of contact with the U.S. healthcare system for these individuals. If eligible for insurance, parolees should be encouraged to first apply for Medicaid. If not eligible, providers are encouraged to refer them to Federally Qualified Health Clinics or other local healthcare providers serving uninsured populations for basic healthcare.
Both confirmed and suspected cases of active tuberculosis are category I conditions, reportable immediately to the patient’s local public health officer. Both confirmed and suspected latent tuberculosis infection are category II conditions, reportable to the patient’s local public health department within 72 hours of recognition of a case or a suspected case. Please see the Wisconsin Tuberculosis Program webpage on reporting for more information.
| Country | TB Incidence (per 100,000) | MDR/RR-TB Incidence (per 100,000)Ɨ |
|---|---|---|
| Cuba | 6.8 | 0.4 |
| Haiti | 159 | 8 |
| Nicaragua | 45 | 0.78 |
| Venezuela | 47 | 2 |
| United States | 2.6 | 0.05 |
*WHO Global Tuberculosis Programme, 2021
ƗRR is TB resistant to rifampicin®; MDR is TB resistant to R + isoniazid
For humanitarian parolees resettled in Wisconsin presenting to clinics or local health departments for TB screening, the Wisconsin Tuberculosis Program and Refugee Health Program recommends the following TB screening components are completed:
- Symptom screening for tuberculosis for all individuals of all ages.
- Persistent cough lasting more than 10 days and one or more of the following: coughing up blood, fever, night sweats, unexplained weight loss, or fatigue.
- Chest radiographs for persons aged 6 months and older if positive IGRA or symptom screen.
- CXR postero-anterior (PA) view for those ≥10 years of age.
- Anterior to posterior (AP) or PA view and lateral view for those <10 years of age.
- Medical examination for persons with positive IGRAs, abnormal chest radiographs consistent with tuberculosis, or positive symptom screening.
- Respiratory sampling if indicated by the chest radiograph, medical examination, or symptom screening
If not eligible for federal medical assistance, the Wisconsin Tuberculosis Program may be able to help. Contact your Local Health Department for more information.
- Active Tuberculosis Disease Fact Sheet, P-42099: (Available in English, Dari, Hmong, Kirundi, Russian, Spanish, and Ukrainian)
- Latent Tuberculosis Infection Fact Sheet, P-2099B): (Available in English, Dari, Hmong, Kirundi, Russian, Spanish, and Ukrainian)
- General Tuberculosis Resources from King County, Washington: Haitian - Creole
- Tuberculosis: General Information Fact Sheet from CDC:
- Questions and Answers About Tuberculosis from CDC:
- The Wisconsin Tuberculosis Record cards can be given to clients who may need to present documentation of TB and latent TB infection (LTBI) screening and treatment and may not have ready access to their medical records. Wallet cards are also available in Dari, Hmong, Burmese, Kirundi, Russian, Ukrainian, and Spanish. Please see the Wisconsin TB Program Webpage for more information and ordering.
- Translated TB Resources from Massachusetts Department of Public Health (MDPH)
- How to Take Your TB Medicine:
- Keep Taking Your TB Medicine:
- You Can Have TB and Feel Healthy:
- You Have TB Infection (A Type of TB):
- Translated resources by the Southeast National TB Center:
- You Can Prevent Tuberculosis: A Patient Educational Handout:
- You Can Prevent Tuberculosis: A Patient Educational Handout: Ukrainian
- You Can Prevent Tuberculosis: A Patient Educational Handout: Haitian-Creole
- You Can Prevent Tuberculosis: A Patient Educational Handout: Russian
- You Can Prevent Tuberculosis: A Patient Educational Handout: Spanish
- You Can Prevent Tuberculosis: A Patient Educational Handout: French
- !2-Dose Regimen for LTBI Patient Educational Brochure:
- 12-Dose Regimen for Latent TB Infection Medication Tracker and Symptom:
- 12-Dose Regimen for Latent TB Infection Medication Tracker and Symptom Checklist: Ukrainian
- 12-Dose Regimen for Latent TB Infection Medication Tracker and Symptom Checklist: Haitian Creole
- 12-Dose Regimen for Latent TB Infection Medication Tracker and Symptom Checklist: Spanish
- 12-Dose Regimen for Latent TB Infection Medication Tracker and Symptom Checklist: Swahili
- 12-Dose Regimen for Latent TB Infection Medication Tracker and Symptom Checklist: other languages
- 4R Regimen For Latent TB Infection Medication Tracker And Symptom Checklist:
- 3HR Regimen For Latent TB Infection Medication Tracker And Symptom
- Patient Fact Sheet Series - Isoniazid:
- Patient Fact Sheet Series - Rifampin:
- Patient Fact Sheet Series -Isoniazid And Rifapentine:
- Educational Tools To Address Tuberculosis In Spanish-speaking, Foreign-born Communities
Culturally informed care
- Practicing Cultural Humility when Serving Immigrant and Refugee Communities: A Guide from EthnoMed on cultural humility for clinicians and healthcare providers
- Fundamentals of Equity and Resettlement: Understanding Social Identities in Resettlement Services – A Switchboard guide "designed to aid in deeper engagement on race, equity, and social identities in resettlement services"
- Guide to Trauma-Informed Care: Preventing Crises and De-escalating Difficult Situations: A guide to help service providers interact with refugees in a trauma-informed way
- Tips and Strategies for Culturally Sensitive Care: A webpage by the Refugee Health Technical Assistance Center that provides background on various aspects of working with refugees, including language, access, gender issues, modesty, cultural and traditional practices, religious observances, and case management
- Tip Sheet on Haitian Culture: An information sheet on Haitian Culture by the State University of New York
Mental health
- Building a Culturally Informed Network of Refugee Mental Healthcare Providers: A guide for refugee service providers to increase cultural awareness in mental health practitioners.
- Guide to Trauma-Informed Care: Preventing Crises and De-escalating Difficult Situations: A guide to help service providers interact with refugees in a trauma-informed way.
- Headington Institute Resources: A collection of resources, including articles, reading courses, exercises, videos, and other materials. These can help caregivers to address resiliency, self-care, and vicarious trauma.
- Institute on Trauma and Trauma-Informed Care: A website with talks, online modules, and manuals on trauma-informed care.
- Mental Health First Aid: A website with trainings, courses, and resources on how to identify and support those with mental health or substance abuse problems.
- Mental Health Resources for Clinicians and Researchers: Information from the International Trauma Consortium. It includes mental health materials and measures available in Ukrainian, Russian, and English.
- Mental Health Technology Transfer Center Network: Resources to support the mental health of refugees and asylum seekers.
- Psychological First Aid: A website by Unbound Medicine. with the “Who, What, Where, When, and Why” of psychological first aid as well as implementation.
- Psychological First Aid During COVID-19: A webinar on how to use psychological first aid in the context of refugee health and COVID-19.
- Psychological First Aid: Guide for Field Workers: A guide from the World Health Organization to practicing psychological first aid in crisis situations as well as how to care for oneself and colleagues.
- Refugee Trauma: From the National Child Traumatic Stress Network. A website with information on the experience of refugee, the effections of trauma, screening and assessment tools, interventions, and resources.
- The 5 Components of Psychological First Aid: An article on the tools of psychological first aid that can be used to "help patients as they respond to traumatic events."
Resources from The National Child Traumatic Stress Network
- Psychological First Aid: Tips for Adults:
- Psychological First Aid: Parent Tips for Helping Adolescents:
- Psychological First Aid: Parent Tips for Helping Infants and Toddlers:
- Psychological First Aid: Parent Tips for Helping Infants and Toddlers - English
- Psychological First Aid: Parent Tips for Helping Infants and Toddlers - Ukrainian
- Psychological First Aid: Parent Tips for Helping Infants and Toddlers - Russian
- Psychological First Aid: Parent Tips for Helping Infants and Toddlers - Spanish
- Psychological First Aid: Parent Tips for Helping Preschoolers:
- Psychological First Aid: Parent Tips for Helping School-Age Children:
- Age-Related Reactions to Traumatic Events:
- After a Crisis: Helping Young Children Heal:
- Bearing Witness: Traumatic Stress and the Helping Professional: A webinar by the University of Minnesota’s Center for Practice Transformation. It focuses on how to identify and manage secondary traumatic stress. It also details the differences between secondary traumatic stress, vicarious trauma, moral injury, compassion fatigue, and burnout.
- “I Was Already Burned Out, and Now This...” Strategies for Staff and Supervisors to Mitigate Burnout, Vicarious Trauma, and Other Occupational Hazards: A 2020 Switchboard training for front-line and management staff who work with refugees. It outlines types of occupational hazards for emotional distress and how to respond.
- Secondary Traumatic Stress: A webpage by the Administration for Children and Families. It offers a description of secondary traumatic stress, symptoms of compassion fatigue, and relevant ways to help.
- Secondary Traumatic Stress Handout: A PDF handout by ProQOL with English, Arabic, and Kiswahili translations. It outlines the definition of secondary traumatic stress. It also lists symptoms, risk factors, and self-care practices.
- Secondary Traumatic Stress Series: A series of webinars by the National Child Traumatic Stress Network. It includes “Cultural Implications of Secondary Traumatic Stress,” “Secondary Traumatic Stress and Provider Self Care in Disaster and Terrorism Settings, Organizational Secondary Traumatic Stress,” and “Secondary Traumatic Stress... What is it?”
- Wellbeing for Service Providers During COVID-19—Managing our Own Emotional Needs While Helping Refugee Clients: A Switchboard article for those helping refugees. It discusses the emotional challenges in helping professions. It also gives ways to recognize and address them.
- Working with Young People in the Trauma Space—Vicarious Trauma: An Orygen webinar for professionals working with young people who have gone through trauma and injustice. It describes a framework of self-care rather than specific self-care practices.
Other resources
Refugees may apply for a green card (adjustment of status) once in the United States. Refugees only need to have a Civil Surgeon review and ensure their vaccinations are up to date. All refugee-based adjustment applicants must submit the vaccination record portion of Form I-693.
Who to contact for help
Questions?
- Email Savitri.Tsering1@wisconsin.gov
- Call 608-422-4269
- Fax 414-270-4775