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Refugee Health Program: Humanitarian Parolee Health Resources

Drone image of the Madison, WI capitol dome at sunrise

As Wisconsin welcomes new humanitarian parolees to our state, it is important for providers to have the knowledge and resources to provide culturally informed care. New populations are eligible for humanitarian parole through federal sponsorship programs, including Uniting for Ukraine (U4U) and processes for Cubans, Haitians, Nicaraguans, and Venezuelans (CHNV).

For more information on Ukrainian arrivals, see the Department of Homeland Security's webpage.

For more information on Cuban, Haitian, Nicaraguan, and Venezuelan arrivals, see the US Citizenship and Immigration Service's (USCIS) webpage.

These populations will need to go through Tuberculosis (TB) evaluation and attestation. Additionally, they 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)

For resources on culturally informed health care for these arrivals, see below. Please note that some general refugee health resources have been included. They may still be useful in guiding care for newly arrived populations.

While those applying to parolee programs are asked to provide a limited amount of medical information before their application is approved, this information is usually not accessible to state health departments.

On April 21, 2022, President Biden announced that the U.S. will welcome up to 100,000 Ukrainians and others fleeing from Russian aggression in the ongoing Russia-Ukraine crisis. Most displaced persons will not be processed through the refugee resettlement program. Instead, they will participate in a new process called Uniting for Ukraine that launched on April 25, 2022.

Participants need a U.S.-based supporter that has U.S. citizenship and can provide financial support.

People approved through the program, referred to as humanitarian parolees, can stay in the U.S. for up to two years.

Because the Department of Homeland Security is not facilitating travel, the Wisconsin Department of Health Services will not be able to provide local jurisdictions with information about humanitarian parolees.

CDC's (Centers for Disease Control and Prevention) translated resources

Information on benefits

Due to current federal law, Ukrainian humanitarian parolees who are paroled into the United States on or after Oct. 1, 2023, are not eligible for federal public benefits and refugee resettlement services (unless they are spouses or child of an ORR-eligible Ukrainian parole OR parent(s) or legal guardian(s) or primary care giver(s) of an ORR-eligible unaccompanied child from Ukraine).

Information on TB and vaccine attestation

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.

Individuals from Cuba and Haiti are eligible for a humanitarian parole program through U.S. sponsorship similar to Uniting for Ukraine (U4U). These individuals will be considered on a case-by-case basis for advanced authorization to travel to the United States for a temporary period of humanitarian parole for up to two years. Cubans and Haitians may also arrive though The Cuban Family Reunification Parole Program or The Haitian Family Reunification Parole (HFRP) Program.

Cubans and Haitians paroled into the United States are eligible for certain Office of Refugee Resettlement (ORR) benefits and services. Those presenting to clinics or health departments seeking medical services should be encouraged to apply for Wisconsin Medicaid by contacting the Income Maintenance Consortium office in their region or apply online through the ACCESS online application portal.

Humanitarian parolees under this program are also eligible to apply for work authorization and a Social Security number. For more information, see ORR Benefits for Cuban/Haitian Entrants.

Processes for Cubans, Haitians, Nicaraguans, and Venezuelans

See below for more health resources on Cuban and Haitian entrants

New populations are eligible for humanitarian parole through federal sponsorship programs. Individuals from Venezuela and Nicaragua are eligible for a humanitarian parole program through U.S. sponsorship similar to Uniting for Ukraine (U4U). These individuals will be considered on a case-by-case basis for advanced authorization to travel to the United States for a temporary period of humanitarian parole for up to two years.

Nicaraguan and Venezuelan humanitarian parolees are not currently eligible for ORR-funded refugee benefits and services including resettlement assistance, a domestic medical screening, or refugee social services. As humanitarian parolees, Nicaraguan and Venezuelans who arrive to the U.S. under this process are eligible to apply for work authorization and a Social Security number.

See below for more health resources on Venezuelan and Nicaraguan entrants.

In April 2023, the Department of Homeland Security announced a new family reunification parole program for persons from Latin America. 

The new processes are for nationals of Colombia, Cuba, Ecuador, El Salvador, Guatemala, Haiti, or Honduras whose family members are U.S. citizens or lawful permanent residents and who have received approval to join their family in the United States. 

Specifically, nationals from these countries can be considered for parole on a case-by-case basis for a period of up to three years while they wait to apply to become lawful permanent residents. 

The purpose of the program is to provide additional, legal pathways for persons from Latin America to enter the United States. Please see USCIS's Family Reunification Parolee Processes webpage.

Resources for clinicians

Translated health resources and culturally informed care

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.

TB Incidence Rates, 2021*
CountryTB Incidence (per 100,000)MDR/RR-TB Incidence (per 100,000)Ɨ
Cuba6.80.4
Haiti1598
Nicaragua450.78
Venezuela472
United States2.60.05

*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

Culturally informed care

Mental health

Resources from The National Child Traumatic Stress Network

Other resources

Refugees and other visa holders may apply for a green card (adjustment of status) once in the United States. They are required to undergo an immigration medical examination. The examination must be done by a doctor who is designated by U.S. Citizenship and Immigration Services (USCIS). USCIS designates certain doctors (known as civil surgeons) to perform the immigration medical examination required for most green card applicants. Please see USCIS's website to find a civil surgeon and learn more about adjustment of status.

Who to contact for help

Questions?

Last revised January 24, 2024