Getting by as a migrant without papers is certainly hard, and if you become sick it can be much worse, even life threatening. So where can you turn in France when you need medical assistance?
In France, migrants without papers, asylum seekers and refugees as well as those who have some kind of residence permit have the same rights to access the medical system as any French citizen. AME (state medical aid) helps those without papers with the financial costs, offering means-tested reimbursements for some of the costs depending on a person's residence status and financial means.
Depending on what kind of migrant status you have in France, you have the right to several different types of medical aid. Sometimes it can be difficult to actually apply for assistance, however. In fact, it is estimated that more than 20% of people who have the right to access free medical care via the CMU-C (Universal free health insurance) do not actually access their right.
AME has an annual budget of 943 million euros, and about 300,000 people have access to it in France, with the exception of French Mayotte in the Indian Ocean.
What it covers
- Medical and dental costs; will pay in advance where needed.
- Medicines are reimbursed or paid for in full or at 65% or 30% of the cost, depending on your means.
- The costs of any tests you might need to take.
- Hospitalization and surgical operations.
- The costs of certain vaccinations and some screening tests.
- Costs linked to contraception and to abortion.
Who can benefit from AME?
AME is for foreigners in France without papers who have been living in the country for more than three months and have an annual income of less than 9,926 euros (meaning that the recipient cannot have earned more than 800 euros per month for the last 12 months). You also need to have a fixed address.
AME is granted automatically to minors when their parents’ situation is irregular, even if the parents are not yet beneficiaries, or have a higher income than that required to benefit. Any partner of a beneficiary who has entered into a civil partnership (Pacs) is also eligible.
Relatives of a beneficiary of AME who are not themselves resident in France and are just visiting are NOT eligible for AME.
People who are in administrative immigration detention centers (CRA) are also eligible for AME and do not have to fulfill any conditions before being able to benefit.
- All medical professionals are obliged to accept AME patients in their clinics.
- If a medical professional refuses to see you because you are an AME beneficiary, you have the right to complain.
- Minors have the right to 100% reimbursement of all their medical costs under AME.
- Adults can get most medicines reimbursed except those on a list of medicines judged weak or inefficient by the French medical authorities.
- AME is provided for one year and is not automatically renewable. Two months before your current AME is due to expire you need to reapply for the following year.
Free universal health insurance (CMU-C)
Once you do get your papers, you can apply to be a member of the social security system CMU-C which provides you with free medical insurance.
This is also given for one year with no automatic renewal.
This is offered to those who have been resident for more than three months at a fixed address in France and have refugee status or are waiting for their asylum claim to be resolved. Again, you need to earn less than 800 euros a month in order to qualify.
PASS centers (Permanently accessible medical care centers)
In Paris and all over France there are medical centers called PASS. They can be found in public hospitals and are there for people without the normal medical insurances.
Migrants without papers as well as French people and other foreigners can access these centers. People with AME or CMU-C cover can also go to these centers because sometimes, despite the laws, it can be difficult for them to access other healthcare centers.
Some organizations offer 24-hour care without asking for insurance cover. This is especially helpful for those in need of maternal or pediatric care, in that case, those people can access PMIs (Services for Maternal and Infant Health protection)
Changes to AME?
There have been some changes mooted to the AME payments and there were many rumors at the end of September 2019. According to French daily Le Monde in September, proposals for reform included a requirement that beneficiaries cover some costs of pharmaceuticals as well as opening special centers for AME patients, essentially creating a two-tier health system. They also included restricting the types of care accessible to AME patients, excluding psychiatric support for example. None of these proposals has come into effect.
In November 2019 the French government announced a raft of more stringent measures towards migration in general. In terms of health provision for all migrants (regardless of their status), the measures were designed to crack down on potential fraud and abuse of free healthcare provision. Most of the measures seemed to be aimed at those who were waiting for their asylum claims to be decided, rather than migrants without papers. However, organizations like La Cimade and Médecins du Monde which work closely with migrants were up in arms about the new measures.
Carine Rolland, a GP with Médecins du Monde, said blocking access to health care was "very dangerous," and that the government was trying to "instrumentalize migrants and push them into ever more precarious positions." The General Medical Council in France (Le Conseil national de l'Ordre des médecins) also reminded the government that "they were sworn to offer aid to all those who asked for it without discrimination." They worried that in future they would be "asked to refuse certain members of the population."
The government has claimed that some are migrating purely for medical reasons and defrauding the French health care system by asking for things like medicines and even prosthetic limbs in order to sell on at a profit. They refer to potential claimants from countries considered "safe", such as Albania and Georgia, who should not be attempting to claim asylum and therefore should not be offered the medical aid offered to other asylum seekers. However, citing a French Senate report from 2018, La Cimade said that only 38 cases of fraud were identified regarding the AME system, representing a tiny percentage of beneficiaries.
Useful linksIf you would like to apply for AME you can fill out this form.
If you would like to apply for CMU-C you can fill out this form.
Here is a list of PASS centers around France.
If you need help filling out the forms you can go to an insurance center where people can help you.
The organization Médecins du Monde (Doctors of the world) have centers in Paris which can help, and in many cities across France.
The BAAM is a welcome bureau for migrants.
Comede is a committee which defends the rights of those in exile to access health care. They have centers in several places including:
Paris, Marseille, St Etienne and Guyana.
This article was based on an original article in French by Bahar Makooi and a second one by the French news team at InfoMigrants. An additional article by Maëva Poulet written in November 2019 provided an update to changes in some of the provision. All three were translated and combined into this one by Emma Wallis.