The cost of dialysis for the estimated 6500 dialysis-dependent undocumented individuals with kidney failure in the United States is high, the quality of dialysis care they receive is poor, and their treatment varies regionally. The AKF continues to provide support as long as the patient remains under the care of participating dialysis centers, which in turn are financial supporters of the AKF. Currently, >1000 such centers provide comprehensive primary care to >20 million uninsured or undocumented individuals annually (4). For now, SL waits patiently in the ED alongside 10–15 other similar patients, all of whom are hoping for one thing: a single dialysis treatment that day. This occurrence of undocumented dialysis-dependent individuals purchasing off-exchange insurance was first described in Illinois in 2014; and in conversations with nephrologists around the country, it occurs elsewhere but is neither widely publicized nor utilized (17). Bulletin 2011–19 from the Division of Insurance (DOI) in Massachusetts explicitly states, “Carriers shall not refuse to issue or renew coverage to an applicant or a member solely because an applicant or member chooses not to provide a social security number” (21). If you are from Finland, Norway or Sweden – you must take your passport and travel visa to a Medicare office.

If you do become ill, call the dialysis center or doctor as instructed. Since the unexpected may happen during a trip and meals may be delayed, you should carry glucose tablets and appropriate snacks, such as low-potassium juice boxes or hard candy, to treat low blood sugar.

Be sure to allow enough planning time to make these arrangements. Check with the transient center about their policy on this. What types of dialysis machine does the center have (conventional, high flux capability)? This amendment, passed in 1986 and referred to as the Emergency Medical Treatment and Active Labor Act, requires that a patient who comes to an ED with an emergent medical condition be provided with treatment (such as dialysis) until stable or transferred to another hospital. About 65% of practicing nephrologists in academic and private centers provide care to these individuals; much of this service is uncompensated or inadequately reimbursed (2). Most doctors encourage travel if the patient's health is stable.

Traveling is often easier for peritoneal dialysis patients because they are not dependent on the availability of a dialysis unit. Make sure you have important phone numbers with such names as your regular doctor, dialysis center, etc. [CDATA[ Her family drops her off by 4:30 a.m. Although for many patients dialysis is a bridge to transplantation, sadly, undocumented individuals are often excluded from transplantation despite the fact that several of them are excellent transplant candidates due to their better overall health, younger age, and available potential donors (3).

What is the average treatment length of dialysis at the center? Off-exchange plans can be purchased directly from a carrier or through an agent or broker. A novel opportunity to provide scheduled dialysis for this population is through the purchase of insurance off the exchange. If you are from Malta and Italy – you are only covered for six months from your date of arrival, and must present your passport. Brantford General Hospital and S.C. Johnson Dialysis Unit 200 Terrace Hill Street Brantford, ON N3R 1G9 Phone: 519-751-5586 Visitors will be accepted according to space and staff availability. The center may request a copy of your medical records in advance.

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