Will undocumented foreigners get free healthcare under NHI? – Motsoaledi responds

Amid heated debate over the National Health Insurance (NHI), Health Minister Aaron Motsoaledi has clarified government’s stance on undocumented foreign nationals receiving free healthcare.

Despite the NHI Act being enacted earlier this year, it remains the subject of intense criticism and scrutiny in some quarters.

Among the questions is whether migrants will be eligible to register and access free healthcare services under the NHI fund.

Motsoaledi on foreign nationals NHI eligibility

In response to a recent parliamentary question on whether NHI funding and resource allocation includes undocumented foreign nationals, Motsoaledi stated it would depend on the “circumstance of the person”.

“If it can be proven that the person came specifically for healthcare services, then government is entitled to charge such a person,” he said.

The minister previously explained that provincial health departments are obligated to treat all patients at public healthcare facilities, regardless of their citizenship status.

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However, he emphasised that the issue of public healthcare facilities being overwhelmed by undocumented foreign patients went beyond his department.

“This is an ongoing challenge that requires a whole-of-government response, including border management, immigration, law enforcement, National Treasury, international relations, Parliament, and others.

“It is not a matter that the health departments can address alone,” Motsoaledi said.

Funding and the NHI fund’s role

Motsoaledi further indicated that the NHI fund will cover the costs for any person treated within the national health system, as stipulated in Section 4 of the NHI Act.

However, when asked who would contribute to the NHI fund on behalf of undocumented foreign nationals, the minister referred to the budgetary process.

“The chief source of funding is from money appropriated annually by Parliament, in other words through the prescribed budget process.

“Payment for care of undocumented foreign nationals remains a challenge for the health departments.”

The minister added that he hoped that revised immigration management, as envisioned in the White Paper on Immigration, would help the health system manage the funding issue more effectively.

Court order and impact on resources

Meanwhile, ActionSA MP Tebogo Letlape raised questions about the impact of a South Gauteng High Court ruling in April 2023, which required government to provide free healthcare services to children of undocumented foreign parents under the age of six and pregnant undocumented immigrants.

Letlape asked how this ruling has affected capacity, resources, and service delivery in maternity and child wards across South Africa’s already burdened public health facilities.

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Motsoaledi, in the reply, clarified that the ruling was not a court judgment but a settlement agreement made an order of the court.

“This was not a court judgment, but a settlement agreement made an order of court, which is different from a court judgment where the judge hears evidence and submissions from all parties and makes a ruling based on what was heard,” he explained.

Motsoaledi on costs of free healthcare for foreign nationals

The minister could not provide specific costs incurred by the Department of Health for free healthcare services offered to the specified undocumented foreign nationals.

“Maternal, newborn, and child health services are provided as part of comprehensive primary healthcare and hospital services.

“As a result, information on resource requirements for and expenditure on these services is not available,” Motsoaledi said.

However, he indicated that the settlement agreement has not significantly increased resource requirements or expenditure.

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“A review of monthly numbers of first antenatal visits, deliveries, inpatient paediatric days, and the number of children under five attending primary healthcare facilities from September 2022 to September 2024 does not show an upward trend.

“This suggests that the court settlement has not resulted in a significant increase in resource requirements or expenditure,” he stated.

Motsoaledi highlighted that provincial health departments are responsible for providing health services to undocumented foreign nationals and for forecasting demand and allocating budgets.

“Whilst some local redistribution of resources to health services that serve a large number of undocumented foreign nationals may be required, the court settlement has not resulted in a significant increase in overall demand for maternal and child health services,” he concluded.