Resources: Immigrant and Refugee 101

The Public Health Nursing Practice Council (or PHN Practice Council) is a collaborative effort between local health department PHN experts and MDH PHN Consultants, which addresses nursing practice issues collectively and systematically in order to develop recommended PHN practice guidelines and tools for PHNs to reference and utilize within PHN practice. Below is information from the council about immigrant and refugee health.


In order to converse about newly arriving populations in Minnesota, it is important to understand key terms and use these correctly.

An immigrant is a non-US citizen or national who enters the United States as an actual or prospective permanent resident with the intent to remain for an indefinite period of time. Approved immigration to the United States is based upon the following principles: the reunification of families, admitting immigrants with skills that are valuable to the U.S. economy, protecting refugees, and promoting diversity.

refugee is an immigrant who cannot return to their country of origin or last residence due to persecution or the well-founded fear of persecution because of race, ethnicity, tribal identity, religion, nationality, political opinion or membership in a particular social group. A refugee receives this status prior to entering the United States as determined by the State Department.

primary refugee is someone who came directly to Minnesota and is connected with a voluntary agency that assists with his or her initial housing and settlement. A secondary refugee arrived in another state first and then relocated to Minnesota, often to join existing family or ethnic communities. They no longer receive assistance with settlement by a voluntary organization.

An asylee is someone who flees his or her country for the same reasons as a refugee, but who receives asylum from the US Citizen and Immigration Service when they are already living in the United States.

Health Assessments

Refugees are required to undergo a medical examination prior to their departure to ensure that they do not have communicable diseases of public health significance, mental disorders involving harmful behaviors or current problems with drug abuse or addiction. The medical examination record is sent to the state health department and then to local public health following the arrival of the refugee.

Primary refugees are recommended (not mandated) to receive a comprehensive health assessment upon their arrival payable by Medical Assistance. This exam rules out communicable disease, updates vaccinations and establishes a medical home for the new arrival. A public health nurse case manages these health assessments and ensures that refugees obtain any follow-up care.

Secondary refugees may or may not have received their health assessment. Often they are no longer officially tracked and neither state nor local public health is aware that they have moved to Minnesota. If they become known to public health and desire a health assessment, a public health nurse can ensure they obtain their screening. An individual applying for asylum may receive their health assessment if they become known to local public health.

Non-refugees applying for an immigrant visa are also required to undergo a medical examination in their home country. If a newly arrived immigrant has been diagnosed with a Class B Tuberculosis condition they are referred to local public health which ensures that an evaluation is completed and any follow-up care is provided. Immunization services and low-cost medical care are other services that some immigrants may obtain from public health agencies.

Refugees and asylees may apply for an adjustment of legal status to obtain a green card for permanent residency one year following their admission to the state. Special medical and vaccination requirements are set for both groups. Five years later, citizenship may be applied for. Neither state nor local public health is involved in this process.

Additional Resources:

Minnesota Department of Health Refugee Health web page

Minnesota Agencies Assisting with Refugee Resettlement

CDC Immigrant and Refugee Health

Minnesota Refugee Health Report 2015

Star Tribune: Minnesota among Top States for Refugee Resettlement

Star Tribune: Refugee Resettlement Costs

Video Clip: Lutheran Social Services Refugee Resettlement