Healthcare and social welfare for undocumented persons

When it comes to the organisation of healthcare and social welfare, it should be noted that there are people residing both legally and illegally in Finland who are usually referred to as undocumented persons. Undocumented persons mean a number of different groups of people who have different service needs. What they all have in common is that they have a limited right to receive public healthcare and social welfare services in Finland. 

Who is an undocumented person?

In this context, undocumented persons mean: 

• persons from countries other than an EU or EEA country or Switzerland who reside in Finland without a residence permit. Their residence permit has expired or their entry into or residence in the country is not in compliance with the Aliens Act or they are waiting in Finland for their residence permit application to be processed.
• persons from countries other than an EU or EEA country or Switzerland who reside in Finland with a temporary residence permit and who do not have a municipality of residence in Finland or the right to receive healthcare services on the basis of EU law or an international treaty.
• persons from countries other than an EU or EEA country or Switzerland whose right to secure a municipality of residence in Finland is being processed or the processing of whose right to a municipality of residence involves some unclarity.
• EU citizens who reside legally in Finland but who do not have insurance cover in case of illness or medical care.

If people do not have a municipality of residence or health insurance in Finland, this does not automatically make then undocumented persons. In this context, undocumented persons do not mean people who stay in Finland for short-term business or tourism purposes (3 months).

Healthcare services for undocumented persons

In Finland, the Municipality of Residence Act lays down provisions on whether people are eligible for public healthcare services. Health insurance matters are decided on the basis of the Health Insurance Act.

However, people may be entitled to receive public healthcare services and/or medical care reimbursements from health insurance if EU law or an international agreement on social security so requires. In such cases, people do not need to have a municipality of residence or health insurance.

Urgent care for undocumented persons

Under the Health Care Act, public healthcare must always provide urgent care to all those who need it. The municipality of residence referred to in the Municipality of residence Act is not a prerequisite for receiving urgent care.

Urgent care means:

• the immediate assessment and treatment required for an injury, a sudden onset of an illness, an exacerbation of a long-term illness, or a deterioration of functional capacity. In these cases, starting the treatment cannot be postponed without aggravating the illness or injury.
• urgent oral healthcare, mental healthcare, substance abuse treatment and psychosocial support.

If a person does not have a municipality of residence or the right to use public healthcare services in Finland on the basis of EU law and an international agreement on social security, they must cover the costs of urgent care themselves.

The costs can be paid after the person has received urgent care.

Essential non-urgent care for undocumented persons

Undocumented adults do not have the right to non-urgent care provided to persons with a minicipality of residence.

However, in addition to urgent care, adult undocumented persons may receive such non-urgent necessary service facilities that the health care professional deems necessary in view of the person's state of health and duration of stay.

Such services include at least: 

• services related to pregnancy and childbirth, 
• services related to the necessary treatment of long-term illnesses and other illnesses, and 
• health checks and vaccinations under the Communicable Diseases Act that are necessary to protect society.

The assessment of essential non-urgent care is based on a case-by-case assessment by a health care professional.

Undocumented children have the right to healthcare services on the same grounds as those underage children who have a municipality of residence in Finland. 

People who come to Finland with the express intention of receiving care are not eligible for necessary non-urgent healthcare.

Patients are responsible for covering the costs of the care themselves

Undocumented persons who receive care in public healthcare must pay the costs of the care in full. 

The wellbeing services counties collect all the costs incurred in providing the care from the persons themselves. If these persons have an insurance policy, the costs can also be collected from the insurance company in accordance with the terms and conditions of the insurance.

Wellbeing services counties may claim compensation from the State for the amount exceeding the client fee in situations where the costs cannot be recovered from the persons themselves. If counties consider these persons to be manifestly without means, they can directly seek compensation from the State without first having to try to recover the costs. People receiving care are always obliged to pay the client fee themselves. 

Social welfare services for undocumented persons

Undocumented persons are not eligible for residence-based social security because they do not have a municipality of residence in Finland.

Under the Social Welfare Act, everyone has, in an emergency situation, the right to receive social services based on their individual needs in a way that does not jeopardise their right to indispensable care and subsistence. The services must always be based on an assessment of the individual service needs made by a social welfare professional. 

Before assessing the need for services and providing the services, the wellbeing services county must determine whether another authority (immigration authority) is responsible for organising health and social services for the undocumented person. The residence permit details and the right to receive services within the reception system are always checked, for example, from the Finnish Immigration Service’s case management system (UMA), to which the counties can apply to have access right for their employees. If clients are covered by reception services, they should primarily be referred to the relevant reception centre where their need for support is assessed.

If they have been referred to the Assistance System for Victims of Human Trafficking operating under the Finnish Immigration Service, the System is responsible for organising health and social services for them.

• Reception services (Finnish Immigration Service)

Organisation of temporary accommodation and other urgent social welfare

Temporary housing is organised for people who need urgent short-term assistance. The organisation of temporary accommodation is associated with different kinds of crises, and the aim is to find an appropriate solution for each person’s situation. 

At the same time, the person’s need for other urgent social welfare should be assessed. An assessment of the person’s need for urgent services is always made by a social welfare professional. 

Even when providing urgent social services, the client must be issued with a decision eligible for appeal together with instructions for requesting an administrative review.

Undocumented children are entitled to receive services under the Child Welfare Act as necessary.

State compensation for costs arising from urgent social services

Wellbeing services counties may receive compensation from the State for the costs arising from urgent social services. The requirement is that urgent social services have been provided to people whose asylum applications have been refused and who are no longer covered by reception services. Compensation is paid for the costs arising from food, medicines and temporary accommodation that are provided as indispensable care.

• State compensation (Kela)