Without a residence permit you can still get care, and the hospital will not report you

This is the fear that keeps the people who need it most away from hospitals: «if I go for treatment without a residence permit, they will report me».

Italian law says the opposite, and has done so for over twenty years. Article 35 of the Testo unico sull'immigrazione (Legislative Decree 286/1998, the Consolidated Immigration Act) states that access to healthcare facilities by a person who is not compliant with residence rules cannot lead to any kind of report to the police authorities, except where a criminal report is compulsory on the same terms as for an Italian citizen.

That last clause is the important part: the duty to report exists for Italians too — it concerns crimes, a gunshot wound for instance — and has nothing to do with not having a permit.

What care is guaranteed

The law speaks of urgent and essential care, outpatient and in hospital, even continuing, for illness and injury, in public facilities and in accredited private ones.

• urgent: care that cannot be postponed without danger to life or harm to health;
• essential: care for conditions that are not immediately dangerous but may become so over time;
• continuing: the word that matters, because it means a treatment once started is not cut off when the emergency ends.

Article 35 guarantees in particular:

• pregnancy and maternity, and the protection of the unborn child;
• the health of minors;
• vaccinations and prophylaxis;
• the diagnosis and treatment of infectious diseases;
• treatment for drug dependency.

The STP code: how to get it

The practical tool is the STP code, which stands for Straniero Temporaneamente Presente (temporarily present foreign national). It is a sixteen-character code that works in place of the codice fiscale for healthcare.

• Where: at ASL desks — the local health authority — or at a hospital. It is assigned when you ask for care, or on explicit request.
• How long: six months, and it is renewable.
• Where it is valid: across the whole country, not only in the city where you got it.
• What you need: your personal details. No residence document is required, which is the whole point.

The ticket, and the declaration of indigence

Holders of an STP code pay the ticket (co-payment) like anyone else. But a person who cannot afford it can sign a dichiarazione di indigenza (declaration of indigence), valid for six months, which gives exemption from the ticket for the services covered by Article 35.

You sign the declaration at the desk. Ask for it: it is not always offered, and without it the bill arrives.

What the STP code is not

Read this part carefully, because confusion here is expensive.

• It is not a residence permit, and it starts no procedure to obtain one. It is only for healthcare.
• It does not give you a family doctor. A family doctor comes with registration in the National Health Service, which requires a permit: if you have one, your path is different and it is described in Registering with the National Health Service: for most people it is free.
• It does not cover everything: it covers urgent, essential and continuing care, not the full assistance available to someone registered with the National Health Service.

If your permit expired, or you are waiting

These are two different situations and it is worth telling them apart.

If you have applied for renewal and hold the receipt, you are generally not in the Article 35 situation: your registration with the National Health Service continues. Bring the receipt and say so at the desk straight away.

If your permit has expired and you have not applied for renewal, the STP code is what keeps you from being left without care while you sort the rest out.

For children it always applies

The protection of minors is named expressly in the law, and does not depend on their parents' status. If you have a child and you are in the situation this article describes, take the child in: vaccinations and paediatric care are among the things guaranteed.

Where to go, besides the hospital

In many cities there are clinics run by associations and volunteers that treat people free of charge and know these procedures better than anyone: they are the right place if you are afraid to walk into a hospital or if a desk turned you away. Ask the Caritas in your city, a municipal immigration desk or an association from your community.

If a hospital tells you they cannot treat you without documents, ask to speak to the direzione sanitaria (medical directorate) and name Article 35 of the Testo unico sull'immigrazione. It is the kind of sentence that changes a conversation.