Italian Citizenship and Healthcare

Are you a foreigner wanting to obtain Italian citizenship? Do you want to know more about healthcare in Italy and the benefits it provides? You are in the right place! In this article, we will outline the key points that characterize healthcare in Italy.

First of all, what is Italian citizenship?

Italian citizenship is the legal status that grants an individual the right to be considered a full member of Italian society, with all associated rights and obligations. This status is regulated by Italian citizenship law, specifically Law 91/1992, which defines the requirements and conditions necessary to obtain Italian citizenship.

How is Italian citizenship obtained?

In some cases, Italian citizenship is obtained automatically, in others, it must be requested.

Let’s see now how Italian citizenship is obtained automatically.

Here are the specific cases:

Citizenship by descent “ius sanguinis”: This principle, enshrined in Article 1 of Law No. 91 of 1992, establishes that an individual can automatically obtain Italian citizenship if at least one of their parents is an Italian citizen at the time of their birth. Italian citizenship can also be passed down through Italian ancestors, provided a direct line of descent is demonstrated.
Citizenship by birth on Italian soil: An individual can obtain Italian citizenship if they are born on Italian soil to unknown parents, stateless parents, or foreign parents whose countries of origin do not automatically grant citizenship to their children born abroad. This principle aims to ensure that children born on Italian territory do not remain stateless. Additionally, if a newborn is found on Italian soil and their origins are unknown, they are considered an Italian citizen unless definitive proof of another citizenship emerges.
Citizenship by adoption: When an Italian citizen adopts a foreign minor, the latter automatically obtains Italian citizenship. This is an important way to guarantee the rights and stability of children adopted by Italian families, offering them full integration into Italian society.
Citizenship by recognition or judicial declaration of paternity or maternity: If an Italian citizen recognizes a minor child as their own after birth or if paternity or maternity is established through a judicial process, the child can obtain Italian citizenship. This process provides a way to establish family ties and ensure that children are legally recognized and can enjoy the rights and opportunities as Italian citizens.
Citizenship by acquisition or reacquisition by parents: If a parent acquires or reacquires Italian citizenship, the minor child can automatically obtain citizenship, provided they live stably and effectively with the parent who has acquired citizenship. This provision aims to ensure that children can benefit from the same status as their parents.

Now let’s move on to the cases where it is possible to apply for Italian citizenship:

Italian citizenship by voluntary acquisition: To voluntarily obtain Italian citizenship, a foreigner or stateless person, regardless of their place of birth, can apply if at least one of their parents (or a grandparent up to the second degree) is an Italian citizen by birth. The application can be submitted through a prior declaration, provided one of the following alternative requirements is met: military service in the armed forces, employment in a public body under the jurisdiction of the State (even abroad), or legal residence in Italy for at least two years (within one year of reaching the age of 18). These requirements aim to ensure a significant connection with Italy and demonstrate a strong commitment to Italian society.
Italian citizenship by birth on Italian territory to foreign parents: In the case of the birth of an individual on Italian soil to foreign parents, the application for Italian citizenship can only be submitted after reaching the age of 18. It is essential that there has been legal and continuous residence in Italy throughout this period.
Italian citizenship by marriage or civil union: Another way to obtain Italian citizenship is through marriage or civil union with an Italian citizen. This allows the foreign spouse to apply for Italian citizenship after meeting certain requirements, such as demonstrating a valid marriage and legal residence in Italy for a certain period of time.
Italian citizenship by residence (“naturalization”): Finally, Italian citizenship can be obtained through legal residence in Italy for a specified period, known as “naturalization.” This process usually requires a period of continuous residence in Italy, demonstration of financial stability, and knowledge of the Italian language.

In any case, the process of acquiring Italian citizenship is governed by specific laws and procedures, and meeting the required criteria is essential for a successful application.

Let’s now look at the advantages associated with Italian citizenship

Acquiring Italian citizenship offers access to many privileges, such as freedom of movement within the European Union, civil rights, consular protection, and a range of important public services.

Let’s focus on a very important public service: free healthcare.

Since 1979, Italy has established the National Health Service (SSN), guaranteeing all residents the right to healthcare, which is predominantly free for those who use it.

A brief history of healthcare in Italy

Law 132 of 1968, known as the Mariotti Law, marked the first, not very successful, attempt to establish a public hospital network. Despite the positive intent of ensuring assistance to all Italian citizens through the creation of the first hospital entities, this law led, within ten years, to a double inequality among citizens due to the establishment of mutual funds.

Initially, protection was limited to workers (and their families) only, as they contributed a portion of their salary to form a fund intended to cover medical and assistance expenses. However, the number of hospitalizations increased, hospital stays were prolonged, and there was an increase in inappropriate hospitalizations, which generated unpaid debts.

As a result, the State intervened with Law 386/1974, which canceled all mutual entity debts towards hospital structures.

This event required a complete revision of the entire national healthcare system, leading to the abolition of the insurance system based on mutuality. All assistance institutions were dissolved and integrated into a single more protective system for all citizens.

The current legal reference for healthcare in Italy is Law No. 833 of 1978

The creation of the National Health Service was formalized through Law 23 December 1978, No. 833, which affirms that health is a fundamental right of every individual and a public interest.

What is the National Health Service?

This law established the National Health Service, a model of assistance still emulated in many countries around the world. It allowed for the rationalization of healthcare spending through planning as a resource control tool and the establishment of a unified national health fund.

The National Health System ensures all Italian citizens and foreign residents in Italy universal access to healthcare. Its main purpose is to provide basic and specialized medical care, along with prevention and health promotion services, at an affordable cost or even free, in most cases.

A shift in focus from the past is evident, with a priority on health protection as a fundamental right of the individual and an interest of the community.

There is a focus on the importance of physical and mental health recovery for the entire population, without discrimination, ensuring equal treatment for all citizens.

How is the National Health Service funded in Italy?

Funding is provided through taxes and social security contributions, ensuring wide availability and accessibility to healthcare for all, regardless of income. However, there are also extra-paid services that provide a higher level of care or treatments not included in the public system.

How does access to healthcare in Italy work for EU citizens?

For citizens from a European Union country, the European Economic Area, or Switzerland, who are in Italy for tourism, healthcare is guaranteed through the European Health Insurance Card (EHIC). This card provides the right to access necessary, even non-urgent, care.

For situations other than tourism, EU citizens can register with the Regional Health Service (SSR) by presenting specific community forms issued by their country of origin. Otherwise, they can do so if they are employed with an Italian work contract or self-employed subject to Italian taxation.

To register with the Regional Health Service, the EU citizen must go to the “Choice and Revocation” desk with an identity document and tax code (photocopies must be provided by the interested party).

Conditions vary depending on the situation:

If in Italy as employees, even seasonal, the work contract must be presented, certifying the employment relationship with an Italian employer and its duration.
If in Italy as self-employed workers, certification of registration with the Chamber of Commerce or a Professional Board or Order must be presented, along with proof of VAT registration or INPS position opening, or the previous year’s Income Tax Return.
If family members of employees or self-employed workers, a self-certification of the family fiscal charge for direct ascendants or children over 21, a translated marriage certificate, and for children, a birth certificate indicating paternity and maternity is required. If the family member is non-EU, a “Residence Card for a family member of an EU/Italian citizen” is required.
If former EU workers in involuntary unemployment status, the former work contract certifying the terminated employment relationship and its duration, along with a self-certification of registration with the employment center of their domicile, is required.

How does access to healthcare in Italy work for non-EU citizens?

Citizens from countries outside the European Union can register with the Regional Health Service if they hold a residence permit for the following reasons:

Employment or self-employment
Registration on employment lists
Family reasons (visa for family reunification or cohesion)
Medical care for pregnant women
Awaiting adoption/fostering/physical and mental recovery of the minor
Subjects undergoing alternative measures to detention
Asylum seekers/political/humanitarian international protection
Political asylum
Humanitarian reasons
Subsidiary/international protection
Extraordinary reception measures for exceptional events
Holders of a CE or EU long-term residence permit (former Residence Card)

The right to registration is revoked in case of:

Non-renewal of the residence permit
Revocation or annulment of the residence permit
Expulsion of the foreign citizen

At the “Choice and Revocation” desk, the citizen must present:

Valid residence permit or receipt of the residence permit request issued by the competent authorities (Police Headquarters, Prefecture, or Post Office), along with documentation proving the reason for the request.
Identity document (except for asylum seekers)
Tax code
Documentation proving, in the case of work-related reasons, that the activity is subject to Italian tax legislation (IRPEF and IRAP).

Conclusion

After this overview, we hope you understand how being in possession of Italian citizenship is a privilege! This privilege is reflected in various aspects of daily life, such as healthcare.

For any further information, consult one of our Italian lawyers specializing in Italian citizenship.

If you are interested in reading other articles, we suggest some very interesting ones.

For frequently asked questions about Italian citizenship, click here

For ways to acquire Italian citizenship, click here

To learn more about the history of Italian citizenship, click here