New Research Highlights Gaps in Medicaid and CHIP Access and Participation for Immigrant Children

WASHINGTON — Hundreds of thousands of immigrant children in the United States face obstacles to obtaining health care, including federal laws that limit their access to comprehensive health insurance and a higher likelihood of being in a low-income household. And even those who meet both income and immigration-status requirements for Medicaid and the companion Children’s Health Insurance Program (CHIP) have a higher uninsurance rate, with eligible foreign-born children three times more likely to lack coverage than U.S.-born children in the same income category in 2019. With poor health in childhood linked to health complications and higher medical costs in adulthood, a child’s access to health care can have long-term individual, family and societal impacts.

A new policy brief from the Migration Policy Institute’s Human Services Initiative examines eligibility and participation of immigrant children (naturalized citizens, lawful permanent residents with less than five years in that status, holders of various temporary statuses and those who are unauthorized) in Medicaid and CHIP, as well as differences in insurance coverage for those who enroll. Drawing on analysis of U.S. Census Bureau data, the brief offers eligibility and participation data by state.

The brief, Immigrant Children’s Medicaid and CHIP Access and Participation: A Data Profile, reveals that nearly 2.3 million immigrant minors met the income-based eligibility requirements to enroll in Medicaid or CHIP in 2019—but 646,000 were uninsured. Another 40 percent, or 909,000, of these children were barred from accessing Medicaid or CHIP due to their immigration status. Even income-eligible immigrant children who were not barred had a relatively high uninsured rate of 18 percent.

Federal rules block many non-citizen children from public health insurance. Thirty-four states and the District of Columbia have filled part of the gap by adopting a federal option Congress provided in 2009 to extend coverage to a greater number of lawfully present immigrant children. Six states and D.C. have gone further by enacting state-funded programs to cover unauthorized immigrant children.

Despite these expansions, however, foreign-born children who are eligible for Medicaid and CHIP on both income and immigration-status grounds remain less likely than U.S.-born children to participate in these programs. As of 2019, 74 percent of federally eligible immigrant children were enrolled in either program versus 92 percent of U.S.-born children. This trend held true within all racial and ethnic categories, with the largest gap in Medicaid and CHIP coverage among Latino and Black children.

The participation gaps between federally eligible immigrant children and their U.S.-born peers may be a function of confusion around complex program eligibility rules, barriers to access such as language and comfort with federal agencies and health-care providers or fear that participating in public benefits will have immigration consequences, writes Valerie Lacarte, a senior policy analyst with MPI’s Human Services Initiative. Participation rates for federally eligible immigrant children varied widely, from 36 percent in Utah to 94 percent in Massachusetts.

“Notwithstanding any improvements in participation, federal eligibility rules continue to exclude hundreds of thousands of immigrant children from these key safety-net programs and may deter many others from participating,” said Lacarte. “Lack of health coverage for this large group of children may compromise their health and development, leading to costly medical conditions and lower productivity later in life.”

You can read the brief here: www.migrationpolicy.org/research/immigrant-children-medicaid-chip.  

This work is the second in a three-part series examining public benefits use among foreign-born populations. The first publication assessed Medicaid access and usage by immigrant adults. A forthcoming brief will examine Supplemental Nutrition Assistance Program (SNAP) access and usage by immigrants.

MPI’s Human Services Initiative focuses on a range of immigration issues affecting children, families and health- and human services programs and policies in the United States. Beyond research examining access to benefits and services, the initiative’s current areas of work include refugee resettlement and unaccompanied children.