Research Shows that Utah and Florida’s “ICHIA Option” Will Improve Access to Health Coverage and Services For Lawfully Residing Immigrant Children

Last week, both the Utah and Florida legislatures passed laws that extend Medicaid and CHIP coverage to lawfully residing children who would otherwise have had to wait five years before becoming eligible to enroll. This is a big victory in two states with some of the highest child uninsurance rates in the country.

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ICHIA Fact Sheet: CHIP and Health Coverage for Lawfully Residing Children

A study in Health Affairs shows that in the states that had passed similar laws as of 2011, these policy changes resulted in children gaining improved access to health coverage and health care services. A few key findings were:

  • Children in states that expanded eligibility for immigrant children experienced a 14.9 percentage point increase in the probability of children having insurance.  Most of this (11.8 percent) was due to greater enrollment in Medicaid and CHIP.
  • Coverage expansions for immigrant children were associated with a substantial decrease (13.7 percentage points) in the probability of immigrant children experiencing unmet need.  These expansions also improved access to a personal doctor or nurse; a usual source of care; well child visits; preventive dental visits; and receipt of specialist care if needed.
  • Increased public coverage for immigrant children was not associated with reductions in private coverage or “crowd out.”  This is likely because low-income immigrant families have limited access to private health insurance.

My colleague Joan Alker blogged last week about the direct estimates of a combined 18,000 children in these two states who would gain coverage. It is worth noting that it is possible that more children will gain coverage as a result of an indirect effect of this new option, which we call the “welcome mat” effect. As our report co-authored with National Council of La Raza found, Latino children have disproportionately high rates of uninsurance. One of the reasons why that high rate exists is because many Latino children (and other uninsured kids of other races and ethnicities) live in so-called “mixed immigration status” families, where one child is a U.S. citizen and another child is lawfully residing.

For example, brothers and sisters of the newly eligible kids in Florida and Utah —who may be eligible but unenrolled citizens or who may be lawfully residing in the U.S. for more than five years—may gain coverage as well when parents learn about this new coverage option and are encouraged to enroll all their children.

Congress’ bipartisan extension of CHIP last year (through MACRA) included the “CHIP bump” which raised federal matching rates for CHIP across the board. As Joan’s blog explains, this helped push Florida and Utah to adopt this coverage expansion. The remaining 20 states that have not yet adopted the ICHIA option have also received the CHIP bump, and now may be a good time for them to take another look at this option!