Getting Back on Track: A Detailed Look at Health Coverage Trends for Latino Children

In This Report:

Introduction

From 2008 to 2016, the Latino child uninsured rate fell steadily, eventually achieving a historic low of 7.7 percent in 2016.1 Although this rate was still higher than that for non-Latino children, the decline signaled steady progress towards narrowing health coverage disparities between Latino children and their peers. However, as the overall child uninsured rate started going in the wrong direction between 2016 and 2019, Latino children were disproportionately affected.2 Erasing years of progress, Latino children’s uninsured rate reached 9.3 percent in 2019.3 This 1.6 percentage point increase was more than twice as fast as the 0.7 percentage point increase for non-Latino youth (from 3.7 percent in 2016 to 4.4 percent in 2019).

Figure 1. Uninsured Rate for Latino and Non-Latino Children, 2016-2019

At the national level, the Trump administration publicized and implemented the “public charge” rule, which penalized adults for using public programs prior to gaining citizenship. Even though 95 percent of Latino children are citizens and not subject to public charge, many Latino families avoided enrolling their children in Medicaid or CHIP out of fear of adverse immigration consequences, known as the “chilling effect.”4 Federal cuts to funding for outreach efforts and health insurance navigators who could help explain the nuances of the public charge rule and remind families of the affordable coverage options available to them only exacerbated the problem.5 Moreover, repeated attempts to repeal the Affordable Care Act (ACA) and ongoing court battles have left many families uncertain about the availability of public coverage.6

At the state level, red tape barriers, such as frequent income reviews between renewal periods, closure of applications without screening eligibility for other assistance programs, and unreasonably quick turnaround deadlines for information requests made getting and keeping coverage harder for families.7 As of 2019, there were approximately 1.83 million uninsured Latino children in the nation, an increase of 354,400 children compared to 2016. This report takes a closer look at who these children are.


Latinos, Immigration, and Citizenship Status

Many Latinos have deep family roots in what is today the United States (U.S.), dating back to well before Europeans arrived on the East Coast and the U.S. expanded its territory to the west and south, annexing large parts of Mexico. Yet, assumptions that all Latinos are immigrants remain prevalent. In fact, the vast majority (80.3 percent) of Latinos in the U.S. are citizens, many of them with long histories that even predate the founding of the U.S.

 

Understanding Diversity within the “Hispanic/Latino” Category

Within the broad label “Hispanic/Latino” there are many different stories shaped by socioeconomic status, documentation status, state of residence, immigration history (or lack thereof for those whose families have lived here since before the U.S. existed), and country of origin (see Appendix A for an explanation of how the U.S. Census Bureau collects and compiles Latino data).8 Across the 50 states and the District of Columbia (D.C.), 65.6 percent of Latino children are of Mexican descent and 9.4 percent are of Puerto Rican descent.9 Children whose families identify as Salvadoran, Dominican, Guatemalan, and Cuban each represent between two and four percent of the national Latino child population (see Figure 2).10 However, there are significant differences at the state level—in Arizona, for example, 90 percent of Latino children are Mexican while in New York, Puerto Rican and Dominican children make up more than half of the Latino child population.

Figure 2. Diversity of Ethnicity within the Latino Child Population in 10 States with Largest Latino Child Population

Which Latino Children are Losing Coverage?

Coverage losses were widespread across age groups and income levels between 2016 and 2019. School-age Latino children saw a slightly sharper increase than young children, jumping 1.8 percentage points from 8.7 percent in 2016 to 10.5 percent in 2019 (see Table 1). The lowest income Latino children, those with family incomes at or below 137 percent of poverty, lost the most ground with their uninsured rate rising more than two percentage points in the three-year period (see Figure 3).11

Table 1. Uninsured Rate for Latino Children by Age, 2016-2019

Figure 3. Uninsured Rate for Latino Children by Income, 2016-2019

These trends illustrate how the systemic barriers to coverage that Latino children face have grown over the past three years. But they do not tell the full story. Looking at the data through the lens of detailed demographics and state residency helps illuminate the distinct challenges that families face in accessing health coverage. Disaggregating the data in this manner can also serve as the first step towards targeted outreach and enrollment efforts to make sure that all children get the care they need to grow and thrive.

When disaggregated, the national uninsured rate of 9.3 percent for Latino children reveals wide variation (see Figure 4). For example, while almost a quarter of children of Honduran descent are uninsured, approximately 8.8 percent of Nicaraguan children are uninsured, and only 3.3 percent of children of Spanish descent are uninsured. The uninsured rate for Puerto Rican children is on par with the uninsured rate for non-Latino children.

Figure 4. National Child Uninsured Rate by Detailed Ethnicity, 2019

Further, the child uninsured rate has not accelerated at an even pace for different communities of Latino children (see Figure 5). While the uninsured rate for Guatemalan children shot up more than seven percentage points during the past three years, the uninsured rate for Puerto Rican children residing in the states or D.C. rose just over a percentage point. Some groups, such as Dominican children, saw no statistically significant change in their uninsured rate over the three years (see Appendix B).

 

Puerto Rico

The Commonwealth of Puerto Rico is a territory of the U.S., and Puerto Ricans are U.S. citizens. The child uninsured rate for Latino children living in the Commonwealth is 3.5 percent.12 In this report, references to Puerto Rican children reflect those who are living in one of the 50 states or the District of Columbia.

 

Figure 5. Changes in Child Uninsured Rate by Detailed Ethnicity, 2016-2019

Factors Associated with Higher Uninsured Rates

State Residency. There is considerable variation in the Latino child uninsured rate by state (see Figure 6). State-level policies play a key role in enhancing or limiting access to health coverage for Latino children. The Latino child uninsured rate ranges from 1.8 percent in Massachusetts to 19.2 percent in Mississippi. The five states with the highest rates of uninsured Latino children are: Mississippi (19.2 percent), Texas (17.7 percent), Tennessee (17.7 percent), Georgia (16.3 percent), and Arkansas (15.5 percent). Between 2016 and 2019, South Carolina saw the largest jump in the uninsured rate for Latino kids, rising 6.8 percentage points from 8.5 percent to 15.3 percent (see Appendix C). California and Texas are home to the largest numbers of Latino children (4.89 million and 3.87 million, respectively) but Latino children in Texas are almost four times more likely to be uninsured compared to their peers in California (see Appendices D and E).

Figure 6. Uninsured Rate for Latino Children, 2019

Importantly, some subgroups of Latinos are more likely to live in certain states — while a quarter of Mexican children live in Texas, less than five percent of Puerto Rican children do. And, while Guatemalan children are most likely to live in California, roughly one in five live in Florida, Texas, or Georgia (19.6 percent) (see Figure 7). As a result of this geographic variation, state and local policies to make coverage more affordable and inclusive to Latino children and families play an important role in reducing the uninsured rate for specific subgroups.

Figure 7. Top Seven States Where Latino Children Live by Detailed Ethnicity

The uninsured rate for Latino children in states that had not implemented Medicaid expansion by 2019 is more than 2.5 times higher than expansion states (14.9 percent to 5.8 percent respectively). For non-Latino children, the uninsured rate in non-expansion states is only slightly more than 1.5 times the rate of expansion states (5.8 percent to 3.6 percent) (see Table 2).

Table 2. Uninsured Rate for Latino and Non-Latino Children by Expansion Status, 2019

Due to sample size and reliability limitations, it is not possible to disaggregate the Latino child uninsured rate by subgroup for every state. However, a closer look at the five states with the highest number of uninsured Latino children illustrates how variable coverage rates are, both within and between states (see Figure 8). In Florida, Colombian and Puerto Rican children have the lowest uninsured rates (3.8 percent and 5.8 percent) overall and Cuban children have the same uninsured rate as non-Latino children (6.8 percent). Almost one out of every two Honduran children in Georgia is uninsured, compared to less than one in five Mexican children in the state, signaling that these communities face different barriers to coverage.

While Arizona has one of the highest numbers of Latino children in the nation, over 90 percent are of Mexican descent. Consequently, it is only possible to estimate the uninsured rate for children of Mexican descent with accuracy in Arizona: 10.4 percent. Children of Mexican descent in Arizona’s neighboring California are much less likely to be uninsured. While Guatemalan children in California have the highest uninsured rate of the state’s reliable estimates for Latino subgroups at 7.5 percent, they are better off than their counterparts in Georgia where 32.2 percent of Guatemalan children are uninsured.

Figure 8. Latino Child Uninsured Rate by Detailed Ethnicity and State, 2019

Language. Federal regulations direct Medicaid agencies to communicate available benefits and eligibility requirements “in plain language” and in “a manner that is accessible and timely” to English-language learners through the provision of oral interpretation and written translations at no cost to the individual. Federal regulations also require that the Medicaid application itself is accessible to English-language learners.13 However, recent research indicates that more oversight of these requirements is needed because language remains a major barrier for many Latino families: Latino adolescents in Spanish-speaking households are more likely to be uninsured than Latino adolescents overall and over half of uninsured school-age Latino children in Texas have at least one parent more comfortable with a language other than English (LOE).14

Disaggregated data shows the communities for whom language is a bigger barrier: less than four percent of Puerto Rican children living in the states or D.C. have parents who indicate that they do not speak English or have difficulty speaking English. In contrast, over one-third of Guatemalan and Honduran children, and over a quarter of Salvadoran children, have parents who are English-language learners. For uninsured Latino children specifically, over half of Guatemalan and Honduran children without health coverage (60.9 percent and 66.6 percent, respectively) live with LOE parents.

 

More than Spanish

Families from Latin America speak a wide variety of languages. For example, the Mexican government recognizes 68 national languages, 63 of which are indigenous.15 In the U.S., there are approximately 32,000 Latino individuals who speak either an Uto-Aztecan language (such as Michoacán Nahuatl or El Nayar Cora) or another Central or South American language (such as Mixtec or Quechua) at home and roughly 26,000 Latinos speak Portuguese in the house.16

 

Citizenship Status of Child. Overall, 95 percent of Latino children are U.S. citizens (see Figure 9). However, for those Latino children who are not citizens, accessing coverage is more difficult. In 16 states, children without citizenship must be lawfully-residing for five years before they can enroll in Medicaid or CHIP and in 43 states undocumented children are not eligible for comprehensive coverage.17 Children and youth with Deferred Action for Childhood Arrivals (DACA) status are also ineligible for federally-funded, comprehensive coverage. As a result of this patchwork of eligibility, some Latino children are more likely to be eligible for public coverage programs than others. For example, while nearly all Puerto Rican children are citizens and can enroll in Medicaid, CHIP, or Marketplace coverage without worrying about the immigration-based restrictions, Venezuelan and Honduran children are much less likely to be citizens, forcing a greater share of them to contend with these barriers. 

Citizenship Status of Parents and Public Charge. Despite the fact that the overwhelming majority of Latino children are citizens, almost half of Latino children who are citizens live in a mixed-status family, meaning they have at least one non-citizen parent. A disproportionate share of uninsured Latino citizen children live in mixed-status families (see Figure 9). In 2018, the Trump Administration introduced the “public charge” rule which would have allowed an immigrant’s participation in public benefit programs to count against them in their application for permanent residency. While the final rule stipulated that children’s participation in programs like Medicaid and CHIP would not affect parents’ green card applications, the long, hostile messaging campaign around the public charge rule left many immigrant families worried and confused. Almost four in five adults in immigrant families with children who indicated that they understood the Trump-era public charge rule did not understand that children’s Medicaid enrollment would not affect their own public charge determination.18 The Trump Administration also worked hard to change immigration policies in other ways, such as by limiting asylum, reducing refugee resettlement, trying to end DACA and Temporary Protected Status (TPS) designations, and conducting high-profile workplace raids.19

The “chilling effect” of the public charge rule and other immigration rule changes was likely widespread across Latino ethnicities. More than half of Honduran, Guatemalan, Salvadoran, Venezuelan, Ecuadoran, Dominican, and Mexican children living in the U.S. have at least one parent who is not a citizen. However, for a few subgroups, the public charge rule was likely less of a concern. For example, roughly 35 percent of Cuban children have at least one non-citizen parent and only 7.1 percent of Puerto Rican children have at least one non-citizen parent (a share lower than non-Latino children overall). Note that although the Biden Administration withdrew the Trump-era public charge rule in March 2021, the data presented here are from 2016-2019 when the Trump-era rule was proposed, finalized, and implemented.

Figure 9. Latino Child Population by Citizenship Status

Citizenship Status of Latino Children Familial Citizenship Status of Citizen Latino Children Familial Citizenship Status of Uninsured Citizen Latino Children

Source: Georgetown University Center for Children and Families analysis of U.S. Census Bureau 2019 American Community Survey (ACS) data using Integrated Public Use Microdata Sample (IPUMS). For the purposes of this analysis, mixed-status families are defined as families where the child is a citizen and at least one parent is not a citizen. Children living in families where parent(s) are citizens include single-parent households with a citizen parent and two-parent households where both parents are citizens.

 

Data Note: Who is included in the non-citizen category?

The American Community Survey tracks citizenship status—not immigration status. The “non-citizen” category includes children and adults who are lawfully-residing permanent residents, lawfully-residing residents under another protected class (for example, temporary protected status, deferred enforcement departure, and special immigrant juveniles), and those without documentation.

 

Recommendations

As communities of color have disproportionately borne the brunt of the COVID-19 crisis, the number of Latino children without coverage has likely worsened. Survey results from 2020 show that Latino households with school age children were three times more likely to report food insecurity than non-Latino white families, signaling widespread economic distress.20 Further, the importance of accessing comprehensive and affordable health coverage is pressing. Latino adults participate in the workforce at a higher rate than the national average,21 but they are less likely to have jobs with employer-sponsored health insurance.22 Latino workers are also more likely than their white counterparts to be in frontline jobs where they are exposed to the virus, leading to higher rates of infection and stress for families.23 And, 31 percent of children affected by the serious COVID-related multisystem inflammatory syndrome have been Latino.24 It will take a concerted, and strategic, effort on the part of national and state policymakers to help Latino children get the health coverage they need both now and into the future.

Federal recommendations:

Conduct robust outreach and enrollment campaigns to reach eligible but uninsured Latino children: The majority of uninsured children are eligible for Medicaid or CHIP but unenrolled. The Medicaid/CHIP participation rate for Latino children is on par with children overall, but increases in Medicaid/CHIP enrollment are correlated with decreases in the uninsured rate.25 Robust outreach programs would help inform Latino families about their coverage options and culturally and linguistically competent enrollment assistance would help eligible children access free or low-cost coverage. The Biden Administration recently announced increased funding for community groups to provide in-person enrollment assistance during the Marketplace special enrollment period created as a result of the COVID-19 pandemic.26 Continuing these investments and ensuring funds are available to assist with enrollment in Medicaid, CHIP, and Marketplace plans could help regain lost ground on Latino child insurance rates.

Clear and consistent messaging around the reversal of the Trump-era Public Charge Rule: On March 9, 2021, the Biden Administration rescinded the public charge rule. 27 However, erasing the rule’s “chilling effect” will take time. While trusted community messengers will be critical in communicating the policy changes (see state/local recommendations below), immigrant families identify U.S. Citizenship and Immigration Services, legal professionals, and state government agencies as among the most trusted sources of information.28 The Administration must use the power of their office to ensure families that they can sign up for coverage without fear.

Remove all citizenship-based eligibility criteria from Medicaid and CHIP: As of 2021, 34 states and the District of Columbia already allow lawfully-residing immigrant children to enroll in Medicaid or CHIP without a five-year waiting period under section 1903(v)(4) of the Social Security Act.29 A total of six states (California, Illinois, Massachusetts, New York, Oregon, and Washington) and the District of Columbia leverage state funds to cover undocumented children.30 Though only five percent of Latino children are not citizens (and an even smaller share are undocumented), eliminating citizenship and immigration-based eligibility restrictions would help reach more children by creating an inclusive public coverage system. Making income eligibility the sole criteria for Medicaid and CHIP across all states would also simplify and strengthen outreach and enrollment messaging and streamline program administration and financing.31

State/local recommendations:

Expand Medicaid: Currently, there are 12 states still refusing to accept federal funds to expand Medicaid eligibility for adults up to 138% of the federal poverty level. Years of research show that expanding Medicaid coverage to more adults lowers the child uninsured rate as newly-eligible parents enroll their whole family.32

Simplify and tailor enrollment and renewal processes: The data presented above show that children in the poorest households and in LOE households are more likely to be uninsured. Burdens such as 10-day turnaround times for state requests for information likely disproportionately affect these families. States should adopt streamlined enrollment and renewal processes that lessen the burden on families and tailor their instructions to meet the linguistic preferences of beneficiaries’ families. Disaggregated data shows that that language is much more likely to be a barrier for Guatemalan and Honduran families, highlighting an opportunity for agencies to craft accessible materials for these communities.

Work with a range of community groups to target outreach and enrollment efforts: Given the diversity within the Latino community, state agencies must ensure that they are working with a variety of groups and community leaders. For example, community leaders reaching out to mixed-status Venezuelan families in Florida may need to use different messages than those working with the Cuban community.

Fund Promotora programs: Promotoras, or community health workers who share a background with those they are serving, can play an important role in connecting Latino communities to coverage.33 Given the disparities highlighted by the disaggregated data, it will be important for state and local governments to partner with Promotoras who have connections in the appropriate community.

Conclusion 

Overall, Latino children are more likely to be uninsured than their peers, even though nearly all Latino children are U.S. citizens. Research has shown that having health coverage as a child has life-long, positive impacts such as improved health, improved educational outcomes, and higher paying jobs in adulthood.34 Efforts to cover more Latino children will require developing a deeper understanding of the characteristics of subgroups of uninsured Latino children such as by age, income level, state residency, and country of origin. As a starting place, policymakers and stakeholders at the state and local level can turn to Census Bureau data to identify groups of Latino children that may benefit from more targeted outreach and enrollment efforts and build partnerships with community health workers to reach them in culturally and linguistically appropriate ways. Over the long term, the Biden Administration can work to improve Census Bureau data to address issues with the sample size and how the questions are phrased to better capture lived experiences. Leaders at the federal and state levels can also begin to rebuild trust among Latino communities by sharing clear and reliable information as they work toward more inclusive health coverage policies.

Methodology

View Methodology here.

Appendix

View Appendix here.

Endnotes

1 We report the U.S. Census Bureau’s categorization of “Hispanic or Latino,” as “Latino.” “Latinx” may also be used to respect various gender identities and expressions. Whitener, K. et al., “Decade of Success for Latino Children’s Health Now in Jeopardy,” (Washington, D.C.: Georgetown Center for Children and Families and UnidosUS, March 2020), available at https://ccf.georgetown.edu/wp-content/uploads/2020/03/Latino-Childrens-Health-Care-Coverage.pdf.
2 Alker, J. and Corcoran, A., “Children’s Uninsured Rate rises by Largest Annual Jump in More than a Decade,” (Washington D.C.: Georgetown Center for Children and Families, October 2020), available at https://ccf.georgetown.edu/2020/10/08/childrens-uninsured-rate-rises-by-largest-annual-jump-in-more-than-a-decade-2/.
3 Unless otherwise noted, all data in this factsheet come from Georgetown University CCF’s analysis of the U.S. Census Bureau American Community Survey’s (ACS) Public Use Microdata Sample, or PUMS. Because PUMS is a slightly smaller sample of the data presented in the Census Bureau’s ACS Detailed Tables, estimates may vary slightly from what is reported in other CCF reports or analyses.
4 Haley, J. et al., “One in Five Adults in Immigrant Families with Children Reported Chilling Effects on Public Benefit,” (Washington, D.C.: The Urban Institute, June 2020), available at https://www.urban.org/research/publication/one-five-adults-immigrant-families-children-reported-chilling-effects-public-benefit-receipt-2019; C. Anderson, “Public Charge and Private Dilemmas: Key Challenges and Best Practices for Fighting the Chilling Effect in Texas, 2017-2019,” (Children’s Defense Fund Texas, November 2020), available at: https://cdftexas.org/wp-content/uploads/sites/8/2021/01/Public-Charge-and-Private-Dilemmas_report_020.pdf.
5 The Trump administration reduced funding for Navigator programs from $63 million in 2016 to $10 million in 2018. Additionally, the funds set aside for outreach and advertising efforts during open enrollment periods suffered a 90 percent reduction. Hispanic/Latino individuals use consumer assistance at a higher rate than non-Hispanic white individuals. See Pollitz, K., Tolbert, J., and Diaz, M., “Data Note: Limited Navigator Funding for Federal Marketplace States,” Kaiser Family Foundation, November 2019, available at https://www.kff.org/health-reform/issue-brief/data-notefurther-reductions-in-navigator-funding-for-federal-marketplace-states/; Pollitz, K., Tolbert, J., Hamel, L., and Kearney, A., “Consumer Assistance in Health Insurance: Evidence of Impact and Unmet Need,” Kaiser Family Foundation, August 2020, available at https://www.kff.org/reportsection/consumer-assistance-in-health-insurance-evidence-of-impactand-unmet-need-issue-brief/; and Hoppe, O., “Affordable Care Act Navigators: Lack of Funding Leads to Consumer Confusion, Decreased Enrollment,” Georgetown University Center for Health Insurance Reform, CHIRblog, January 18, 2019, available at http://chirblog.org/lack-of-navigator-funding-leads-confusion-decreased-enrollment/.
6 Kirzinger, A., Muñana, C., and Brodie, M., “KFF Health Tracking Poll – January 2019: The Public on Next Steps for the ACA and Proposals to Expand Coverage,” (Washington, D.C.: Kaiser Family Foundation, January 2019), available at https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-january-2019/.
7 Brooks, T., Park, E., and Roygardner, L., “Medicaid and CHIP Enrollment Decline Suggests the Child Uninsured Rate May Rise Again,” (Washington, D.C.: Georgetown University Center for Children and Families, May 2019), available at https://ccf.georgetown.edu/wp-content/uploads/2019/06/Enrollment-Decline.pdf.
8 Indeed, there is considerable debate around the use of the pan-ethnic label “Hispanic/Latino.” While the label is a social construct that masks the complexities of individuals’ lives, some contend that the unification of various identities lends political clout to otherwise marginalized groups. See: González op. cit. and Rubin, V., “Counting a Diverse Nation: Disaggregating Data on Race and Ethnicity to Advance a Culture of Health” (Oakland, CA: Policy Link, 2018), available at: https://www.policylink.org/sites/default/files/Counting_a_Diverse_Nation_08_15_18.pdf.
9 Note that the uninsured rate for Puerto Rican children reflects those who are living in one of the 50 states or the District of Columbia. In addition to the American Community Survey, the U.S. Census Bureau fields a Puerto Rico Community Survey annually.
10 There is significant evidence that these socially-constructed groupings shape the way that people encounter the healthcare system and can have meaningful impacts on individuals’ access and health outcomes. For example, recent research found that while foreign-born Cuban women ages 25-64 experienced lower mortality rates than non-Hispanic white women, Mexican and Puerto Rican women both had higher mortality rates. Fenelon, A., Chinn, J., and Anderson, R., “A Comprehensive Analysis of the Mortality Experience of Hispanic Subgroups in the United States: Variation by Age, Country of Origin, and Nativity,” SMM- Population Health 3 (December 2017, pg. 245-254), available at https://www.sciencedirect.com/science/article/pii/S2352827316300763.
11 CCF uses the Census Poverty Threshold as a proxy for the Federal Poverty Level (FPL) which is used to determine Medicaid eligibility. See methodology section for more detail.
12 Georgetown University Center for Children and Families analysis of U.S. Census Bureau 2019 Puerto Rico Community Survey (PCRS) data using Public Use Microdata Sample (PUMS). The Puerto Rico Community Survey, while similar to the American Community Survey, differs slightly on several questions. For more information on the PCRS, see U.S. Census Bureau, “Understanding and Using Puerto Rico Community Survey Data: What All Data Users Need to Know,” (Washington, D.C.: U.S. Census Bureau, April 2020), available at https://www.census.gov/content/dam/Census/library/publications/2020/acs/acs_prcs_handbook_2020.pdf.
13 42 C.F.R. 435.905 (2016) and 42 C.F.R. 435.907 (2013).
14 LOE is used in place of limited English proficiency (LEP), to stress the assets and abilities, rather than the deficiencies, of individuals. Knipper, S.,  Rivers, W., and Goodman, J., “Effects of Citizenship Status, Latino Ethnicity, and Household Language on Health Insurance Coverage for U.S. Adolescents, 2007-2016,” Health Services Research  54, no. 6 (2019): 1166-1173, available at https://pubmed.ncbi.nlm.nih.gov/31385302/; and Alvarez Caraveo et al., “Barriers to Medicaid and CHIP Coverage for Eligible but Uninsured Latinx Children: A Texas Case Study,” (Washington D.C.: Urban Institute, February 2021), available at https://www.urban.org/sites/default/files/publication/103471/barriers-to-medicaid-and-chip-coverage-for-eligible-but-uninsured-latinx-children-a-texas-case-study_1.pdf.
15 Čirjack, A., “How Many Native Languages are Spoken in Mexico?” World Atlas, June 16, 2020, available at https://www.worldatlas.com/how-many-native-languages-are-spoken-in-mexico.html.
16 Georgetown University Center for Children and Families analysis of U.S. Census Bureau 2019 American Community Survey (ACS) data using Public Use Microdata Sample (PUMS).
17 Brooks, T. et al., “Medicaid and CHIP Eligibility and Enrollment Policies as of January 2021: Findings from a 50-State Survey,” (Washington D.C.: Georgetown University Center for Children and Families and Kaiser Family Foundation, March 2021), available at https://www.kff.org/report-section/medicaid-and-chip-eligibility-and-enrollment-policies-as-of-january-2021-findings-from-a-50-state-survey-report/.
18 Haley, J., “One in Five Adults in Immigrant Families,” op. cit.
19 Pierce, S. and Bolter, J., “Dismantling and Reconstructing the U.S. Immigration System: A Catalog of Changes under the Trump Presidency,” (Washington D.C.: Migration Policy Institute, July 2020), available at https://www.migrationpolicy.org/research/us-immigration-system-changes-trump-presidency.
20 Gupta, P., Gonzalez, D., and Waxman, E., “Forty Percent of Black and Hispanic Parents of School-Age Children are Food Insecure,” (Washington D.C.: Urban Institute, December 2020), available at https://www.urban.org/research/publication/forty-percent-black-and-hispanic-parents-school-age-children-are-food-insecure.
21 “Latino Unemployment Rate Drops Slightly to 8.6%,” (Washington D.C.: UnidosUS, February 2021), available at http://publications.unidosus.org/bitstream/handle/123456789/2119/unidosus_latinojobsreport_2521.pdf?sequence=1&isAllowed=y.
22 “Employer-Sponsored Coverage Rates for the Nonelderly by Race/Ethnicity,” (Washington D.C.: Kaiser Family Foundation, 2019), available at https://www.kff.org/other/state-indicator/nonelderly-employer-coverage-rate-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
23 Dubay, L., “How Risk of Exposure to the Coronavirus at Work Varies by Race and Ethnicity and How to Protect the Health and Well-Being of Workers and Their Families,” (Washington D.C.: Urban Institute, December 2020), available at https://www.urban.org/research/publication/how-risk-exposure-coronavirus-work-varies-race-and-ethnicity-and-how-protect-health-and-well-being-workers-and-their-families.
24 “Health Department-Reported Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) in the United States,” U.S. Centers for Disease Control and Prevention, May 3, 2021, available at https://www.cdc.gov/mis-c/cases/index.html#:~:text=Cases%20have%20occurred%20in%20children,virus%20that%20causes%20COVID%2D19.; and Fernandes, D. et al., “Severe Acute Respiratory Syndrome Coronavirus 2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth,” The Journal of Pediatrics, November 13, 2020, available at https://www.jpeds.com/article/S0022-3476(20)31393-7/fulltext#tbl4.
25 Haley, J., et al., “Progress in Children’s Coverage Continued to Stall Out in 2018: Trends in Children’s Uninsurance and Medicaid/CHIP Participation,” (Washington D.C.: Urban Institute, October 2020), available at https://www.urban.org/sites/default/files/publication/102983/progress-in-childrens-coverage-continued-to-stall-out-in-2018.pdf.
26 U.S. Department of Health and Human Services, HHS Announces the Largest Ever Funding Allocation for Navigators and Releases Final Numbers for 2021 Marketplace Open Enrollment, Press Release (April 21, 2021), available at https://www.cms.gov/newsroom/press-releases/hhs-announces-largest-ever-funding-allocation-navigators-and-releases-final-numbers-2021-marketplace.
27 “Inadmissibility on Public Charge Grounds; Implementation of Vacatur,” 86 Federal Register: 14221-14229 (March 9, 2021), available at https://www.federalregister.gov/documents/2021/03/15/2021-05357/inadmissibility-on-public-charge-grounds-implementation-of-vacatur.
28 Haley, J., “One in Five Adults in Immigrant Families,” op. cit.
29 Brooks, T. op. cit.
30 Ibid.; H.B. 130, 2021 General Assembly (Vermont, 2021).
31 Whitener, K. and Alker, J., “Covering All Children,” (Washington D.C.: Georgetown University Center for Children and Families, February 2020), available at https://ccf.georgetown.edu/wp-content/uploads/2020/02/CoverAllKidsFinal.pdf.
32 Searing, A., Corcoran, A., and Alker, J., “Children Are Left Behind When States Fail to Expand Medicaid,” (Washington D.C.: Georgetown Center for Children and Families, February 2020), available at https://ccf.georgetown.edu/2021/02/17/report-finds-medicaid-expansion-associated-with-lower-child-uninsured-rates/; Hudson, J. and Moriya, A., “Medicaid Expansion for Adults Had Measurable ‘Welcome Mat’ Effects on Their Children,” Health Affairs 36, no. 9 (September 2017), available at https://www.healthaffairs.org/doi/ full/10.1377/hlthaff.2017.0347.
33 Capitman, J. “The Effectiveness of a Promotora Health Education Model for Improving Latino Health Care Access in California’s Central Valley,” (Central Valley Health Policy Institute), available at http://www.fresnostate.edu/chhs/cvhpi/documents/cms-final-report.pdf.
34 Park, E., Alker, J., and Corcoran, A., “Jeopardizing a Sound Investment: Why a Short-Term Cuts to Medicaid Coverage During Pregnancy and Childhood Could Result in Long-Term Harm,” (Washington D.C.: The Commonwealth Foundation, December 2020), available at https://www.commonwealthfund.org/publications/issue-briefs/2020/dec/short-term-cuts-medicaid-long-term-harm.

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