Since 2009, states have had the option to extend Medicaid and CHIP eligibility to lawfully residing immigrant children and pregnant people without a five-year waiting period through what is known as ICHIA (a reference to a 2007 bill called the Immigrant Children’s Health Improvement Act) or CHIPRA §214 (a reference to the section of the CHIP reauthorization bill that made ICHIA a Medicaid/CHIP state option). As of January 2022, more than two-thirds of states have adopted ICHIA for children and about half have done so for pregnant people. (To see if your state has adopted this policy option, visit our State Data Hub.) Recent research from the Migration Policy Institute (MPI) shows the impact of these state policy decisions and highlights the need for continuing to make the health coverage system more equitable.
Nationally, MPI estimates that close to 2.3 million foreign-born children were income eligible for Medicaid and CHIP in 2019, about 60% of whom held an immigration status that made them eligible for Medicaid/CHIP while the other 40% were ineligible based on their immigration status. Among those eligible for Medicaid/CHIP, about 252,000 were uninsured.
This tells us that there is room for improvement in two key areas – making more children eligible for coverage and enrolling those who are eligible but uninsured today. Doing so would help narrow coverage disparities, especially among Latino children. More than half of the 2.3 million income-eligible immigrant children in 2019 were Latino.
The state-by-state trends in eligibility and participation reveal the importance of state policy choices in helping more children gain coverage. Low-income immigrant children were almost twice as likely to be eligible for Medicaid/CHIP in states that have adopted ICHIA compared to states that have yet to do so (64% vs. 35%). But simply making more children eligible is not enough.
On average, participation rates for immigrant children are higher in states that have adopted ICHIA than in states that have not (74% vs. 68%), but the states with the lowest participation rates among immigrant children (Utah, Arkansas, South Carolina, Texas, and Nevada) have all adopted ICHIA. Other barriers are making it harder for children in these states to enroll and stay enrolled. The authors point to fear of immigration-related consequences and language barriers as possible causes for lower participation rates. Medicaid/CHIP renewal processes could also be partly to blame – with the exception of South Carolina, the states with the lowest participation rates for immigrant children have yet to adopt 12-month continuous eligibility for children in Medicaid.
Unfortunately, limited eligibility for immigrant children and lower participation rates among those who are eligible contribute to higher uninsured rates. Immigrant children who met both income and immigration-status requirements for Medicaid and CHIP had an uninsured rate that was three times higher than that of U.S.-born children in the same income range.
Research has shown that children with health coverage are not only more likely to grow into healthier adults, they also do better in school and have greater financial security. Policymakers must redouble their efforts to narrow these coverage inequities and ensure all children have the health coverage they need to thrive.