Closing a Hole in the Safety Net: Utah and Florida Make 18,000 Immigrant Children Eligible for Medicaid and CHIP

Last month, in spite of the polarized political environment nationwide around both health care and immigration policy, legislators in Utah and Florida opted to provide access to affordable health care for 18,000 lawfully present immigrant children who had previously been excluded (1,000 in Utah; 17,000 in Florida).  With the addition of Utah and Florida, 30 states and the District of Columbia now allow lawfully present children, regardless of how long they have been in the United States, to be eligible for Medicaid and CHIP, providing them with affordable and comprehensive health insurance.

This step is significant because of the harsh history of denying even the most basic benefits to immigrants, including children. Provisions in the 1996 welfare reform law denied food stamp benefits (now called Supplemental Nutrition Assistance Program, or SNAP) to many  legal immigrants who arrived after the date of enactment, and imposed a five-year waiting period before most legal immigrants could qualify for other federally funded means-tested public benefit programs, such as Medicaid and Temporary Assistance for Needy Families (TANF). Subsequent legislation allowed lawfully present immigrant children to access SNAP but required a five-year waiting period for adults. States could choose to assist some of these immigrant populations, but without any federal financial support.

The choices made by Utah and Florida take advantage of an option added in subsequent federal laws, which rolled back some of the harshest of these provisions in both SNAP and health programs. In the 2009 reauthorization of the Children’s Health Insurance Program (CHIP), states were given the option to provide health insurance for lawfully present children during their first five years in the country and receive federal matching dollars for the coverage. This state option is known as the ICHIA option because it originated as the Legal Immigrant Children’s Health Improvement Act (ICHIA) before it was included in the CHIP reauthorization.

Adopting the ICHIA options is a win-win for children and states. The benefits to children are clear – they have access to affordable health care, allowing them to receive needed care. Their families also benefit by having one less worry about unexpected medical costs. Without access to affordable health care, children are more likely to struggle in school and their families live in fear of high medical bills. Providing children with affordable health care allows them to receive regular care, including developmental screens, and access to preventative care, such as immunizations.

States that have taken up the ICHIA option have seen an increased rate of children with health insurance and a decline in unmet health needs among immigrant children, signaling that children covered through the ICHIA option were otherwise uninsured. Children are one of our most important resources – our future workforce, future taxpayers, and future business owners. Kudos to the advocates and policy makers in Utah and Florida who recognized the importance of investing in children’s health and worked to provide 18,000 more children with access to affordable health insurance.

But this is just the first step.  As the diversity of children in the United States continues to grow, the disparate treatment of immigrant and mixed-status families holds us all back. We believe the federal policies that deny lawfully present immigrants access to benefits should be repealed.  In the meantime, the remaining 20 states should take the ICHIA option and make all lawfully present children eligible for Medicaid and CHIP.  In addition to implementing the ICHIA option, states can and should go further to increase access to health insurance for immigrants. Such options include ensuring that children in mixed-status families don’t face unnecessary barriers to enrollment or using state dollars to include all residents in Medicaid or CHIP who are income eligible.