Unaccompanied Immigrant Children Must Have Access to Medicaid across the Country
April is Medicaid Awareness Month and a chance to celebrate the impact access to affordable health care has made in the lives of millions of people around the United States. Unfortunately, however, thousands of children are deprived of the benefits of Medicaid access because of their immigration status.
Unaccompanied immigrant children are children who arrive at our borders alone to seek protection or are separated from family members they traveled with. Once they make it across the border, unaccompanied children are kept in facilities and shelters around the country until they are reunited with their families. When they are released from government custody, they enter a 50-state patchwork where they are rarely able to access health insurance.
Unaccompanied children are children. They are children who have been through a lot, but they are also children who will fall off the monkey bars and break a wrist, who get chicken pox or other childhood diseases, who need their eyesight and hearing checked. If you can remember the times that you or your family needed care when you were a child, you can understand that health care is something that all children need.
Disparities in Access to Medicaid for Immigrant Families
In general, non-citizens must have a “qualified” immigration status to be eligible for Medicaid or Children’s Health Insurance Program (CHIP), and many, including most lawful permanent residents or “green card” holders, must wait five years after obtaining qualified status before they may enroll. However, 35 states allow children who have already obtained legal immigration status to receive Medicaid and/or CHIP without waiting for five years. This doesn’t apply to most unaccompanied children who do not yet have legal immigration status when they are released from government custody. They are in the process of obtaining asylum or other forms of legal protection and therefore, only a few states offer them health coverage. According to the Kaiser Family Foundation:
Currently, six states (California, DC, Illinois, New York, Oregon and Washington) provide comprehensive state-funded coverage to all income-eligible children, regardless of immigration status. Massachusetts provides primary and preventive services to all children, regardless of immigration status or income. Several states will extend Medicaid-like, state-funded coverage to immigrant children including Maine and Vermont in July 2022, and Connecticut to children under age nine in January 2023.
As a result, many undocumented children and their families must rely on health care accessible through schools, federally qualified health centers, public health departments, free clinics, and nonprofit care systems. Undocumented children are three times more likely to be living in poverty than children in non-immigrant families, which makes affording care out-of-pocket difficult. And of course, in addition to the financial barriers, language and cultural differences, and fear of exposure to government systems and deportation due to immigration status, also hamper access to care.
What does that look like for the children the Young Center serves?
Particularly for children who are released to states that have not expanded Medicaid to all children, it can mean scrambling to find a medical provider who can prescribe a needed medication, so the child’s care is not interrupted after release from government custody. When family members and sponsors are not able to line up providers for children with particular vulnerabilities such as mental health challenges, disabilities, or survivors of violence, the Office of Refugee Resettlement (ORR) which has custody of unaccompanied children, can delay release and keep children in facilities longer. This often leads to increased stress on and harm to both children and their families. While some children determined to be ‘particularly vulnerable’ may be released with limited “post-release services,” including a case manager that can provide some help identifying resources, for the most part children and sponsor families are on their own. Moreover, post-release services are often limited in scope, culturally insensitive and fail to meet the therapeutic needs of children and their families.
Why is Medicaid access so important?
As the non-partisan research institute Center on Budget and Policy Priorities explains, Medicaid is the gold standard for children’s coverage because it requires states to provide a robust set of comprehensive and preventive health services, including regular well-child exams; hearing, vision, and dental screenings; and other services to treat physical, mental, and developmental illnesses and disabilities, such as speech and physical therapy and medical equipment and supplies. Medicaid’s comprehensive benefits ensure children get the care they need wherever they need it, including at school.
Health care is a human right, but expanding health insurance to immigrant children also makes financial and public health sense. Undocumented patients without coverage are more likely to return repeatedly to emergency rooms for the same condition because they can’t access health care for prevention, early diagnosis, and treatment. This leads to more serious and more costly health conditions in the long term. Research also shows that children covered by Medicaid during childhood have better health as adults; are more likely to graduate from high school and college; and have higher wages and pay more in taxes as adults.
Access to health care also improves mental health outcomes. Many children in ORR custody have experienced intense trauma from events that occurred while in their country of origin, during their migration journey, or upon arriving in the United States. They have experienced or witnessed violence, been separated from family and loved ones, and faced fear of imminent deportation. It is not surprising then that unaccompanied immigrant children experience high rates of anxiety, depression, and PTSD. Still, immigrant children are less likely to receive mental health services. In his State of the Union earlier this year President Biden outlined a national mental health strategy to address the “unprecedented mental health crisis among people of all ages.” As it stands, undocumented children will be left out of many of the benefits of this new strategy as well.
Access to Medicaid or other affordable health care leads to healthier children, healthier adults, and healthier communities. As the American Academy of Pediatrics says, “All immigrant children seeking safe haven should have comprehensive health care and insurance coverage.”
What can be done to make that vision a reality?
ORR and the federal government as a whole must take a more active role in ensuring that unaccompanied children have access to health care coverage.
Congress should direct increased funds to providers, hospitals, and community centers that serve immigrant communities.
Congress should provide increased or matching funds to states that expand Medicaid coverage for undocumented children to encourage more states to do so.
Congress should pass the Health Equity and Access Under the Law (HEAL) Act and Lifting Immigrant Families Through Benefits Access Restoration Act (LIFT the BAR) Act because unaccompanied children are often part of mixed status families and so the more family members that can access care the better the health of the entire family is.
Written by Young Center Policy Analyst for Disability Rights Anne Kelsey.
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