Enrollment in Health Insurance Lags Among Latino Children
Jun. 24—Not long ago,
The situation was fraught because the 12-year-old girl was ailing. She had developed breathing problems and was always fatigued, to the point that she couldn't participate in gym class.
With the help of Camarena, who works for the Children's Defense Fund-Texas, a child advocacy nonprofit, the mother again applied to the state's Medicaid agency. Despite Camarena's certainty that the girl met all the qualifications, the application was again denied.
"It made no sense that one child was in and one was out," Camarena said in an interview.
This time Camarena pressed the agency for a review. After six weeks or so, the mystery was solved. The agency had miscoded the application, identifying the girl not as a child but an adult, which in
The girl, a Latina, was finally enrolled. Two weeks later, Camarena said, the child underwent surgery to repair a faulty heart valve that could have cost her life.
"Having health insurance literally saved her life," Camarena said.
But more than 1.8 million Latino children in
Latino Children Much Less Likely to
In
as non-Latino children.
State
Latino children, uninsured rate
Non-Latino children, uninsured rate
Likelihood that Latino children are uninsured compared with non-Latino children
10.9
2.8
Almost 4x
10.2
7.7
Almost 1.5x
15.5
4.2
More than 3.5x
4.7
2.7
More than 1.5x
7.4
4.2
Almost 2x
4.8
3.1
More than 1.5x
9.5
6.8
Almost 1.5x
16.3
5.9
Almost 3x
9.1
3.9
Almost 2.5x
6
3.6
More than 1.5x
12.3
6.5
Almost 2x
11.8
4.6
More than 2.5x
8.7
4
More than 2x
13.4
3.8
More than 3.5x
7.5
2.3
More than 3x
1.8
1.4
Almost 1.5x
5.1
3.1
More than 1.5x
6.7
3
More than 2x
19.2
5.4
More than 3.5x
11.8
6.3
Almost 2x
10
4.3
Almost 2.5x
12.3
4.7
More than 2.5x
6.9
3.4
2x
12.6
4.4
Almost 3x
8.3
4.6
Almost 2x
10.8
7.8
Almost 1.5x
5.5
3.8
Almost 1.5x
15.3
4.9
More than 3x
17.7
3.9
More than 4.5x
17.7
8.1
More than 2x
9.3
4.4
More than 2x
14.6
6.6
More than 2x
12.3
3.7
Almost 3.5x
5.1
2.6
Almost 2x
8.4
3.1
More than 2.5x
* Note: States with relevant standard errors greater than 25% not included.
Source:
According to a recent analysis by the
By 2019, the numbers had climbed to 4.4% for non-Latino children and to 9.3% for Latino kids.
The report blames the rising rates of uninsured Latino children on anti-immigrant federal policies and rhetoric during the Trump administration, including the targeting of immigrants who use public safety net programs and cutting of funds for outreach efforts to enroll people in health insurance. But it also highlights state actions, including decisions not to expand Medicaid eligibility under the Affordable Care Act and bureaucratic procedures that can make it difficult to maintain enrollment in Medicaid.
The report says some of the federal and state actions have reduced enrollment for all children, but Latino children have been particularly affected.
"Something that jumped out to me was how incredibly important state policy decisions are," said
The citizenship status of the children has not been an obvious factor in the rising rates of Latino children without health insurance. Most Latino children living in the United States—95%, according to the Georgetown analysis of census data—are
In the case of the
Rate of Latino Children with Health Insurance Drops
Between 2016 and 2019, the percentage of Latino children with health insurance fell in the United
States by 1.6 percentage points and by much more in some states.
State
Uninsured rate 2016
Uninsured rate 2019
Percentage point change
7.3
10.9
3.7
11.1
10.2
-0.9
9.4
15.5
6.1*
4.1
4.7
0.5*
7.4
7.4
0
3.6
4.8
1.2
8.6
9.5
0.9
13.2
16.3
3.1*
10.3
9.1
-1.1
3.3
6
2.7*
8.1
12.3
4.2*
7.7
11.8
4.1*
9.7
8.7
-1
11.6
13.4
1.8
7.2
7.5
0.3
—
1.8
—
4.9
5.1
0.3
9
6.7
-2.3
—
19.2
—
9
11.8
2.8
12.1
10
-2
9.8
12.3
2.5
6.5
6.9
0.4
4.7
5.4
0.7
2.7
2.6
0
11.2
12.6
1.4
5.9
8.3
2.4
9.3
10.8
1.5
5.6
5.5
-0.1
6.2
4.6
-1.6
8.5
15.3
6.8*
11.7
17.7
6.0*
13.5
17.7
4.3*
7.7
9.3
1.6*
11.1
14.6
3.5
13.3
12.3
-1
3.8
5.1
1.3
6.4
8.4
2
*Change is significant at the 90% confidence level relative to the prior year indicated. To ensure accuracy and
consistency, Georgetown CCF calculates the coefficient of variation (CV; also known as the relative standard error) for
each estimate. Estimates with CVs greater than 25% are not presented in this analysis. As a consequence, some states
are excluded entirely from the above table and others include only one estimate.
Source:
The timing of the increased numbers of Latino kids without insurance, coming as the coronavirus pandemic hit
"It is very disturbing, not least of which because these trends were occurring as Latino kids were entering this tremendous health crisis, which put them in an even more vulnerable position," he said.
Some experts, including
"It's like looking at reservoirs in
And many people choose not to enroll in insurance, he said, and are able to take advantage of opportunities for free health care.
Federal and State Barriers
In 2017, the Trump administration slashed funding to help people enroll in ACA health insurance marketplaces. That program paid for public service announcements as well as community guides, called navigators, who could walk residents through the often confusing signup process for both ACA plans and Medicaid. The Biden administration has restored that funding.
In 2019, the Trump administration expanded the federal "public charge" rule, which sought to deny legal status to immigrants who used safety net programs such as Medicaid. Although the final rule exempted programs used by children, immigrant advocates said it deterred many Latinos.
"There was widespread fear in our communities, and you could see people going back into the shadows," Camarena said. "We saw many families not applying or not renewing or literally pulling out of these services even though they were entitled to them."
A federal court blocked the implementation of the expanded public charge rule last year and President
If federal actions contributed to the decline in health insurance among Latino kids, state policies and administrative hurdles deepened the problem, health policy experts and advocacy groups say.
One of the main factors affecting the enrollment of Latino children in health insurance is whether they live in states that have expanded Medicaid under the Affordable Care Act.
The law, widely known as Obamacare, provided states with a higher federal match to extend Medicaid benefits to all adults with incomes up to 138% of the federal poverty line. Thirty-eight states and
Of the five states with the largest percentages of Latino children without health insurance—Mississippi (19.2%),
While children of noneligible adults still can qualify for Medicaid depending on the family's income, studies show children are less likely to be enrolled in Medicaid if their parents aren't either.
According to the Georgetown analysis, the rate of Latino children without health insurance in states that had not expanded Medicaid by 2019 was more than 2.5 times higher than that in states that had expanded—14.9% compared with 5.8%.
A number of states with high rates of uninsured Latino children also impose five-year waiting periods for legally residing immigrants before they can qualify for Medicaid benefits. Among those states are
Bureaucratic Burdens
Critics point to other state bureaucratic hurdles to Medicaid enrollment for children in general and for Latino children in particular.
According to a 2020 review of Medicaid policies by the
But many of the states with high rates of uninsured children do not have such policies and require enrollees to provide documentation multiple times a year. Families often receive requests for such submissions with very short response windows, and face disenrollment of their children. That is particularly burdensome on Latino parents, who may have poor English language skills.
Bureaucratic mistakes, from coding errors to late mailings, also can trip up immigrants. Documents often are generated automatically and might be prompted by inaccurate information about, for example, a parent's employment situation or income, said
Camarena said it is common for letters asking for documentation to arrive after the response deadline has passed. Even when the letters do arrive on time, it is often impossible for parents to secure the necessary documents from employers on such a tight turnaround.
Camarena said she's seen parents confused about the repeated requests for information they think they have already submitted. Whitener said that families with multiple children can receive requests at different times for different children, making it a nightmare to keep track of what has to be submitted and for whom.
"Parents and families that we see locally, some of them are just overwhelmed and busy just trying to provide a roof over their head and food for their families," Camarena said. "Health is important, but sometimes they don't think about it until it's needed."
Earlier this year, the
The state of
Although promotoras often are Spanish speakers and federal regulations require states to offer oral interpretation and written translations to applicants, the Georgetown report concluded that English proficiency remains a barrier in Medicaid enrollment.
In response to questions from
Asked about allegations of frequent errors occurring in the handling of Medicaid applications, Weldon wrote that the commission "utilizes a variety of quality assurance and quality control techniques to monitor and ensure accuracy in case work. We regularly provide training to our team members to ensure they have the most accurate information possible to provide to the public about benefits enrollment."
The Georgetown report may be the first to examine differences in health insurance enrollment among Latino children of different national backgrounds. It reveals, for example, that nearly a quarter of children whose families came from
Those differences, Whitener said, likely can be attributed to how long families have lived in
Even more, she said, the differences among Latino groups reflect the policies in the states where they end up settling.
In
But
___
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