More states offer health coverage to immigrant children

A small but growing number of states are extending government health benefits to children regardless of their immigration status.

Come January, Connecticut and New Jersey will join the nine states plus Washington, D.C., that already allow children without permanent legal status to enroll in either Medicaid, the public health plan for residents with lower incomes, or in its sister program, the Children's Health Insurance Program, known as CHIP.

The change is costing the states millions of dollars. Although the federal government usually pays for at least half the cost of those programs, the states extending health benefits to kids lacking permanent legal status do so without receiving any federal money.

Despite the cost, momentum is growing: Connecticut, Maine, New Jersey, Rhode Island and Vermont passed legislation in the past two years extending the coverage, part of a larger effort to insure more children. The pandemic gave extra urgency to their push.

Maine included pregnant women in its legislation passed last year. State Sen. Anne Carney, a Democrat who championed the extension, said financial concerns should not justify leaving any children or pregnant women without access to health care. The change will cost the state $1.5 million a year, according to budget documents.

"They are kids living in Maine and going to school in Maine and like their peers who were born in Maine or born in the U.S. or have citizenship status, they all have the same health needs," Carney said in an interview. "And there is no policy reason to differentiate between two kids sitting next to each other in school."

But no state led by Republicans, who tend to favor tighter limits on immigration and oppose the expansion of safety net programs, has approved such legislation.

Some critics say the move unfairly rewards people living in the country illegally. Jessica M. Vaughan, director of policy studies for the Center for Immigration Studies, a think tank that favors tighter immigration restrictions, said it is unfair to immigrants who follow the rules to provide benefits to those who are not here legally. She says it is unfair as well to employers who follow the law.

If taxpayers pay for health care for those here illegally, she wrote in an email, "in effect that is a subsidy to the employers of illegal workers, who can more easily get away with paying illegal workers below-subsistence wages, knowing that taxpayers will cover the gap between the low wages and what the workers need to support their families."

She added that by "offering these benefits, states are putting out the welcome mat for illegal immigrants, and citizens and legal immigrants have to foot the bill."

Supporters of extending coverage say such arguments lack compassion, depriving children of preventive health care, while ignoring public health lessons learned most recently during the COVID-19 pandemic. Assuring the health of immigrants, whether they are in the country legally or not, helps keep the overall population healthy.

"The fact that states independently are covering children is not necessarily based on politics but the realization that having a healthy population is a benefit to states themselves," said Valerie Lacarte, senior policy analyst with the Migration Policy Institute, a think tank that favors more legal immigration and other policy changes to discourage individual border crossings in search of asylum.

According to a June report Lacarte authored, of the estimated 2.3 million foreign-born children under 19 years old who by family income were eligible for Medicaid or CHIP in 2019, 909,000 were barred from those programs as a result of their immigration status.

About 43% of them, or nearly 391,000, were uninsured, according to the institute. That compares with 6% of U.S.-born children who were uninsured, the institute says.

In 1993, Massachusetts became the first state to extend health benefits to children without permanent legal status, Lacarte said. More states followed in the 2000s, particularly recently. They include California, Illinois, New York, Oregon, Washington and Washington, D.C.

In all those states, each with Democratic-led legislatures, the bills often have been part of overall efforts to ensure that as many children in the state, immigrant or otherwise, have health insurance. Those actions include eliminating premiums, increasing income eligibility levels and lessening red tape in renewing coverage.

"We're trying to make sure all kids in New Jersey are covered," said Democratic state Sen. Joseph Vitale, chair of the Senate Health, Human Services and Senior Citizens Committee and sponsor of the measure. "Kids are kids, and they deserve to have access to health care like the rest of us regardless of immigration status."

In New Jersey, which will enroll kids lacking permanent legal status starting in January, the additional cost to the state, as well as other changes the legislature adopted to increase the enrollment of children in health insurance, is estimated at up to $15 million a year.

States always have had the choice of providing health care to immigrants living in the country illegally. For immigrants with temporary legal status, however, rules have changed over the years.

Until 1996, immigrants living legally in the United States had the same access as citizens to Medicaid and many other federally funded entitlement programs, Lacarte said, as long as they otherwise qualified, which typically meant meeting income eligibility requirements.

But Congress established a five-year waiting period for many immigrants with legal status before they could be eligible for Medicaid and CHIP. Some immigrants were exempted from the five-year requirement -- asylum-seekers and refugees, for example -- but most green-card holders were subject to the waiting period.

Congress in 2009 allowed states to waive the five-year waiting period in Medicaid and CHIP for most legally authorized immigrant children. And if they chose that option, the states could still qualify for federal matching funds to cover those immigrant enrollees.

A large majority of states elected the new option. According to the Kaiser Family Foundation, as of January, 34 states plus Washington, D.C., waive the five-year waiting period to enroll legally residing immigrant children in their Medicaid and CHIP programs. Twenty-four states and Washington, D.C., do the same for legally residing pregnant women.

States also can seek federal matching Medicaid funds for emergency health care provided to children in families with low incomes regardless of their immigration status.

Carney, the Maine senator, said it's time for the federal government to end patchwork policies at both the state and federal government. "I would very strongly argue for the federal match for everyone," she said.