A small but growing number of states are extending government health benefits to children, regardless of immigration status.
Come January, Connecticut and New Jersey will join the nine more states washington d.c.which already allow children without permanent legal status to enroll in either Medicaid, the public health plan for low-income residents, or its sister program, the Children’s Health Insurance Programknown as CHIP.
The change is costing states millions of dollars. Although the federal government typically pays at least half the cost of these programs, states that extend health benefits to children without permanent legal status do so without receiving federal money.
Despite the cost, the momentum is building: Connecticut, Maine, New Jersey, Rhode Island and Vermont has passed legislation in the past two years to extend coverage, as part of a broader effort to insure more children. The pandemic has given added urgency to their push.
Maine included pregnant women in its legislation passed last year. State Senator Anne Carney, a Democrat who has championed the extension, said financial concerns should not justify leaving children or pregnant women without access to health care. The change will cost the state $1.5 million per year, according to the budget documents.
“These are children who live in Maine and go to school Maine and like their peers who were born in Maine or born in WE or have citizenship status, they all have the same health needs,” Carney said in an interview. “And there is no political reason to differentiate between two children sitting next to each other in school.
But no state led by Republicanswho tend to favor tighter limits on immigration and oppose the expansion of safety net programs, endorsed such legislation.
Some critics say the move unfairly rewards people living in the country illegally. Jessica M.Vaughandirector of political studies for the Center for Immigration Studies, a think tank that favors tougher immigration restrictions, said it was unfair for immigrants who follow the rules to provide benefits to those who are not here legally. She says it’s also unfair to law-abiding employers.
If taxpayers pay for health care for those who are here illegally, she wrote in an email, “it is in effect a subsidy to employers of illegal workers, who can more easily get away with paying illegal workers below the living wage, knowing that taxpayers are covering the gap between low wages and what workers need to support their families.”
She added that by “providing these benefits, states are laying the welcome rug for illegal immigrants, and citizens and legal immigrants must pick up the tab.”
Proponents of extending coverage say such arguments lack compassion, depriving children of preventive health care, while ignoring public health lessons learned more recently during the COVID-19 pandemic. Ensuring the health of immigrants, whether they are in the country legally or not, helps keep the overall population healthy.
“That states cover children independently is not necessarily based on politics, but on the realization that having a healthy population is a benefit to the states themselves,” said Valerie LacarteSenior Policy Analyst at Migration Policy Institutea think tank that promotes more legal immigration and other policy changes to discourage individual border crossings seeking asylum.
According to a June report by Lacarte, of the 2.3 million foreign-born children under age 19 who, based on household income, were eligible for Medicaid or CHIP in 2019, 909,000 were excluded from these programs because of their immigration status.
About 43% of them, or nearly 391,000, were uninsured, according to the institute. This compares to 6% of WE-children born who were uninsured, says the institute.
In 1993, Massachusetts became the first state to extend health benefits to children without permanent legal status, Lacarte said. Other states followed in the 2000s, especially recently. They understand California, Illinois, New York, Oregon, Washington and washington d.c.
In all of those states, each with Democratic-led legislatures, the bills have often been part of overall efforts to ensure that as many children in the state, immigrant or not, have health insurance. . These measures include eliminating premiums, increasing income eligibility levels and reducing red tape associated with renewing coverage.
“We try to make sure that all the children in New Jersey are covered,” the Democratic state senator said. Joseph Vitalepresident of the Senate Health, Human Services and Seniors Committee and sponsor of the measure. “Children are children and they deserve to have access to health care like the rest of us, regardless of their immigration status.”
In New Jerseywho will enroll children without permanent legal status beginning in January, the additional cost to the state, along with other changes lawmakers passed to increase enrollment of children in health insurance, is estimated to be up to at $15 million a year.
States have always had the choice of providing health care to immigrants living illegally in the country. For immigrants with temporary legal status, however, the rules have changed over the years.
Until 1996, immigrants living legally in United States had the same access as citizens to Medicaid and many other federally funded entitlement programs, Lacarte said, as long as they were otherwise qualified, which usually meant meeting income eligibility criteria.
But Congress established a five-year waiting period for many immigrants with legal status before they can qualify 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 this option, states could still receive matching federal funds to cover these registered immigrants.
A large majority of states have chosen the new option. According to Kaiser Family Foundationin January, 34 states more washington d.c., waive the five-year waiting period to enroll legally resident immigrant children in their Medicaid and CHIP programs. Twenty-four states and washington d.c.do the same for pregnant women residing legally.
States can also apply for federal Medicaid matching funds for emergency health care provided to children of low-income families, regardless of immigration status.
Carney, the Maine senator, said it was time for the federal government to put an end to the patchwork policies at the state and federal levels. “I would advocate very strongly for the federal game for everyone,” she said.
