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Journal Issue: Health Insurance for Children Volume 13 Number 1 Spring 2003

Gaps in Coverage for Children in Immigrant Families
Gabrielle Lessard Leighton Ku

Introduction

One in every five American children is a member of an immigrant family.1 Despite their substantial numbers, these children are much less likely to have health insurance and ready access to health care than children in native-born citizen families. Family immigration status is, in fact, one of the most important risk factors for the lack of health care coverage among children in the United States. About one-third of the nation's low-income,2 uninsured children live in immigrant families (see Figure 1). Almost all of these children meet the income requirements for eligibility for Medicaid or the State Children's Health Insurance Program (SCHIP), but for various reasons they are not enrolled. For example, some of these children are ineligible for Medicaid and SCHIP because of immigrant eligibility restrictions. Many others are eligible but not enrolled because their families encounter language barriers to enrollment, are confused about program rules and eligibility status, or are worried about repercussions if they use public benefits. Not only are children of immigrants more likely to be uninsured and less likely to gain access to health care services than children in native families, but communication barriers can also result in immigrant children receiving lower-quality services.

The linguistic, cultural, legal, and socioeconomic circumstances of immigrants pose special challenges and opportunities for policy officials and health care practitioners seeking to provide health care and health insurance coverage to children in immigrant families. And because children in immigrant families constitute such a large share of the nation's uninsured, successfully reducing the total number of uninsured children depends in large measure on how well the needs of immigrant families are addressed. Furthermore, immigrants are increasingly a concern for every state. Although immigrants traditionally have been concentrated in a handful of states—California, Florida, New Jersey, New York, and Texas—an increasing number are relocating throughout the country in pursuit of employment. Seventy percent of immigrants still reside in California, Florida, New Jersey, New York, and Texas, but the immigration growth rate during the 1990s was highest in southern and central states such as Iowa, Nevada, North Carolina, and Virginia.3 Health care and social service providers across the country are learning how to adjust their services to accommodate the needs of immigrant families.

Federal, state, and local policies and practices can either promote or undermine insurance coverage and access to care for this large but underserved population. This article discusses the barriers immigrant children face in securing health coverage and quality care and describes strategies that have been adopted to overcome these barriers. The article concludes with policy recommendations and suggestions for future steps to improve public health insurance programs for immigrant children.