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Covering Immigrant Children: Where do we stand?. Joan Alker Deputy Executive Director Georgetown Center for Children and Families http://ccf.georgetown.edu. Children’s Coverage, 2007. Children = 78.6 million. Uninsured 11%. Employer-Sponsored Insurance 55%. Medicaid/Other Public 29%.

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Covering Immigrant Children: Where do we stand?

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Covering immigrant children where do we stand

Covering Immigrant Children: Where do we stand?

Joan Alker

Deputy Executive Director

Georgetown Center for Children and Families http://ccf.georgetown.edu


Children s coverage 2007

Children’s Coverage, 2007

Children = 78.6 million

Uninsured 11%

Employer-Sponsored Insurance 55%

Medicaid/Other Public

29%

Individual Coverage 4%

Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.


Non citizen children s coverage 2007

Non-Citizen Children’s Coverage, 2007

Children = 2.8 million

Employer-Sponsored Insurance 32%

Uninsured 34%

Individual Coverage 3%

Medicaid/Other Public

27%

Source: K. Schwartz, et al., “Health Insurance Coverage of America’s Children,” Kaiser Commission on Medicaid and the Uninsured (January 2009).


Uninsured children vs all children by race and ethnicity 2007

Uninsured Children vs. All Children,by Race and Ethnicity, 2007

Multiracial (3%)

Multiracial (2%)

Am. Indian(1%)

Am. Indian (1%)

Asian

Asian

Black

Black

Hispanic

Hispanic

White

White

8.9 Million

78.6 Million

NOTES: Children includes all individuals under age 19. American Indian category includes Aleutian Eskimos. Asian includes South Pacific Islander. Data may not total 100% due to rounding.SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.


Children s coverage by citizenship status 2007

Children’s Coverage, by Citizenship Status, 2007

Number

1.1 M

1.6 M

76.0 M

Source: K. Schwartz, et al., “Health Insurance Coverage of America’s Children,” Kaiser Commission on Medicaid and the Uninsured (January 2009).


Covering immigrant children where do we stand

A closer look at public programs and children


Medicaid and chip enrollment 2007

Medicaid and CHIP Enrollment, 2007

36.5 million

7.1 million

CHIP

29.3 million

Medicaid

Source: Center for Children and Families analysis of the Statistical Enrollment Data System (SEDS) FY 2007 Master File (February 11, 2008).

Note: Data represent children ever enrolled in Medicaid or CHIP.


Key differences in medicaid v chip

Key differences in Medicaid v. CHIP

  • Medicaid is an entitlement. This guarantees coverage and funding.

  • CHIP is not, though recent reauthorization makes financing more secure. Generally serves higher income children.

  • Medicaid benefits are more comprehensive (EPSDT v. CHIP benchmarks).

    • Cost-sharing protections are tighter.


Covering immigrant children where do we stand

States that Currently Cover Lawfully Residing Immigrant Children and Pregnant Women with State-Only Funds

WA

NH

VT

MT

ME

ND

OR

MN

MA

ID

WI

SD

NY

WY

MI

RI

CT

IA

PA

NV

NE

NJ

OH

IL

UT

IN

DE

CO

CA

WV

KS

VA

MD

MO

KY

NC

DC

TN

AZ

OK

NM

AR

SC

MS

AL

GA

TX

LA

AK

FL

HI

Source: National Immigration Law Center, “State-Funded Medical Assistance Programs” (Updated September 2008) and National Immigration Law Center, “State-Funded SCHIP Programs” (Updated September 2008).

Note: The following states also offer coverage to some immigrant children and/or pregnant women, but are not included in the map due to the small number of people actually covered: AK, CO, FL, OH, NM, WY


Covering immigrant children where do we stand

States that Cover All Children, Regardless of Immigration Status with State-Only Funds

WA

NH

VT

MT

ME

ND

OR

MN

MA

ID

WI

SD

NY

WY

MI

RI

CT

IA

PA

NV

NE

NJ

OH

IL

UT

IN

DE

CO

CA

WV

KS

VA

MD

MO

KY

NC

DC

TN

AZ

OK

NM

AR

SC

MS

AL

GA

TX

LA

AK

FL

HI

Note: Some California counties offer coverage to all children regardless of status, but it is not offered statewide.

Source: National Immigration Law Center, “State-Funded Medical Assistance Programs” (Updated September 2008) and National Immigration Law Center, “State-Funded SCHIP Programs” (Updated September 2008).


Covering immigrant children where do we stand

Children with at Least One Unauthorized Immigrant Parent, by Status, 2003-2008

(in millions)

Note: Children are persons under age 18 who are not married.

Source: Pew Hispanic Center tabulations from augmented March Current Population Surveys


Chipra key features

CHIPRA: Key Features

Was signed into law on Feb. 4th – one of the first bills in this Congress.

President Obama described it as a downpayment on health care reform

New funding levels and formula

New incentives to enroll Medicaid children

Eligibility changes (ICHIA being one of them!)

Significant new emphasis on quality, access


Covering immigrant children where do we stand

“In a decent society, there are certain obligations that are not subject to tradeoffs or negotiation – health care for our children is one of those obligations. That is why we have passed this legislation to continue coverage for seven million children, cover an additional four million children in need, and finally lift the ban on states providing insurance to legal immigrant children if they choose to do so.”

President Barack Obama at CHIPRA bill signing


New coverage for immigrants in chipra

New Coverage for Immigrants in CHIPRA

  • As of 4/1/09, states have option to obtain federal matching dollars for covering “lawfully residing” children and pregnant women regardless of date of entry and without any waiting period.

  • Can cover them through Medicaid and CHIP but must start with lowest income kids

  • No federal funding to cover undocumented immigrants

  • States could now use state funds to cover other immigrants (e.g., lawfully residing adults, undocumented children)


What does lawfully residing mean

What Does “Lawfully Residing” Mean?

  • Lawfully Residing is broader than “qualified” immigrant; includes green-card holders (lawful permanent residents) as well as other immigrants

    • Certain battered immigrants and dependents, U visa holders, residents of “compact of free association states,” persons with deferred action status, and other lawfully present immigrants should be included

  • SSA defines “lawfully residing” as lawfully present and residing in the U.S.

  • CMS will have to issue guidance on this.


What does lawfully residing mean cont

What Does “Lawfully Residing” Mean? (cont.)

  • Could include or not include many categories

    • Example #1: Massachusetts covers PRUCOLS as well as visiting foreign students

    • Example #2: New Mexico: Battered Legally Permanent Residents (LPRs)

  • Issue for CMS guidance: strike a balance between more covered groups or making it too broad (and politically unfeasible)


Which states will pick up the option

Which states will pick up the option?

  • States with “replacement” programs are expected to –

  • States without – UT had a bill that moved through the legislature but died in the final hours.


Prospects for health care reform

Prospects for Health Care Reform

In his FY 2010 budget, President Obama establishes a reserve fund of $634 billion as a down payment on health reform. The President laid out eight broad principles for reform, but is leaving the details to Congress.


Congress on fast track

Congress on fast track

  • House process: Three Committees are developing a joint bill (Ways and Means, Energy and Commerce, and Education and Labor)

  • Senate process:

    Finance Committee and HELP Committee are both developing products.


Baucus november white paper

Baucus “November White Paper”

“Currently, legal immigrant children and pregnant women are subject to a five-year waiting period before they can become eligible for Medicaid or CHIP. Not only does this exacerbate health disparities, but it increases the number of uninsured. The waiting period should be eliminated and eligible legal immigrants should have access to Medicaid and CHIP.

Source: M. Baucus, “Call to Action: Health Reform 2009,” U.S. Senator Max Baucus (D-Mont.), (November, 2008).


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