Access to Health Care for Latino Mixed-Status Families

1. Access to Health Care for Latino Mixed-Status Families Kara D. Ryan, MPP Research Analyst, Health Policy Project National Council of La Raza (NCLR) Diversity RxOctober 19, 2010

2. Presentation Overview • Background: Why did we undertake this • research? • Overview and Findings: What did the research show? • Implications: How does the research inform NCLR’s • policy recommendations?

3. Background

4. Health Care Reform • Legislative debate • Implementation of the laws

5. Most Latino children are citizens living in immigrant families. Source: Richard Fry and Jeffrey S. Passel, Latino Children: A Majority Are U.S.-Born Offspring of Immigrants (Washington, DC: Pew Hispanic Center, May 2009).

6. Children in mixed-status families are more vulnerable to uninsurance. Source: Jeffrey S. Passel and D’Vera Cohn, A Portrait of Unauthorized Immigrants in the United States (Washington, DC: Pew Hispanic Center, 2009).

7. Research Overview & Findings

8. Research Objectives: 1. How do we best facilitate access to insurance for eligibleLatinos in mixed-status families? 2. What are the other alternatives sources of health care that should be explored for Latinos who remain uninsured?

9. Focus Group Locations Source: Kaiser Family Foundation, State Health Facts: Percentage of Population Hispanic. www.statehealthfacts.org

10. Focus Group Participants • All groups: Latino adults with citizen children under 18 • Citizenship: • 4 groups entirely of noncitizen parents • 3 groups of citizen and noncitizen parents • Insurance: • 5 groups uninsured parents of insured children • 1 group of fully insured families (parents/children) • 1 group of fully uninsured families (parents/children)

11. Findings:

12. State coverage programs are critical to children’s health care access. Findings: 1 “For the children, it is easier because they have Medicaid and everything is covered. They have their own pediatrician and they give you regular visits for them every three months, or whatever it is, and whatever happens, you take them there.” –Uninsured noncitizen parent, Charlotte, NC

13. Experiences with public coverage programs varied by state: facilitators increase access. Findings: 2a “The baby’s social worker is the one who applied for us and filled out the paperwork and then the card comes to your house.” –Uninsured noncitizen parent, Chicago, IL “You can talk to the school about signing him up for insurance and they will help you.” –Uninsured noncitizen parent, Portland, OR

14. Experiences with public coverage programs varied by state: eligibility policies matter. Findings: 2b “My son’s case, when he lived in New York, he did not have any legal documentation and he had [state CHIP program] insurance… Now that we are here [North Carolina], as a legal resident, he is not eligible for insurance because he has not been here for five years.” –Uninsured noncitizen parent, Charlotte, NC

15. Access to health coverage and care often varied within the same family. Findings: 3 “I tried to find out everything to see if we would qualify for insurance and…the only one that would qualify for insurance was the [child] that was born here and not the one that was born in [Central America].” –Uninsured noncitizen parent, Fairfax, VA “My [U.S. citizen] son has better medical care than my [noncitizen] daughter … I have been trying to take her to a private doctor, even if I pay cash for her, but I can’t pay [for] advanced exams nor can I take her to specialists—and with my son, I can take him.” –Uninsured noncitizen parent, Fairfax, VA

16. Parents make decisions about their children’s health differently than their own. Findings: 4 “I believe that my health is important because obviously they depend [on] me, but if I can resolve my situation with a medication that I can buy at [a retailer] or a natural remedy, I will. But that is not the same for my children. For me, children—I don’t care if I have to pay, with sacrifice I will do it for them. I can get sick but my children cannot.” –Uninsured noncitizen parent, Fairfax, VA

17. Health care is often unaffordable—even for families whose members are insured. Findings: 5 “I wish I could be able to pay [a] pending bill, but because there is no work around and I have a small baby—I think I am going to pay more in daycare in order to work than the actual hospital bill.” –Uninsured noncitizen parent, Charlotte, NC “Many times the insurance will not cover everything and so the community clinics will offer a low price, and the generic product that they give you saves you money, and the private clinics…they will charge you…” –Insured noncitizen parent, Chicago, IL

18. Parents sometimes perceive unequal treatment in children’s health care settings. Findings: 6 “I went to my private doctor to take my son, he had hurt himself in a sport. She was a different doctor and she did not know us and she wrote on the paper ‘no insurance’ and she sent us to get x-rays… Back when my son was a baby we didn’t have insurance, but she never checked. I think she looked at my face, saw that I was Mexican and assumed that I did not have insurance.” –Uninsured noncitizen parent, Portland, OR

19. Policy Implications

20. Recommendations • Maximize enrollment: • Engage community-based facilitators for outreach. • Streamline screenings for new applicants. • Maximize access to financial assistance. • Maximize access for the uninsured: • Invest in community health centers (CHC)s. • Encourage family-based approaches to health care. • Remove waiting periods and exclusions for immigrants.

21. What’s Next? • Upcoming: Report with full findings and implications for health care reform implementation. • Thoughts?: Contact Kara Ryan to receive the report and join the conversation: kryan@nclr.orgor 202.776.1703.