Children living in the U.S. without citizenship status are four times more likely to go uninsured and more than twice as likely to receive delayed care than a sibling who achieves citizenship, according to a new study.
These kids are also more likely to have relatively worse health outcomes and lower wages later in life, the Health Affairs research published Tuesday shows. That's despite 69% of them becoming citizens by the age of 30 and over 80% of them achieving citizenship by age 50.
More so than income, area, or race, citizenship is the greatest indicator of whether a child will go uninsured.
Kids with citizenship were 85% more likely to be covered by the Children's Health Insurance Program than their noncitizen siblings in mixed status families.
In comparing the gap between this subset of citizen and noncitizen kids in mixed status families and those kids of varying statuses in a wider population, the void among mixed status families is up to 79% greater.
"Seeing those wide disparities is really alarming, even though it's not necessarily surprising," said Kelly Whitener, Associate Professor at the Georgetown University McCourt School of Public Policy's Center for Children and Families. "Having access to Medicaid is kind of one part of the puzzle."
In a 2018 survey of over 250,000 citizen children and 8,000 non citizen children, Hispanic children were nearly six times more likely to be noncitizens than Black, Non-Hispanic children and four times more likely than White Non-Hispanic children.
Noncitizen siblings were also most likely to live in poverty (53%) and receive delayed care due to high costs (7%), according to the study.
Whitener said it would be helpful if Medicaid learned who among the noncitizen groups are eligible for coverage and learn how to reach them.
But among immigrant communities, there's widespread fear that accessing public benefits will cause family members to be deported or will jeopardize permanent status, Whitener said.
CHIP eligibility restrictions imposed in 1996 create a five-year waiting period for noncitizen children before they can enroll. About 35 states have used waivers to override the rule for noncitizen Medicaid users and 24 have done it for CHIP. Federal legislation gave states the option to cover legal immigrant children and pregnant women without a waiting period in 2009. Undocumented children remained excluded.
There's progress in states like Pennsylvania, Delaware, and Connecticut toward using state funds to lift the waiting period for lawfully residing children and undocumented children, according to Whitener. But she said there needs to be leadership at the federal level.]
House Representatives in the Progressive Caucus plan to reintroduce the Health Equity and Access under the Law for Immigrant Families Act of 2021 before Congress ends later this week. Advocates say prior introductions were stalled due to a lack of appetite for cutting the waiting period across multiple benefit programs, but they are optimistic.
Co-sponsored by Rep. Pramila Jayapal (D-Wash.), the bill removes the five-year waiting period public and supports Affordable Care Act tax credit for the children of immigrants born in the U.S.