Insurance and Health Care Outcomes in Regions Where Undocumented Children Are Medicaid-Eligible

Abstract

OBJECTIVES: Expansion of insurance eligibility is associated with positive health outcomes. We compared uninsurance and health care utilization for (1) all children, and (2) children in immigrant families (CIF) and non-CIF who resided inside and outside of the seven US states/territories offering public health insurance to children regardless of documentation status (“extended-eligibility states/territories”). METHODS: Using the cross-sectional, nationally representative National Survey of Children’s Health-2019, we used survey-weighted, multivariable Poisson regression to assess the association of residence in nonextended- versus extended-eligibility states/territories with uninsurance and with health care utilization measures for (1) all children, and (2) CIF versus non-CIF, adjusting for demographic covariates. RESULTS: Of the 29 433 respondents, the 4035 (weighted 27.2%) children in extended- versus nonextended-eligibility states/territories were more likely to be CIF (27.4% vs 20.5%, P < .001), 12 to 17 years old (37.2% vs 33.2%, P = .048), non-White (60.1% vs 45.9%, P < .001), and have a non-English primary language (20.6% vs 11.1%, P < .001). The relative risk of uninsurance for children in nonextended- versus extended-eligibility states/territories was 2.0 (95% confidence interval 1.4–3.0), after adjusting for covariates. Fewer children in extended- versus nonextended-eligibility states/territories were uninsured (adjusted prevalence 3.7% vs 7.5%, P < .001), had forgone medical (2.2% vs 3.1%, P = .07) or dental care (17.1% vs 20.5%, P = .02), and had no preventive visit (14.3% vs 17.0%, P = .04). More CIF than non-CIF were uninsured, regardless of residence in nonextended- versus extended-eligibility states/territories: CIF 11.2% vs 5.7%, P < .001; non-CIF 6.1% vs 3.1% P < .001. CONCLUSIONS: Residence in nonextended-eligibility states/territories, compared with in extended-eligibility states/territories, was associated with higher uninsurance and less preventive health care utilization.

Promoting Health for Latino Immigrant Families—A Call for Improved Systems and Policies

“…3 Medicaid coverage for undocumented children is limited to 11 states and Washington, DC, despite being associated with increased preventive care receipt for all children regardless of documentation status. 4 While many mixed-documentation status families seek preventive care at federally qualified health centers (FQHCs), they face significant cost barriers to receiving subspecialty services or imaging outside the FQHC setting, where sliding-scale fees no longer apply. Families then face the dilemma of prioritizing their child's health vs meeting other basic needs.…”

Comparison of healthcare quality for uninsured and underinsured children through community health centres in Canada and the USA: a scoping review protocol

“…Although both countries’ models serve similar population targets, no study has examined the quality of healthcare provided for children, who remain uniquely vulnerable to poor health outcomes if unable to access care in a timely manner 12. Comparative health policy across countries can help each see their policies more clearly, and act as a barometer for policy development 13.…”

“…Although both countries’ models serve similar population targets, no study has examined the quality of healthcare provided for children, who remain uniquely vulnerable to poor health outcomes if unable to access care in a timely manner. 12 Comparative health policy across countries can help each see their policies more clearly, and act as a barometer for policy development. 13 As policy-makers face increased calls for better access to healthcare for uninsured and underinsured children and families in both Canada and the USA, 11 14 this scoping review will provide a synthesis of best practices to guide decision-making at a critical time.…”

Need for Culturally Competent and Responsive Cancer Education for African Immigrant Families and Youth Living in the United States

“…The United States has begun to address disparities in immigrant health, such as affordances of health care following the implementation of the Affordable Care Act or state-level legislation allowing immigrants (especially the young, pregnant persons, and older people) to be eligible for state Medicare. States that have expanded care for immigrant children have seen reductions in no-insurance rates and rates of families forgoing medical care [ 7 ]. However, there is a current dearth of initiatives directly designed for African immigrants.…”