Column: Here’s a proven, immigrant-inclusive policy so more kids have health insurance

December 7, 2021 4:49 am

by Carl Court/Getty Images

Michigan continues to be a national leader in the percentage of kids with health insurance. 

The most recent Kids Count data found that 97% of kids are insured in the state compared to 94% nationally. This is due in large part to policy decisions that expand eligibility and improve health care access and affordability, especially for our youngest and most vulnerable Michiganders. 

But Michigan should be striving to reach and cover all kids, which will require policy changes as well as outreach, engagement and enrollment. In fact, there is one health policy option that has been available to the state for over a decade that Michigan has yet to adopt. And the state’s delay is creating an unnecessary barrier to care for expectant parents, children and young adults — and preventing our insured rates from being even higher. 

The Immigrant Children’s Health Improvement Act (ICHIA) option was included in the federal 2009 Children’s Health Insurance Program Reauthorization Act (also known as CHIPRA). This administrative policy change allows states to enroll immigrants who are lawfully residing children (up to 21 years old) and/or pregnant in Medicaid and the federal Children’s Health Insurance Program (CHIP) sooner — specifically, without a five-year waiting period. Federal law currently prevents certain “qualified” immigrants (a subset of all lawfully present immigrants) who entered the United States on or after Aug. 22, 1996, from enrolling in some public programs until they have lived in the country for five years.

Michigan is in the minority of 16 states that have not implemented this immigrant-inclusive policy for children and among the half of states that have not done so for pregnant people. This change does not require legislative action and can be made administratively by the Michigan Department of Health and Human Services, plus it would come with substantial federal matching funds.

However, perhaps the only upside to Michigan waiting to adopt this policy is the ability to first see positive outcomes from other states. States that had extended Medicaid and CHIP coverage to lawfully residing children via the ICHIA option by 2011 saw an increase in the probability of children having insurance and also a nearly 14% decrease in the probability of immigrant children experiencing any unmet health need. 

The Michigan League for Public Policy’s new report, Covering More of Michigan’s Children: Making the Most of Existing Federal Flexibilities to Remove the Five-Year Waiting Period for Immigrant Children & Pregnant People, delves into the background, additional benefits and state-level impacts of the ICHIA option and makes the case for why it’s still better late than never to adopt this beneficial policy. 

Michigan Department of Health and Human Services | Susan J. Demas

If Michigan were to take up the ICHIA option for children, the state would extend Medicaid and CHIP coverage to an estimated 3,000 to 4,000 children who would be newly eligible for these programs without a five-year wait. We know that Medicaid and CHIP can lead to consistent, quality care for children and support financial stability for families. 

Coverage would extend to Hispanic or Latino children in Michigan in particular, because they represent a large share of those who are themselves foreign-born or are a part of immigrant families, are more likely to be income-eligible for Medicaid and CHIP, and are more likely to be uninsured than children in other racial and ethnic groups today. The ICHIA option’s targeted scope would result in a small increase in the number of children who are insured, but it would also reduce the uninsured rate among non-citizen residents specifically (over two-thirds of Michigan immigrants who are uninsured are non-citizens). 

And in taking up the ICHIA option for pregnant people, Michigan has an opportunity to build on the Maternity Outpatient Medical Services program, which currently provides prenatal care and up to 60 days of postpartum care to Medicaid-eligible pregnant people, regardless of immigration status. The ICHIA option could cement access to future coverage gains for this group, such as Medicaid postpartum coverage extensions from 60 days to a full year.

The ICHIA option is an immigrant-inclusive policy that would impact thousands of families across Michigan. Plus, not only would this policy contribute to a climate of inclusion — particularly on the heels of the “public charge”-induced chilling effect — but it would also have a limited fiscal impact because the state would receive substantial federal matching funds to cover the cost of care. Specifically, Michigan would receive matching payments at the Enhanced Federal Medical Assistance Percentage (FMAP) rate for CHIP, meaning the state would be responsible for less than one-fifth of the total cost per child during their first five years in the country. And, for Medicaid postpartum coverage extensions for pregnant immigrants, the state would be matched at the Medicaid FMAP rate. 

Other states’ implementation of the ICHIA option should be encouraging and serve as an example to Michigan policymakers, allowing us to see their successes and choose to follow their lead. It is time that our state policymakers join their peers across the country in adopting this immigrant-inclusive, fiscally sound policy that will bring Michigan closer to covering all kids and achieving healthier outcomes in our state.

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Simon Marshall-Shah
Simon Marshall-Shah

Simon Marshall-Shah is a state policy fellow at the Michigan League for Public Policy. He previously worked in Washington, D.C,. at the Association for Community Affiliated Plans (ACAP), providing federal policy and advocacy support to nonprofit, Medicaid health plans (Safety Net Health Plans) related to the ACA Marketplaces.