Medicaid programs get help in covering additional immigrant children
A growing number of states are providing health coverage to legal immigrant children and pregnant women through Medicaid or other state programs, under the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). Using the Immigrant Children's Health Improvement Act (ICHIA) option, states now have the option to provide federally matched Medicaid or CHIP to some or all of the legal immigrants they have been covering solely with state funds.
States getting federal dollars
For the most part, the states that are taking advantage of the ICHIA option had already covered legal immigrant children and pregnant women with state-only funds prior to CHIPRA, and therefore, "jumped at the opportunity to get federal dollars for this effort," says Laura Parisi, a health policy analyst with Families USA in Washington, DC.
"This basically allows them to keep covering these individuals for less money. It is good that we see that many states taking the option to continue covering those folks, albeit with more federal help, as opposed to cutting the coverage altogether, which is obviously an option," says Jennifer Sullivan, a Families USA senior health policy analyst.
Fourteen states plus the District of Columbia fall into this category: California, Hawaii, Illinois, Massachusetts, Maine, Maryland, Minnesota, New Jersey, New Mexico, New York, Pennsylvania, Texas, Virginia, and Washington.
"Thanks to the ICHIA provision, Washington state is now covering lawfully documented immigrants under our Medicaid and SCHIP programs who were previously barred from this coverage under the five-year ban," says Teresa Mosqueda, director of advocacy and legislative relations at Children's Alliance in Seattle. Before ICHIA, these children were covered by Washington State children's health program for children who are income eligible, but do not qualify for the federally matched programs due to citizenship. "Now, we can offer the same health coverage to all children," says Ms. Mosqueda.
In addition, Delaware and Nebraska both currently cover legal immigrants using state-only funds, and are considered likely to elect the option. Connecticut also currently covers legal immigrant children and pregnant women using state-only dollars, but has not yet passed a state budget. The ICHIA option is proposed in both the governor's and legislative budget, and is considered very likely to pass.
"This will provide much needed federal reimbursement for a population we have been covering for years with state-only dollars," says Sharon Langer, JD, senior policy fellow at Connecticut Voices for Children in New Haven.
State proposes ICHIA coverage
The state's governor and legislature have proposed using the ICHIA option to continue coverage for kids and pregnant women. "Connecticut has covered recent immigrants since 1997, except for one year, with state-only dollars, says Ms. Langer. "Unfortunately, both the governor and the legislature have proposed dropping coverage for immigrant adults living in the community. It is extremely unlikely lawmakers will find the state dollars to cover the adults."
Utah, a state that did not previously fund coverage for legal immigrant children and pregnant women, acted early on electing the option and attempted to pass ICHIA legislation this past spring. However, this effort was defeated in the Senate.
In exploring the ICHIA option in CHIPRA, Utah estimated that an additional 800 children would have enrolled in Medicaid or CHIP. The cost to the state would have been $391,600 for FY 2010. "CHIPRA was passed halfway through our state's last legislative session, which runs from late January through early March," says Lincoln Nehring, Medicaid policy director at the Utah Health Policy Project in Salt Lake City. "We had two legislators, a Republican in the House and Democrat in Senate, run legislation to remove the waiting period for children only. We have not been able to accurately estimate how many pregnant women would qualify, so it was decided to just do kids."
Bills failed overall
Each bill passed its respective bodies. However, while support clearly existed in making this change, funding proved to be too great of a challenge. The Senate bill failed in the House, and the House bill never received a vote in the Senate. "We are running legislation again in the 2010 session to make the change," says Mr. Nehring. "However, given the state's budget situation and the increased money needed to cover the 20% enrollment growth our Medicaid program has experienced in the last year, chances of passage are slim."
Wisconsin and Iowa, which both passed legislation to cover legal immigrant children and pregnant women for the first time, did so as part of a larger eligibility expansion in their CHIP programs. The ICHIA option allowed Rhode Island to restore coverage for legal immigrant children and pregnant women, who were cut from the program in 2006.
"We are very pleased to say that Rhode Island has chosen to use the ICHIA provision in CHIPRA to restore coverage for lawfully residing immigrant children," says Jill K. Beckwith, MPH, a policy analyst with Rhode Island KIDS COUNT in Providence. The governor submitted this as part of his recommended FY 2010 budget, and the General Assembly concurred, allowing Rhode Island to reinstate RIte Care coverage that was eliminated in June 2008.
Ms. Beckwith says CHIPRA allows Rhode Island to further build on the federal-state partnership to maximize all available dollars for children's health coverage.
"Rhode Island has a strong track record of investing in children's coverage," says Ms. Beckwith. "The ICHIA provision enables leading states like Rhode Island to fully utilize all federal dollars on the table, and to build on and strengthen our commitment to making sure that all Rhode Island children have access to affordable health coverage."
The Rhode Island Department of Human Services (DHS) anticipates an approximate implementation date of Oct. 1, 2009, pending approval by CMS. The state estimates that approximately 1,272 lawfully residing immigrant children may enroll in RIte Care, which will enable them to get the checkups and preventive care they need to stay healthy and see the doctor when they get sick.
Colorado passed a bill in the last legislative session that authorizes ICHIA when funding becomes available. Although funding is not currently available, the authorizing language allows the Department of Health Care Policy and financing to submit a budget request in a future fiscal year that allows for providing Medicaid and CHIP to legal immigrant children and pregnant women.
"This is a very positive step in the right direction for Colorado," says Adela Flores-Brennan, health care attorney with the Colorado Center on Law and Policy in Denver. "The five-year waiting period is such an arbitrary concept that creates health inequities and disparities for a population of Colorado's pregnant women and children who, but for the five-year period, would be eligible to receive affordable health coverage."
Ms. Flores-Brennan says it is poor policy to exclude them. "The impact on the state budget will not be huge, relative to other Medicaid costs or other populations," she says.
The fiscal note that accompanied the bill anticipated implementation in fiscal year 2010-2011. "It remains to be seen, though, whether it will be part of the governor's budget request," says Ms. Flores-Brennan. "While, of course, it is disappointing that we have to wait for funding, it is the fiscal reality for us and most other states."
For 2011-2012, the state anticipates being able to cover 1,316 pregnant women and children in Medicaid and the state's CHIP program (CHP+). In 2012-13, the forecast increases to 2,626.
"Colorado previously covered, using state dollars, only pregnant women who were made ineligible for Medicaid by the five-year waiting period," says Ms. Flores-Brennan. "The passage of ICHIA here allows us to draw down federal matching dollars for those women and expand to cover legal immigrant children in Medicaid and CHP+, and legal immigrant pregnant women eligible for CHP+."
Numbers aren't large
In actuality, the number of people actually covered with the ICHIA option is not that large. "The biggest burden is the ideologic one, as to whether or not you should be providing coverage to immigrants," says Ms. Sullivan. "Some states are in a tight situation, and they may make the budget argument. But at the end of the day, we are not talking about adding a significant number of children to the rolls. There aren't many children that fall in this five-year bar category."
What ICHIA does is simplify the program. "And obviously, the CHIP match is very favorable. So, states are getting a lot of money to provide coverage to immigrants," says Ms. Sullivan.
There has not yet been any official guidance from the Centers for Medicare & Medicaid Services on ICHIA. Some states may be adopting a "wait-and-see" approach before moving forward.
"I'm not sure we will see a huge flood of states wanting to pick up the option once that guidance is out there," says Ms. Sullivan. "But I would bet that some states are going to be a little more hesitant to plow down that path until they see what the official matching rate is going to be for the various populations. This is particularly true for states that want to do this for the first time, and are going to be putting up some of their own dollars for this that they weren't putting up before."
Generally speaking, there have been a lot of gains made in children's coverage this year, despite the recession. "It seems that states are still very committed to getting kids covered, even more so that the recession is affecting more and more families," says Ms. Sullivan. "If a family loses a job and was never eligible for this kind of coverage before, they are the poster child for what CHIP is designed for. So, states are recognizing that, and to the extent that they can, they are keeping their doors open."
In some cases, there has been fairly large eligibility expansion, and also simplification of the application process. "Part of the reason for that is states are reaching for what CHIPRA calls performance bonuses. This is extra money for states reaching out to get kids enrolled," says Ms. Sullivan.
Some states are making a single application for Medicaid and CHIP, or doing express lane eligibility, so families can get other coverage as well if they need it. "Those are no small things when it comes down to it," says Ms. Sullivan. "You can have a great program, but if no one knows about it or can get in the door, then it's not helping anyone."
One big exception is California. "With almost a million kids enrolled in that state, coverage is really in jeopardy right now. This is a travesty and something we are watching very closely," says Ms. Sullivan.
Other states have contemplated either capping their programs or scaling back some expansions. But for the most part, states are eager to continue the mission of getting kids covered. "And I'm not entirely surprised," says Ms. Sullivan. "CHIP is a popular program. States like it because they get a lot of bang for their buck. And we just went through a long, tedious, two-year struggle to reauthorize the program."
Contact Ms. Beckwith at (401) 351-9400, ext. 20 or [email protected], Ms. Flores-Brennan at (303) 573.5669, ext. 313 or af [email protected], Ms Langer at (203) 498-4240 or [email protected], Ms. Mosqueda at (206) 324-0340, ext. 21 or [email protected], Mr. Nehring at (801) 433-2299 or [email protected], Ms. Parisi at (202) 628-3030 or [email protected], Ms. Sullivan at (202) 628-3030 or [email protected].
A growing number of states are providing health coverage to legal immigrant children and pregnant women through Medicaid or other state programs, under the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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