Health care access a struggle for undocumented immigrant children
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* Teddi Nicolaus

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Photo by AJR_Images, courtesy iStockphoto

Adriana Cardena was 4 when she crossed the Rio Grande river with her mother in 1981 to join her father, who had already come to the U.S. to find work. Growing up as an undocumented immigrant child in Texas, Cardena knows first-hand the struggles immigrant parents face to keep their children healthy.

“In the place where I lived, we didn’t have a community health clinic, or a federally qualified health center, or clinics at our schools,” said Cardena, MPA, who is now director of Protecting Immigrant Families, a national coalition of more than 650 member organizations working to increase health care access for immigrant families. “When you don’t have those kinds of access, parents rely on over-the counter-medications or have to wait until something is really drastic in order to take their children to the ER. And that has an impact not only on the family but on the entire community.”

Cardena’s childhood story continues to play out each day across the U.S. as immigrant families struggle to gain access to something public health leaders say should be a human right rather than a privilege.

According to federal data and the most recent Survey of Immigrants, a partnership between KFF and *The Los Angeles Times,* immigrants make up 16% of the U.S. adult population and play an important role in the nation’s workforce, culture and economy, contributing tens of billions of dollars each year in federal, state and local taxes. No matter how long they have been in the U.S., most immigrants surveyed said they came to the U.S. to find better jobs, educational opportunities and a brighter future for their children.

Despite their optimism, undocumented immigrants face unique challenges, especially in accessing health care for their children. No federal programs provide health care to undocumented children. Except for emergency care, the children of undocumented immigrants are prohibited from enrolling in any federally funded coverage, including Medicaid, Medicare, the Children’s Health Insurance Program or coverage through the Affordable Care Act marketplace. Even many lawfully present immigrants face a five-year waiting period to enroll in Medicaid or CHIP.

Further complicating the situation, children of undocumented immigrants are often U.S.-born citizens who may be eligible for benefits, but do not receive them because of immigration-related fears and confusion about eligibility restrictions. As a result, undocumented immigrants seek health care from a patchwork system of safety net providers such as federally qualified community health centers, public hospitals, migrant health centers, health fairs, and school and community clinics.

“Immigrant families are very creative and resilient in trying to find solutions,” Cardena told *The Nation’s Health.* “They find ways to cope and make choices between paying rent or being able to take their kid to the doctor because he has a high fever in the middle of the night. Those are things that shouldn’t be happening in our country at this point because we have resources to take care of everybody.”

Aiming to close the coverage gaps, a growing number of states are moving to provide comprehensive state-funded coverage to all income-eligible children, regardless of immigration status. California became the first in 2016 when it extended Medi-Cal, its state version of Medicaid, to undocumented income-eligible children in 2016. This year, California extended the program to residents of all ages, regardless of their immigration status. Public health leaders and immigration advocates hope more states take similar moves to ensure equitable access to coverage.

“Going to a health care facility can sometimes be seen as a luxury and not as the human right that we need it to be,” said APHA member Ilan Shapiro, MD, MBA, medical affairs officer at AltaMed Health Services, the nation’s largest independent federally qualified community health center. “When we have a choice as a society to create a healthier community, we need to make sure that we are taking care of the people that need a little extra help, especially the children.”

> “When we have a choice as a society to create a healthier community, we need to make sure that we are taking care of the people that need a little extra help, especially the children.”
> 
> *— Ilan Shapiro*

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At left, Junior, an immigrant from Guatemala, is checked bya physicians assistant at a clinic in Stamford, Connecticut, in May 2020. Many parents of children who arrive in the U.S. without legalpermission face barriers to health care for their kids. Some states are providing heath insurance coverage to undocumented children.

Photo by John Moore, courtesy Getty Images

Currently, more than a dozen states plus the District of Columbia provide state-funded heath insurance coverage to undocumented children. According to a 2022 study in *Pediatrics*, undocumented children who live in states that offer such coverage are less likely to be uninsured and more likely to get medical and dental care, including preventive care, than kids who live in states that have not expanded coverage.

“My dream is that after seeing that the investment is worth it, we will have a healthier community where children are improving, growing and giving back to the community in different ways,” Shapiro told *The Nation’s Health.* “When we take care of all children, we are taking care of the entire country.”

On Jan. 1, Utah became the first state with a Republican-led legislature to extend its state-funded CHIP benefits to children who were previously ineligible due to their immigration status. The bill gained bipartisan support by capping annual spending and requiring applicants to have a working parent or guardian, among other compromises. But policymakers on both sides of the aisle agreed that funding the program would be more cost-efficient than having the state cover the cost of emergency hospital visits.

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A mother brings her child to a free clinic testing for lead blood levels held by the Los Angeles County Department of Public Health in East Los Angeles in 2022. Some undocumented immigrants in the U.S. rely on community clinics for health care for their children, though they are not located in all areas.

Photo by Mayra Beltran Vasquez, courtesy Los Angeles County Department of Public Health

The Utah Department of Health and Human Services stresses the importance of medical, dental and mental health services for children and assures parents that their child’s immigration status will not be reported to U.S. Immigration and Customs Enforcement.

Utah has historically had one of the highest rates of uninsured children in the nation, said Ciriac Alvarez Valle, senior policy analyst at the advocacy group Voices for Utah Children.

“Health coverage is a foundational step to ensuring kids have the opportunity to thrive in our state,” Alvarez Valle told *The Nation’s Health.* “Having coverage will ensure they get the preventive care they need, like their annual doctor visits, dentist appointments and vaccines.”

In neighboring Colorado, undocumented residents can enroll in OmniSalud, a marketplace coverage program that offers them a safe way to compare affordable health insurance plans and enroll on a secure online platform.

The plans carry no premium costs for individuals with incomes up to 138% of the federal poverty level, regardless of immigration status. Meanwhile, Massachusetts’ Children’s Medical Security Plan provides primary and preventive medical and dental services to all children, regardless of immigration status or family income. Other states that provide benefits to undocumented children include Connecticut, Illinois, Maine, New Jersey, New York, Rhode Island, Oregon, Washington and Vermont as well as the District of Columbia.

Even in states that provide no such coverage, small community-led programs can bring big benefits. Every Tuesday morning in Pittsburgh, a mobile medical van operated by Salud Para Niños pulls up in front of the nonprofit clinic Casa San José in the city’s Beechview neighborhood. Inside the colorful van — paid for by the Pittsburgh Penguins Foundation and Ronald McDonald House Charities — pediatrician G. Chaves-Gnecco, MD, MPH, and his small team cheerfully provide culturally and linguistically competent primary care to undocumented kids who might never qualify for health insurance under Pennsylvania law.

Chaves-Gnecco founded Salud Para Niños — Health for the Children — in 2002 at Pittsburgh’s UPMC Children’s Hospital as the first pediatric bilingual clinic in southwestern Pennsylvania. The program’s main goal is to address barriers to health care and decrease health disparities, said Chaves-Gnecco, a professor of pediatrics at the University of Pittsburgh School of Medicine.

“In Pennsylvania, we have close to 24,000 children who don’t qualify for federal or state health insurance,” Chaves-Gnecco told *The Nation’s Health.* “The COVID-19 pandemic taught us that having chronic conditions caused many…to have complications that included hospitalizations, intensive care admissions and deaths. We are here to help as many children as possible get the expert care they need.”

Back in Texas, Cardena — now a U.S. citizen who lives in El Paso — mentions a scar she has had ever since she cut her forehead on the side of a bench at a rodeo when she was 8. The hospital stitched it up, but her father had to pay $25 a month for several years to cover the care, which was a lot of money for her family, she said. To avoid the added expense of having the stitches out at the hospital, her mother asked a nurse in the neighborhood to do the job.

“That story really demonstrates how you find ways to deal with your children’s illnesses when you have no immigration status,” Cardena said.

For more information, visit [www.kff.org](http://www.kff.org).

*   Copyright The Nation’s Health, American Public Health Association