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George Washington University, School of Public Health and Health Services, Department of Health Policy


Geiger Gibson/RCHN Community Health Foundation Research Collaborative Policy Research Brief No. 7


Medicaid & SCHIP; Immigrant Health


In the coming weeks, Congress will consider the reauthorization of the State Children's Health Insurance Program (SCHIP), whose legislative authorization will expire on March 31, 2009. SCHIP's overarching goal, in tandem with Medicaid, is to assure coverage of low-income children, regardless of race or national origin. As the proportion of uninsured immigrant children grows, a crucial question is whether the SCHIP reauthorization will address the need to restore eligibility for legal immigrant children and pregnant women. Although SCHIP and Medicaid have been successful in improving health insurance coverage for most low-income American children since the mid-1990s, the health coverage gaps for immigrant children have deepened and about half of all low-income immigrant children are now uninsured.

SCHIP reauthorization represents a critical opportunity to restore access to Medicaid and SCHIP coverage for some of the most vulnerable children and pregnant women, those who are legally-admitted immigrants. (Undocumented immigrants would remain ineligible for Medicaid and SCHIP, as they always have been, except for coverage of emergency care under Medicaid.) Welfare reform legislation passed in 1996 requires that most legal immigrants wait for five years before qualifying for coverage under Medicaid, regardless of how poor or sick they are. While numerous Senators and Congressmen from both sides of the aisle have supported proposals to allow states to restore coverage for legal immigrant children and pregnant women, they have yet to come to a full vote before both chambers of Congress.

The lack of coverage makes it harder for these children and pregnant women to get necessary health care, especially if they lack access to a health center or other safety net provider. Thus, they may fail to receive immunizations or prenatal care, which are needed to grow up healthy. The restoration of Medicaid and SCHIP would enhance health centers' ability to furnish care for more needy patients in the community, by freeing up funds now used for uncompensated care.

Barring coverage for legal immigrant children and pregnant women jeopardizes community health while discriminating against future citizens, workers and family members. Restoring Medicaid and SCHIP coverage to these vulnerable populations will improve their health and strengthen their ability to contribute to the nation and economy.

Open Access