Thousands of immigrant children who arrived through legal channels in Indiana – about 17% – do not have insurance coverage and the Indiana Commission on Improving the Status of Children in Indiana recently voted to do something about it.
Specifically, the panel urges lawmakers to close this gap by removing a five-year regulatory waiting period.
“That’s a lot of kids,” said Mark Fairchild, director of political communications with health care association Covering Kids & Families of Indiana. “We’re looking at about one in five or one in six of this total population of immigrant children without medical coverage.”
Fairchild, head of the insurance coverage subcommittee, presented his findings to the commission detailing the thousands of children and hundreds of adults whose incomes would otherwise qualify them for Medicaid or the health insurance program for children (CHIP).
But Indiana, unlike the majority of states, chose not to waive a five-year waiting period for immigrants to enroll in the government program.
“We don’t have the ability to get into it earlier than that; five years is a long time and we’re talking about kids here,” Fairchild said. “It’s a substantial gap for the life of any child.”
Fairchild noted that, for young children in particular, this delay in care can have huge consequences. As an autism therapist, he noted that early intervention could be crucial in connecting children with developmental disabilities to appropriate care and resources.
The committee decided to recommend eliminating the five-year waiting period in a voice vote before questioning Fairchild, advocating for expanded insurance coverage for Indiana’s immigrant community.
About one in four documented immigrants does not have health insurance in Indiana. Instead, they resort to Medicaid emergency coverage, which pays for vital healthcare, including heart attack treatment or delivery costs.
“It’s very fair to say that our new immigrant population faces many barriers, regardless of our performance as a state. There are language barriers, cultural barriers, to understanding how our health care system works compared to other countries,” says Fairchild. “This group is at much higher risk and with gaps in coverage, they miss out on screenings, checkups, early vaccinations.”
Fairchild pointed out that this portion of the uninsured population meets all other Medicaid requirements but slips through the cracks.
In the meantime, charities are trying to cover some of the gap, but removing the five-year waiting period would dramatically improve the state’s dismal maternal and child health rates, he said. declared.
For children, being uninsured reduces their access to vital preventive health care, such as developmental screenings and vaccines. Parents learn less about raising their children with healthy habits, which will impact the rest of their lives.
The Medicaid Office of Policy and Planning can change the rule without General Assembly authorization, Fairchild said, but its protections would not be as strong. No lawmakers have yet been identified to carry the legislation, but Rep. Maureen Bauer, D-South Bend, drafted similar legislation last year.
In a statement, Bauer said she was grateful for the commission’s recommendation, adding that the state had the option to waive the five-year restriction since 2009.
“Today’s recommendation reinforces that our state must recognize that access to health care is a basic need. Infant mortality rates are often used as an indicator of a community’s public health, and it early prenatal care and medical screenings have been proven to improve outcomes for healthy pregnancies,” Bauer said. “By eliminating the five-year waiting period, we’ll reduce emergency department use, create healthier communities and a more welcoming state for new Hoosier families. It’s a step in the right direction.”
An estimated 4,513 to 5,961 children under the age of 19 would be eligible if the waiting period ended, along with 475 to 627 young adults aged 19 to 21. Approximately 481 to 634 pregnant women would also benefit from coverage.
The federal government covers about two-thirds of Medicaid services and three-quarters of CHIP, meaning Indiana would only be responsible for about $3.8 million to $5 million. Some of these costs could be recovered through hospital assessment fees.
Outside of the immigrant population, Indiana has a higher rate of uninsured children compared to the national average. Fairchild’s committee was created when, after years of decline, uninsured rates began to rise again.
“We saw a real concern that something was going in the wrong direction,” Fairchild said. “Now we can say that over the past two years the uninsured rates for children have improved slightly – but a lot of that is due to some of the rules that have been suspended during COVID.”
Fairchild warned that its data was tainted by the COVID-19 pandemic and may not be completely accurate.
The small increase in insurance rates during the pandemic can be attributed to agencies’ refusal to remove people from government insurance programs, as outlined in the rules of the public health emergency. It meant thousands of Hoosiers didn’t have to worry about losing their insurance coverage as their lives were turned upside down by COVID-19.
Despite this, there are still approximately 110,000 to 120,000 uninsured children in Indiana.
One measure recommended by Fairchild would be to expand continued eligibility for children, with fewer checks to determine if families met income requirements.
“So if they’re covered, they can stay there for at least a year so they can establish a primary care physician without being interrupted, even if they don’t qualify eight months out of the year,” Fairchild said. .
Another proposal would eliminate the “90-day rule” with CHIP, which requires parents to wait 90 days after voluntarily giving up their employer’s coverage to qualify for the government program.
“It left a gap in coverage for children and we were concerned about that,” Fairchild said. “A lot of families go into this (private insurance program), try to make it work, and then have to drop it based on the family’s income level. And now they’re left with this 90-day gap.”
Fairchild noted that coverage for a family, which receives less government subsidy than coverage for a single employee, can cost hundreds of dollars compared to much cheaper individual policies.
Enforcement of the 90-day rule has been suspended during the public health emergency, and the federal government is drafting a rule to eliminate the waiting period nationwide. However, Fairchild said the state should be prepared to act alone if the federal government does not act quickly.