Utilizing CHIP Coverage to Expand Healthcare for Noncitizens - The National Law Review

Tuesday, February 15, 2022

According to a recent report by Manatt Health, released in January 2022, the Children’s Health Insurance Program (“CHIP”) can be utilized by policymakers to extend prenatal health coverage to noncitizens and their children in the United States. Advocates argue that expanding access to health coverage for noncitizens will improve health outcomes for vulnerable populations.

Disparities in Health Coverage

Despite ongoing efforts to expand access to health coverage in the United States, significant disparities continue to plague the American healthcare system. For instance, undocumented immigrants are less likely to have healthcare coverage when compared to both immigrants with legal status and U.S. citizens. Of course, this disparity stems at least in part from U.S. healthcare laws that assess public coverage eligibility based on citizenship.

As noted in a recent article on this blog, although underinsurance of children in the United States recently reached historic lows, a disparity continues to exist between children with citizen parents and those with at least one noncitizen parent. In fact, children with citizen parents were 3.3% uninsured, while those with at least one noncitizen parent were 6.0% uninsured. By 2019, these numbers grew worse for children with at least one noncitizen parent: those who lacked proper health insurance rose to 8.0%.

Unfortunately, citizens and noncitizens do not share the same access to healthcare in the United States. These disparities have led some policymakers to consider expanding the CHIP coverage option, or the unborn child option, which offers care from conception to birth, including prenatal services, labor, and delivery, as well as postpartum services regardless of citizenship status.

What is the CHIP Coverage Option?

CHIP, a program administered by the U.S. Department of Health and Human Services (“HHS”), provides states with matching funds to provide health insurance for families with children. The program was implemented as part of the Balanced Budget Act of 1997, aimed at providing coverage for families with modest incomes who would otherwise not qualify for Medicaid coverage.

States have the option to expand their CHIP coverage to provide pregnant individuals with healthcare no matter their immigration status (the “unborn child option”). That said, only one-third of states offer this option today. At this time, Pennsylvania has not implemented the unborn child option; noncitizens seeking to learn more about Pennsylvania health coverage options can do so here.

To adopt this option and receive funding under Title XXI, states must submit a CHIP state plan amendment (“SPA”). According to the report from Manatt Health, a Section 1115 waiver is not required, making approval of this option “relatively straightforward.” States have the right to set their own eligibility standards, including choosing what income levels qualify for coverage under the option.

Notably, past studies have shown that the CHIP coverage option for noncitizens and their children led to increased prenatal care utilization in states that implemented the option. The report concluded that the program has the potential to help states improve access to care and the quality of prenatal care for pregnant noncitizens.

Benefits of Expanding Coverage

The benefits of expanding healthcare access are relatively clear, as explained by in recent post by Victoria Bailey of Health Payer Intelligence. However, it may be necessary to implement careful outreach to noncitizen communities given their more limited interactions with the healthcare system due to fears of becoming a public charge or other exclusionary immigration policies.

The necessity of expanding healthcare coverage is underscored by the sheer numbers involved. After all, the number of immigrants and refugees in the United States has increased dramatically in recent years. Today, over 1 in 4 children in the United States are born to immigrant families.

Especially given the urgency of the current public health crisis, questions of accessibility for this vulnerable population are more important now than ever before. Ultimately, it will be policymakers who decide whether utilization of the CHIP coverage option will the best solution to this problem.