Thousands of immigrant children who came through legal channels to Indiana — roughly 17% — don’t have insurance coverage and the Indiana Commission on Improving the Status of Children in Indiana voted Wednesday to do something about it.
Specifically, the panel is urging lawmakers to fix that gap by waiving a regulatory five-year waiting period.
“That’s a whole lot of kids,” said Mark Fairchild, the director of policy & communication with healthcare nonprofit Covering Kids & Families of Indiana. “We’re looking at about one in five or one in six of that total immigrant children population without healthcare coverage.”
Fairchild, leading the insurance coverage subcommittee, presented findings to the commission detailing the thousands of children and hundreds of adults whose incomes would otherwise qualify them for Medicaid or the Children’s Health Insurance Program (CHIP).
But Indiana, unlike a majority of states, has opted not to waive a five-year waiting period for immigrants to enroll in the government program.
“We don’t have an option to get in there any sooner than that…five years is a long time and we’re talking about kids here,” Fairchild said. “That’s a substantial gap for any kid’s life.”
Fairchild noted that, for young children especially, this delayed care can have enormous consequences. As an autism therapist, he noted that early intervention could be crucial for connecting children with developmental disabilities to appropriate care and resources.
The committee decided to recommend removing the five-year waiting period in a voice vote before asking Fairchild any questions, advocating for expanded insurance coverage for Indiana’s immigrant community.
The stakes for immigrant children, pregnant women
About one in four documented immigrants do not have health insurance in Indiana. Instead, they resort to emergency Medicaid coverage, which pays for life-saving healthcare including heart attack treatments or delivery costs.
“It’s very fair to say that our new immigrant population has a lot of barriers in front of them, regardless of how well we do as a state. There’s language barriers, cultural barriers, figuring out how our healthcare system works versus other countries,” Fairchild said. “This group has a lot more risk and with gaps in coverage they miss… screenings, health checks, early vaccinations.”
Fairchild emphasized that this portion of the uninsured population meet all other requirements for Medicaid but fall through the cracks.
In the meantime, charitable organizations attempt to cover some of the gap, but waiving the five-year waiting period would vastly improve the state’s dismal maternal and infant health rates.
For children, being uninsured reduces their access to vital preventative healthcare, 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 Office of Medicaid Policy and Planning can change the rule without authorization from the General Assembly, Fairchild said, but its protections wouldn’t be as strong. No legislator has been identified to carry the legislation yet, but Rep. Maureen Bauer, D-South Bend, authored similar legislation last year.
In a statement, Bauer said she was grateful for the commission’s recommendation, adding that the state has had the option to waive the five-year restriction since 2009.
“Today’s recommendation solidifies the fact that our state must recognize that access to health care is a basic need. Infant mortality rates are often used as an indicator of the public health of a community, and early prenatal care and health screenings are proven to increase outcomes for healthy pregnancies,” Bauer said. “By removing the five-year waiting period, we will reduce the reliance on emergency services, create healthier communities, and be a more welcoming state to new Hoosier families. This is 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, as well as 475 to 627 young adults between the ages of 19 and 21. Roughly 481 to 634 pregnant women would also gain coverage.
The federal government covers approximately two-thirds of Medicaid services and three-quarters of CHIP, meaning Indiana would only be responsible for roughly $3.8 to $5 million. Part of those costs could be recouped under the hospital assessment fees.
Overall higher uninsured rates for Hoosier children
Outside of the immigrant population, Indiana has a higher rate of children uninsured compared to the national average. Fairchild’s committee was created when, after years of decline, uninsured rates started increasing again.
“We saw a real worry that something was going in the wrong direction,” Fairchild said. “Now we can say in the last couple of 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 cautioned that his data was tainted by the COVID-19 pandemic and may not be completely accurate.
The small increase in insurance rates in the pandemic can be attributed to agencies declining to remove people from government insurance programs, as outlined in the rules of the public health emergency. This meant thousands of Hoosiers didn’t need to worry about losing their insurance coverage as their lives were upended by COVID-19.
Despite that, there are still roughly 110,000-120,000 children left uninsured in Indiana.
One move Fairchild recommended would be extending continuous eligibility for children, with fewer check-ins to determine if families met income requirements.
“So if they’re on coverage, they can stay on it for at least a year so they can establish a primary care doctor… without getting interrupted even if they don’t qualify eight months into the year,” Fairchild said.
Another proposal would eliminate the “90-day rule” with CHIP, that requires parents wait 90 days after voluntarily dropping their employer coverage to qualify for the government program.
“This left a gap in children’s coverage and we were concerned about that,” Fairchild said. “A lot of families get into that (private insurance program), attempt 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 covering a family, which receives less government subsidies than single employee coverage, can cost hundreds of dollars compared to far cheaper individual policies.
Enforcement of the 90-day rule was 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 on their own if the federal government doesn’t move swiftly.
The Indiana Capital Chronicle is an independent, not-for-profit news organization that covers state government, policy and elections.