Sep, 28, 2022

Supporting Health Equity and Affordable Health Coverage for Immigrant Populations

State Health and Value Strategies

Ensuring affordable health coverage and healthcare for immigrant populations in the United States is critical to advancing health equity. In a new series, State Health and Value Strategies (SHVS), with support from the Robert Wood Johnson Foundation, highlights strategies for states to expand affordable health coverage to immigrant populations in the United States. The Supporting Health Equity and Affordable Health Coverage for Immigrant Populations series examines a range of strategies that states have at their disposal to help extend coverage to immigrant populations, including those who do not qualify for subsidized health insurance under the Patient Protection and Affordable Care Act (ACA) or other public programs due to immigration status.

The first issue brief in the series, State-Funded Affordable Coverage Programs for Immigrants, provides an overview of the national immigrant health coverage landscape. Access to affordable health coverage and healthcare for immigrant populations in the U.S. is critical to advancing health equity and the issue brief offers considerations for policymakers related to state-funded affordable coverage programs for low-income individuals who do not qualify for subsidized health insurance under the ACA or other public programs due to immigration status. The second issue brief in the series, CHIP Coverage Option for Pregnant Immigrants and their Children, reviews how states may provide pregnancy-related care through the Children’s Health Insurance Program (CHIP) to targeted low-income children from conception to birth (the so called “unborn child” option). This option enables states to provide prenatal, labor and delivery, and postpartum services to pregnant individuals, regardless of immigration status.

The third brief in this series, Reshaping the Narrative on Public Charge to Reach Immigrant Populations that Need Affordable Health Insurance, presents strategies to connect eligible individuals to affordable coverage. The Biden administration issued a final rule clarifying that the use of Medicaid/CHIP benefits (other than government-funded institutionalization for long-term care) or Marketplace coverage will not be considered in a public charge determination, the longstanding concept in immigration law referring to individuals who are likely to be dependent on the government for support. However, many immigrants and their families remain concerned that enrolling in Medicaid/CHIP, Marketplace, and other public health insurance programs will jeopardize their immigration status. 

As part of the series, SHVS has also published analyses of revisions to the public charge rule. The Department of Homeland Security (DHS) issued a final rule on the “Public Charge Ground of Inadmissibility,” on September 8, 2022. Our expert perspective highlights how the final rule largely reinstates the approach to public charge determinations that DHS applied until a regulatory reform in 2019, including by excluding Medicaid and other in-kind public benefits from the public charge determination. For a deeper dive into the details of the public charge rule, see the issue brief SHVS published on the proposed rule. 

As part of the series, SHVS also hosted a webinar, State Strategies to Support Afghan Evacuees in Accessing Health Coverage, that provided an overview of eligibility standards for evacuees and strategies for states to expedite enrollment in health coverage following the mass evacuation of Afghans in September, 2021.

Looking ahead, SHVS has additional programming planned for the series in the form of communications materials to support states as they outreach to immigrant communities. Through the series, SHVS will support states as they innovate and test alternative pathways to providing coverage for immigrant populations.