Latino Children at the Intersection of Immigration and Health Care Policy: Understanding Coverage Disparities Related to Documentation Status

Introduction: Nearly 10 million Latino children have immigrant parents, and these children experience significant health insurance disparities. Most (60%) belong to mixed-status families where parents and children have different documentation statuses, yet little is known about the role of parental documentation status in these disparities. I present qualitative data to contextualize findings from my previous quantitative, nationally-representative analysis of documentation status and children’s coverage within a larger mixed-methods study.

Methods: I conducted semi-structured interviews with a stratified, purposive sample of 20 Latino immigrant parents of varying documentation statuses, and 10 key community agency informants in a Midwestern state whose immigrant community has grown markedly in recent years.

Results: Parents and key informants described mechanisms that may help explain disparities revealed in my previous quantitative analyses, where I found that undocumented children were the most likely to be uninsured, but even U.S.-born children with undocumented parents were significantly more likely to lack coverage than their counterparts with naturalized or legal resident parents. Parents reported hesitancy to enroll children in Medicaid/CHIP programs, both for fear of detection/deportation and/or fear of penalization for their children’s public program participation. Parents’ own ineligibility for public programs often leads to confusion about their citizen and non-citizen children’s eligibility. Many parents reported seeking enrollment assistance at community agencies/clinics whose staff attempt to ease fears and dispel confusion.

Conclusions: Immigrant adults face significant restrictions to coverage, restrictions which are maintained even under ACA expansions. These policies intended to restrict access for immigrant adults may ultimately exclude their children.