This toolkit provides an overview of available policy options for state and local governments to expand health care coverage for undocumented immigrants. Approximately, 45% of undocumented immigrants in the United States (U.S.) are uninsured, compared to 23% of documented immigrants and 8% of U.S. citizens (1). Lack of health insurance coverage among undocumented immigrants is linked to delays seeking health care and underutilization of cost-effective health care services (2). Improving access to care for undocumented immigrants could contribute to better health outcomes and financial security in immigrant households (3). In this toolkit, we review a selection of policies and programs that state and local governments have implemented to provide health care coverage to undocumented immigrants. These efforts include policies, programs, and partnerships with community organizations. We classify these efforts into three distinct categories: (A) State initiatives: 1) State programs that extend eligibility criteria to Medicaid programs and CHIP. 2) Waivers to create Uncompensated Care Pools (UCP). 3 ) End-Stage Renal Disease (ESRD) treatment. (B) Local/county initiatives include: 1) Government-run medical homes. 2) County programs in partnership with FQHCs and other community clinics. (C) Partnerships with consular authorities and community organizations. We provide a list of available policies and programs in states such as California, Texas, New Mexico, New York, Arizona, District of Columbia, Washington, Illinois and Massachusetts that can inspire similar efforts in other states and counties with a presence of undocumented immigrant population.

Objective

To assess the association between short maternal height and four types of mother-child nutritional status groupings within Mexican households.

Design

We classified mother-child dyads into four groups: stunted child and a non-overweight/non-obese mother (stunting-only), non-stunted child and an overweight/obese mother (overweight-only), stunted child with an overweight/obese mother (double-burden) and households with neither child stunting nor overweight/obese mothers (neither-condition). We assessed the association between maternal height and mother-child nutrition status using multinomial logistic regression, controlling for socio-economic covariates.

Setting

Nationally representative cross-section of households from the 2012 Mexican National Health and Nutrition Survey.

Participants

Children <5 years of age were matched to their mothers, resulting in a sample of 4706 mother-child dyads.

Results

We found that among children with stunting, 53·3% have an overweight/obese mother. Double-burden was observed in 8·1% of Mexican households. Maternal short stature increased the probability of stunting-only by 3·5% points (p.p.) and double-burden by 9·7 p.p. (P < 0·05). The inverse association was observed for overweight-only and neither-condition households, where the probability of these outcomes decreased by 7·2 and 6 p.p. in households with short-statured mothers (P < 0·05), respectively.

Conclusions

Women with short stature are more likely to develop overweight and simultaneously have a stunted child than those who are not short-statured. Our findings underline the challenges faced by public health systems, which have to balance the provision of services for both an undernourished and increasingly overweight/obese population.

OBJECTIVE: To estimate the avoidance of Medicaid enrollment among Latino and Asian immigrants due to fears about immigration status. In 2019, changes to the public charge rule made it difficult for immigrants to receive a green card or permanent residence visa, particularly for those who used health and nutrition benefits. Despite the Biden administrations reversal of these changes, fear and misinformation persist among immigrants. DATA SOURCES: Pooled data from the 2017 to 2020 California Health Interview Survey. STUDY DESIGN: We used adjusted predicted probability models to estimate differences in access to and use of health care and health insurance coverage among Latino and Asian immigrant adults with and without green cards, using US citizens as the reference. We estimated the avoidance of Medicaid enrollment among immigrants without a green card, the immigrant population subject to the public charge rule. DATA COLLECTION/EXTRACTION METHODS: Population stratified by race/ethnicity and green card status. PRINCIPAL FINDINGS: Latino immigrants without a green card were -23.1% (CI: -27.8, -18.4) less likely to be insured, -9.2% (CI: -12.8, -5.5) less likely to have Medicaid coverage, -9.3% (CI: -14.5, -4.1) less likely to have a usual source of care, and -8.4% (CI: -13.2, -0.3) less likely to have a physician visit relative to citizens. Asian immigrants without a green card were -11.7% (CI: -19.7, -3.72) less likely to be insured, -8.8% (CI: -11.6, -6.1) less likely to have Medicaid coverage, -11.6% (CI: -19.3, -3.9) less likely to have a usual source of care, and -11.0% (CI: -19.2, -2.3) less likely to have a physician visit. Between 107,956 and 192,905 Latino immigrants and 1294 and 4702 Asian immigrants in California likely avoided Medicaid enrollment due to fears about their immigration status. CONCLUSION: While our estimates are lower than those of previous studies, our findings highlight barriers to health care for immigrants despite the reversal of the changes in the public charge rule. Since the public charge rule was not abolished, immigrants with low incomes might choose not to seek health care, despite recent efforts in California to expand Medicaid coverage to all eligible immigrants regardless of documentation statuses.

Since the 1960s the immigrant population in the United States has increased fourfold, reaching 44.7 million, or 13.7 percent of the US population, in 2018. The shifting immigrant demography presents several challenges for US health policy makers. We examine recent trends in immigrant health and health care after the Great Recession and the nationwide implementation of the Affordable Care Act. Recent immigrants are more likely to have lower incidence of chronic health conditions than other groups in the US, although these differences vary along the citizenship and documentation status continuum. Health care inequities among immigrants and US-born residents increased after the Great Recession and later diminished after the Affordable Care Act took effect. Unremitting inequities remain, however, particularly among noncitizen immigrants. The number of aging immigrants is growing, which will present a challenge to the expansion of coverage to this population. Health care and immigration policy changes are needed to integrate immigrants successfully into the US health care system.

INTRODUCTION: Telehealth can potentially improve the quality of healthcare through increased access to primary care. While telehealth use increased during the COVID-19 pandemic, racial/ethnic disparities in the use of telemedicine persisted during this period. Little is known about the relationship between health coverage and patient race/ethnicity after the onset of the COVID-19 pandemic. OBJECTIVE: This study examines how differences in patient race/ethnicity and health coverage are associated with the number of in-person vs. telehealth visits among patients with chronic conditions before and after Californias stay-at-home order (SAHO) was issued on 19 March 2020. METHODS: We used weekly patient visit data (in-person (N = 63, 491) and telehealth visits (N = 55, 472)) from seven primary care sites of an integrated, multi-specialty medical group in Los Angeles County that served a diverse patient population between January 2020 and December 2020 to examine differences in telehealth visits reported for Latino and non-Latino Asian, Black, and white patients with chronic conditions (type 2 diabetes, pre-diabetes, and hypertension). After adjusting for age and sex, we estimate differences by race/ethnicity and the type of insurance using an interrupted time series with a multivariate logistic regression model to study telehealth use by race/ethnicity and type of health coverage before and after the SAHO. A limitation of our research is the analysis of aggregated patient data, which limited the number of individual-level confounders in the regression analyses. RESULTS: Our descriptive analysis shows that telehealth visits increased immediately after the SAHO for all race/ethnicity groups. Our adjusted analysis shows that the likelihood of having a telehealth visit was lower among uninsured patients and those with Medicaid or Medicare coverage compared to patients with private insurance. Latino and Asian patients had a lower probability of telehealth use compared with white patients. DISCUSSION: To address access to chronic care management through telehealth, we suggest targeting efforts on uninsured adults and those with Medicare or Medicaid coverage, who may benefit from increased telehealth use to manage their chronic care.

This policy brief estimates the potential chilling effects of the approved changes to the public charge rule on children’s access to healthcare across 7 California regions.