Uninsured immigrant children and access to health care

My patient was 15 years old when he was in a severe car accident. After finally going home from the hospital almost six months later, he still had chronic injuries that needed ongoing outpatient specialty care and surgery. What should have been just another 6-12 months of recovery turned into several years of barriers to proper medical care and prolonged disability.

The patient was born outside the United States and did not qualify for health insurance that could pay for the care he still needed. Not surprisingly, this impacted his ability to attend high school, spend time with friends and ultimately enjoy life as a typical teen. As a pediatrician caring for children in immigrant families, thinking about options for healthcare care is part of my routine. Caring for this patient was frustrating and challenging, with years of coordinating care, charity applications and attempting to get funded coverage.

In the United States, 1 in 4 children live in an immigrant family—they are foreign-born or live with at least one foreign-born parent. In Houston, 50% of children live in immigrant families. Texas also has the highest uninsured rate of all U.S. children, and immigrant children are even more likely to be uninsured. Healthcare providers in Texas have probably interacted with these children in clinics, hospitals and emergency rooms. Knowing how to get these children the care they need is essential.

While some states have extended insurance coverage to all children regardless of immigration status, this is not the case in Texas. Uninsured, lawfully residing immigrant children who meet eligibility should be encouraged to enroll in Texas Medicaid or CHIP and can be referred to various resources to assist with applying. Those who don’t qualify can access medical care at Federally Qualified Health Centers (FQHCs), which accept all patients regardless of their ability to pay, free clinics and school-based clinics found all across greater Houston.

The Harris Health System is another option for uninsured children living in Harris County via it’s Financial Assistance Program. While most FQHCs and free clinics include only primary care services, Harris Health also has subspecialty care in partnership with pediatric specialists from Baylor College of Medicine and the University of Texas Health Science Center at Houston (UTHealth).

Texas Children’s Hospital’s Program for Immigrant and Refugee Child Health has compiled a Low Cost Clinic List publicly available to help providers connect families to many of these options. Other programs like GoodRx can also help improve access to prescription medications for uninsured children.

Lastly, the Children with Special Health Care Needs Program through the Texas Department of Health and Human Services can expand healthcare coverage for children in Texas under 21 years with chronic or debilitating medical conditions,. Despite long wait lists, this option can provide essential medical care for low-income immigrant children like the patient, who do not otherwise qualify for any coverage based on their immigration status and have extensive medical needs.

There is still a lot to be done to reduce the uninsured rate for all children in Texas. However, as healthcare providers in one of the most ethnically diverse cities in the nation, we can impact the health of uninsured immigrant children walking into our clinics and hospitals today.

Staying informed about local options can help us better advocate for a child’s individual needs and connect families to accessible healthcare services, ultimately working towards reducing health disparities for this vulnerable population.

By Dr. Ana C. Monterrey, assistant professor of pediatrics, Baylor College of Medicine, Division of Academic General Pediatrics

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