Research objective: The first objective is to measure the effect of parental documentation status, a child’s own status, and their interaction on health insurance coverage among the children of Latino immigrants. Latino children experience the highest uninsurance rate among their peers. Those with immigrant parents experience the greatest coverage disparities, and most (60%) of these 10 million children belong to mixed-status families in which parents and children have different documentation statuses. Immigrant adults face significant restrictions on public coverage, and barriers related to documentation status suggest that policies intended to restrict access for immigrant adults may ultimately exclude their children, most of whom are U.S.-born citizens. Because of these federal restrictions – which are maintained under the ACA – the bulk of immigrant healthcare policymaking is ultimately delegated to states.  Thus, our second objective is to examine if the effect of parental documentation status is modified by disparate state-level policies.

Study Design: We use measures of documentation status from the Survey of Income & Program Participation to examine its effect on coverage among a nationally representative cross-section of 4244 children with at least one Latino immigrant parent. Our pooled sample includes 1263 children from the final (12^th) Wave of the 2004 SIPP Panel (data collected in Sep. 2007) and 2981 children from the 2^ndWave of the 2008 Panel (data collected in Dec. 2008). We first estimate uninsurance rates by parental documentation status (naturalized citizen, legal permanent resident, or undocumented) and children’s own status (above categories plus U.S.-born citizen). We then estimate the sample average marginal effect of a child’s own documentation status, and compare this effect over different values of parental documentation status to examine how parental status alters the effect of a child’s status on coverage. Finally, a multi-level random coefficients model examines state-level Medicaid/CHIP policy as a modifier in the relationship between parental status and coverage. All models include child-, family-, and/or state-level controls and account for complex survey design.

Findings: Among the children of Latino immigrants, undocumented children fare the worst, with an uninsurance rate of 66.2%. U.S.-born children have the lowest uninsurance rate (26.9%), yet adjusted models show that the marginal effect of a child’s own status differs significantly by parental status. In particular, having at least one undocumented parent significantly diminishes a child’s probability of being covered. These relationships hold even when examining U.S.-born children alone and, importantly, over 80% of the children of Latino immigrants are U.S-born citizens. Multi-level analyses reveal that state-level policies mitigate the effect of parental status.

Conclusions: Although there are certainly differences in coverage rates due to children’s own documentation status, parental documentation status is also an important driver behind disparities in coverage among children of Latino immigrants, though state policies moderate this impact. In developing and evaluating healthcare (e.g., the ACA) and immigration policies, federal and state policymakers must consider both the impact of restrictive policies for immigrant adults themselves, and the indirect, detrimental effects on their children.