Association for Public Policy Analysis & Management

Although recent legal permanent residents and undocumented immigrants are generally barred from accessing publicly provided health insurance, some states in the U.S. have chosen to cover immigrant children with or without federal matching dollars. Little systematic research has tested whether these generous state policies effectively reduce disparities in health care and improve health outcomes. In this study, we examine the contextual effect of U.S. state health insurance eligibility policy, particularly with respect to immigrant children, on race/ethnic and nativity-based disparities in regular health care for children. Originally-collected data on state-specific Children’s Health Insurance Program (CHIP) eligibility policies are integrated with child-level, nationally representative data from the 1996, 2001, 2004, and 2008 panels of the Survey of Income and Program Participation. Utilizing multilevel logistic regression, the analysis tests our hypothesis that race/ethnic, particularly Hispanic versus white, and nativity-based disparities in regular doctor visits will be less pronounced among children who reside in states with more generous health insurance programs. In contrast to past studies that focus on one state or region of the U.S. or on a short time frame, the current study considers the entire temporal span of the CHIP policy throughout all 50 U.S. states and the District of Columbia. Preliminary findings support the conclusion that a significant portion of between-state variation in children’s access to routine health care results from diversity in CHIP eligibility rules for poor and foreign-born children. Efforts to extend CHIP coverage to near-poor as well as impoverished children are particularly important for reducing the disadvantage experienced by Hispanic children. Immigrant-specific disparities are reduced when states do not require five years residency for CHIP participation.  These policies increase access to health insurance coverage, as expected, leading to improved health care utilization.