Q&A: How State Advocates Take Action to Get More Kids Covered

In 2020, 4.3 million children under the age of 19 living in the United States had no access to health coverage. That same year we observed the largest jump in uninsured children in more than a decade. As a response to longstanding gaps in health care access and the impact on immigrant communities, many states have introduced Cover All Kids legislation. Cover All Kids refers to a state-funded, comprehensive, Medicaid-like program for income-eligible children and adolescents regardless of their citizenship or immigration status. Voices for Health Justice advocates Suzanne Curry from Health Care for Allin Massachusetts, Kony Serrano Portillo of CASA in Maryland, and Freddy Mejia from the Commonwealth Institute for Fiscal Analysis in Virginia, share insights into their states’ current and upcoming advocacy to ensuring that all kids have access to the care they need. 

Curry (MA): Massachusetts is in a better place than most states with respect to universal coverage for children. In fact, 98.5% of all children, regardless of their immigration status, have some form of insurance coverage. However, there are significant limitations to what this coverage entails. Safety net programs currently available to certain immigrant children and young adults do not cover or have considerable limits on essential services, such as eyeglasses coverage, caps on mental health visits and prescription drugs. Health Care For All’s HelpLine regularly hears from families who cannot get critical services, simply because of their immigration status. 

Mejia (VA): After Medicaid expansion in 2018, hundreds of thousands of Virginia adults have benefited from new eligibility. Since then, advocates have successfully galvanized for more health coverage expansions, including prenatal coverage for all income-eligible people regardless of immigration status. However, there has not been a push to expand access on a larger scale since 2018. Too many children in Virginia are denied access to health coverage simply because of their immigration status. We want to change that and provide a simple message to all Virginia families: if you earn below a certain amount, your children can access comprehensive and affordable health coverage.  

Serrano (MD): After successfully advocating for the passage of the Healthy Babies Equity Act, we see the expansion of the Children’s Health Insurance Program (CHIP) as a critical next step in expanding healthcare for all in Maryland. The Healthy Babies Equity Act expands Medicaid coverage to cover prenatal and postpartum care to pregnant people and one year of coverage for infants up to the age of one regardless of immigration status. COVID-19 exacerbated long-persisting healthcare accessibility struggles in immigrant communities, generating a sense of urgency from local governments who have felt the increased need amongst immigrant communities for health services. 

Curry (MA): The percentage of children that are not covered by at least some form of medical coverage is very low in Massachusetts. However, within these numbers, lies a gap of 30,000 children and youth under the age of 21 that would be eligible for coverage under Cover All Kids. 

Mejia (VA): Approximately, 13,000 undocumented and uninsured children would newly qualify for health coverage through a Cover All Kids program. Additionally, a more straightforward message could create a “welcome mat” effect for parents to pursue health coverage for their children who are citizens or legally residing and are already eligible for Medicaid/CHIP, but may not be enrolled. 

Serrano (MD): In Maryland, there are approximately 48,000 uninsured children. Overall, the state's uninsured rate is 4.3 percent amongst this population and the 10th lowest in the country.  

Curry (MA): Utilizing our existing Children’s Health Access Coalition provided a jumping-off point for this work. Effective strategies include engaging providers to share stories with legislators about families they work with, and collecting and sharing stories of families who would benefit with the most appropriate messengers. Additionally, we shared detailed research about what health coverage options are currently available for children in the state of any immigration status. It’s key to share data about how many kids would be helped, how much it would cost and successes in other states with legislators. 

Mejia (VA): We have leveraged our leadership and participation in existing coalitions in Virginia, including the Healthcare for All Virginians Coalition and the Virginia Coalition for Immigrant Rights (VACIR) to connect with supportive partners. We have also published information on the need and opportunity of Cover All Kids in both English and Spanish to reach more people. 

Serrano (MD): To pass the Healthy Babies Equity Act, we organized and mobilized our members, organizational partners, state and local legislators, and the health care sector. Our goal is to continue to use and build on this strategy for health care expansion for immigrant communities that ensures access to high quality care, programs and services for children and the immigrant population in the state. 

Curry (MA): In 2023, we want to build a more visible campaign and better utilize our relationships with immigrant and community organizations to build advocacy power. We will also look to the states that have recently passed and implemented Cover All Kids to identify strategies that we can employ in Massachusetts, and we hope to engage more legislators through education efforts such as briefings and one-on-one meetings.  

Mejia (VA): We plan on working with legislative champions to introduce legislation next year to pass and fund the Cover All Kids program. We look forward to working with new and existing partners for the second consecutive year to raise awareness of the issue for community members, stakeholders and legislators. 

Serrano (MD): In January of 2023, CASA is committed to introducing comprehensive legislation to ensure that every Marylander has access to health care, regardless of their immigration status. Cover All Kids (specifically CHIP expansion), will be a critical part of our effort to expand care to the entire undocumented community.  

Momentum for Cover All Kids efforts are indicative of how state advocates across the country continue to respond to the call-to-action to eliminate barriers to affordable health care access for immigrant communities. The next blog in this series will feature advocates in states that have passed Cover All Kids legislation and are going into the implementation phase.