Healthcare Access Disparities for Immigrant Children Amid Changing US Policy

A recent study published in JAMA Network Open highlights significant disparities in healthcare access for immigrant children in the United States compared to their US-born peers. The research utilized the National Survey of Children's Health data from 2016 to 2022, encompassing over 279,000 children, to measure outcomes such as insurance continuity, usual sources of primary and sick care, forgone medical care, and challenges accessing subspecialty care. Immigrant children were found to have higher uninsured rates, greater difficulty maintaining uninterrupted insurance, and increased odds of unmet medical needs and referral challenges. Federal and state policies significantly impact healthcare access for immigrant children. While the Biden administration expanded the definition of "qualified noncitizen" to include Deferred Action for Childhood Arrivals (DACA) recipients, enabling some access to Medicaid and CHIP, the Trump-era changes under H.R. 1 have imposed restrictions limiting eligibility. Thirty-eight states and Washington, DC, waived Medicaid and CHIP waiting periods as of early 2025, improving coverage inclusivity in certain jurisdictions. However, new restrictions slated for 2027 are expected to exclude many immigrants, including DACA recipients, from Affordable Care Act marketplace subsidies, with the Congressional Budget Office estimating that nearly 1 million people could lose coverage due to these immigration-related provisions. Demographic analysis revealed that immigrant children are disproportionately represented in lower-income brackets, with over half living below 200% of the federal poverty line, and racial/ethnic composition differing notably from US-born children. This socioeconomic vulnerability correlates with higher uninsured rates during the prior 12 months (16.5% versus 5.2% for US-born children). Immigrant children also exhibit lower odds of having a usual place for primary care and sick care and markedly higher odds of foregoing medical care or encountering barriers to subspecialty referrals. State-level inclusivity policies have demonstrated positive impacts on immigrant children's health insurance continuity and access to primary care. Immigrant children in states with the most inclusive coverage policies show significantly higher odds of uninterrupted insurance compared to their counterparts in less inclusive states. Nevertheless, these policies have not fully alleviated challenges related to subspecialty referrals or forgone care. The study underscores the complex interaction between federal immigration policy, state healthcare inclusivity measures, and health equity for immigrant children. Limitations of the study include potential misclassification in survey responses and insufficient data on undocumented immigrant children. The findings suggest that expanding inclusive state policies on insurance eligibility may be a key avenue to reducing healthcare access disparities for immigrant children, with implications for payers, providers, and policymakers involved in Medicaid, CHIP, and ACA marketplace administration.