Declining Enrollment of Asian and Hispanic Children in State Medicaid Program


NJ Spotlight

Family Care — New Jersey’s Medicaid program — has lost nearly 50,000 youngsters in the past year and a half alone, according to a new study.


The number of children enrolled in New Jersey Family Care — the state’s Medicaid program — is now at a five-year low, having lost nearly 50,000 youngsters in the past year and a half alone, according to a new study. But all racial groups have not fared the same.

The number of Asian and Hispanic kids in New Jersey without health insurance increased between 2017 and 2018, a situation that is particularly concerning since these two racial groups already make up more than half the uninsured children statewide, New Jersey Policy Perspective said in the study released Monday.

During that same period, the number of African American and white children without coverage fell by even greater numbers, the left-leaning research group found after analyzing new census data.

Representatives from NJPP and New Jersey Citizen Action, which also participated in the report’s release, blamed the racial disparities in part on fear among immigrant families over various anti-immigration policies from the Trump administration. Last year, one in seven adults in an immigrant family nationwide avoided signing up for a public benefit program because of concerns about a specific regulatory proposal that has since been blocked by the courts, according to an Urban Institute study.

In its review of census data, NJPP found that the number of uninsured Asian and Hispanic New Jerseyans under age 18 grew by 2,621 from 2017 to 2018. During that same period, the number of black and white children without insurance declined by 3,591, it said. This development mirrors national trends, they said.

Worries about the ‘public charge rule’

In particular, the groups blamed confusion over changes Trump proposed to the “public charge rule,” which would have made it harder for some immigrants to become citizens or obtain visas if they had enrolled in public health or social service programs.

New Jersey was among the baker’s dozen of states that sued to stop the plan and multiple states courts have now blocked the plan; the state Department of Human Services, which runs Family Care, has also opposed the rule in official comments to federal officials. But immigrant advocates said the proposal still had a chilling effect on immigrant families, including those who have legal status.

Erika Nava, a policy analyst with NJPP, called it an “invisible wall” of “misinformation” that makes it harder for immigrant families to navigate the system and get the help they need.

“It should be easy for every child to obtain health care (coverage) without fear, but unfortunately that is not the case,” said NJPP’s health care policy director Ray Castro, who wrote the report. “This harmful trend helps explain the precipitous decline in New Jersey Family Care.”

To reach and cover more Asian and Hispanic children — and reverse the declining participation of children in Family Care —NJPP and Citizen Action called for New Jersey to join a half dozen other states that have already enacted universal health insurance coverage for minors, regardless of their immigration status. These groups also urged state officials to reduce what they called the administrative barriers to enrollment, including a requirement that kids be uninsured for three months before they can be eligible.

‘Deep concern’ in Murphy administration

The DHS has opposed Trump administration policies it sees as anti-immigrant and said it was “deeply concerned” about reports that these proposals might be keeping children from getting the coverage they need.

“We will continue to work with community organizations to provide outreach and assistance for New Jersey families,” said DHS Commissioner Carole Johnson. “We will continue to make outreach and (Family Care) enrollment a priority throughout the year and especially as marketplace enrollment begins this week,” she said, noting that Family Care outreach workers visit community events, schools and other social service programs to help people sign up.

(Open enrollment for the ACA’s marketplace, or exchange, begins Friday and last six weeks. The marketplace covers those who earn too much to qualify for Family Care, but don’t get coverage through their jobs. But through this annual process, some residents realize they are in fact Medicaid-eligible. According to Laura Waddell, a health care organizer with Citizen Action, some 195,000 Garden State residents have incomes that would enable them to obtain Family Care, but are not currently enrolled.)

In April, NJPP said an estimated 78,000 New Jersey kids were uninsured; previous estimates from the group suggested that roughly half of these may be youngsters who do not qualify for the current Medicaid program as a result of their immigration status. The group found that health care coverage declined by 14% for New Jersey immigrants of all ages in 2018.

Proposal for universal coverage

As of August, there were nearly 779,700 children in the Family Care program; it also covers more than 1 million poor and low-income adults. Participation among kids peaked in May 2018, at roughly 819,000, but has dropped almost continually since, except for several months in the spring. Before the ACA took full effect, in 2014, the program included close to 713,000 youngsters, Castro said.

While youth enrollment in Family Care — which is run by the state but funded by a mix of state and federal funds, with nearly 80% from Washington, D.C. — has dropped overall, the uninsured rate among New Jerseyans under age 18 has actually remained relatively stable in the last few years, NJPP found; in 2018 it was 3.9% for children in New Jersey. Castro said employer-based insurance programs have grown slightly, likely absorbing some of those once covered by programs like Medicaid.

State Sen. Joseph Vitale (D-Middlesex) has championed proposals to expand health insurance since long before the 2010 Affordable Care Act was adopted nationally, which allowed New Jersey to expand its Medicaid program; Vitale suggested he would sponsor a measure to create universal children’s health insurance when NJPP unveiled a blueprint for such coverage in April. Castro said Monday the senator is expected to introduce this legislation soon; Vitale said the proposal is still being assembled.

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