Michigan could expand coverage to uninsured, lawfully residing children but hasn’t, says report


Patrick Jones


Michigan has the ability to enroll 3,000 to 4,000 more “lawfully residing” immigrant children and pregnant women in Medicaid or the Children’s Health Insurance Program (CHIP) through a 2007 act—the Legal Immigrant Children’s Health Improvement Act (ICHIA). However, the state has yet to do so, according to a report from the Michigan League for Public Policy (MLPP).

The act gives states the opportunity to waive the five-year waiting period for newly legal child and pregnant immigrants to receive government issued coverage. MLPP said making use of this policy would increase access for underserved communities—especially Latinx or Hispanic communities— and contribute to the climate of inclusion all while receiving “substantial” federal matching funds. 


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In 1996, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) restricted immigrants from accessing benefits by instituting a five-year waiting period for lawfully present immigrants to receive coverage. In 2009, the Children’s Health Insurance Program Reauthorization Act (CHIPRA) gave states the option to use ICHIA to waive the waiting period for their residents. 

Since 2009, 35 states have adopted the ICHIA option for children, pregnant people, or both. However, Michigan is one of 16 states not using this option. Joan Alker, executive director of the Georgetown University Center for Children and Families said:

“Michigan is actually falling behind as more than two-thirds of states have eliminated the waiting period for lawfully residing immigrant children and are seeing improvements in their access to healthcare and fewer unmet healthcare needs. Research shows that access to Medicaid in childhood helps lead to longer, healthier lives, a better chance to finish high school and college, and more prosperous futures for children—so why would a state want to delay those benefits by five years for any child?” 

According to the report, immigrant Michiganders are twice as likely to be uninsured than those who are U.S.-born with over two-thirds of uninsured immigrants being noncitizens. This program would reduce the uninsured rate specifically amongst noncitizen populations and would bring Michigan closer to providing affordable, accessible care to all children.  

Hispanic and Latinx children are more likely to be uninsured in Michigan with a 7% uninsured rate. This rate is double that of all other racial and ethic groups in Michigan and has continued to increase over the last few years, according to the report. Below is data showing uninsured and poverty rates of underserved communities. 


Image: Michigan League for Public Policy


The report said:

“Explicitly anti-immigration policies such as a 2019 presidential proclamation requiring proof of health insurance (or means to obtain it quickly) to lawfully immigrate to the country also limited immigration options for many lower-income people, contributed to a narrative about immigrants burdening the healthcare system and created a climate of fear about enrollment, which deterred families from enrolling in robust coverage.”

The report said this option would encourage underserved communities to receive care and would “combat a climate of fear” of immigrations status change from receiving services. For families in Medicaid and CHIP, low premiums and controlled out-of-pocket costs can provide financial security and decrease unexpected medical bills.  

The amount spent by the state would be limited upon expanding ICHIA option coverage, said the report. Medicaid postpartum coverage extensions, for example, would be matched at the Medicaid Federal Medical Assistance Percentage (FMAP) rate. Michigan would also receive matching payments at the Enhanced FMAP rate for CHIP. Alker said: 

“This would also be a smart fiscal decision as Michigan would receive substantial federal matching funds allowing the state to make this important long-term investment in the future of Michigan’s children.”