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Many Latino children fall through the cracks in the health care system

Some are ineligible, and other don't know they could be receiving care
Monday, October 22, 2007 | 10:22 a.m. CDT; updated 12:17 p.m. CDT, Tuesday, July 22, 2008
Lourdes Curiel, 5, of Mexico, Mo., fell and broke her arm in September. Lourdes was dropped from the Medicaid rolls before the accident. Javier Curiel, a small grocery store owner, has since accrued more than $1,000 in medical bills related to the injury.

When Guadalupe’s two daughters get sick, she takes them to the doctor. They were born in America, so they are eligible for MC+ for Kids, the State Children’s Health Insurance Program (SCHIP) in Missouri.

When her son gets sick, it’s a different story. He was born in Mexico, so he’s uninsured. Guadalupe and her husband, who asked not to be named because they fear repercussions, pay out of pocket when he needs medical attention.

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“When I’m sick, I try to hold off and wait (to go to the doctor),” Guadalupe said in Spanish, through an interpreter. “But when my child is sick, I know I have to take him in. I don’t want things to get worse.”

Though Guadalupe and her family live in Sedalia, the disparity between siblings in the mixed-status families is typical for Latinos across the country, contributing to Latino children being the least insured segment of the U.S. population.

As the question of reauthorizing the State Children’s Health Insurance Program is played out under the bright lights of Washington’s political battlefields, the gap in coverage for Latino families and their children continues to widen. One in five Latino children is still uninsured. Though they account for only 18 percent of the population under 18, Latinos account for almost 35 percent of America’s 9 million uninsured children. And, of the nearly 3 million uninsured Latino children in America, 70 percent are eligible for SCHIP coverage but do not apply. Language barriers and fear of attracting the notice of the government are contributing factors.

SCHIP was created in 1997 to help low-income families insure their children. For the last 10 years, the federal government has provided $40 billion through SCHIP for states to expand coverage of uninsured kids. According to a January report from the Kaiser Commission for the Uninsured, it has worked: The number of uninsured children in the U.S. has dropped by one third since 1997.

The program, however, was only authorized to last 10 years. In anticipation of SCHIP’s expiration on Sept. 30, Congress, the president and countless interests groups negotiated the shape of the program’s future for nearly a year. On Oct. 3, President Bush vetoed a bill that reauthorized and expanded SCHIP, but the bill’s supporters vowed to gather enough votes to override the president’s veto.

Legal immigrants caught in middle

For six years, Elia Sandoval has been a mother to the Hispanic community of Mexico, Mo. She and her husband came with work visas in 2001 to work as preachers at the Church of the Nazarene and helped establish the town’s first Hispanic ministry. She helps Latino families navigate the confusing world of health care and social services.

“I help them fill out the papers, and I go to the doctor with them (to interpret),” she said. “I am always with them. When the women have their babies, they are practically delivered right into my hands.”

Elia Sandoval said she has been able to help 40 Hispanic families who worship at the church. She has not been as successful with her 15-year-old nephew, whom the Sandovals brought to live with them from Mexico. The boy’s father died when he was 5 years old, and his mother could no longer support him alone.

“We wanted to give him a second chance in America,” Elia Sandoval said. “He needed a new day.”

Though Elia and Juan are legal residents and Robert came to America on a student visa, he is not eligible to be insured through Missouri’s SCHIP program.

MC+ for Kids is not available to legal immigrant children until they have been in the United States for five years. Excluding new legal immigrants from Medicaid and SCHIP started in 1996, as part of federal welfare reform legislation.

When SCHIP was up for reauthorization this year, many child advocates and Latino and immigrant rights activists called for that stipulation to be eliminated from the program. An amendment to extend eligibility to legal immigrants passed with bipartisan support in the House version of the bill in July.

However, when the Senate reconfigured the bill in September, the amendment, known as the Immigrant Children’s Health Improvement Act (ICHIA), was gone.

Joan Suarez, chairwoman for Missouri Immigrant and Refugee Advocates, estimates that of the 150,000 legal immigrants in Missouri, 40 percent are children. At least 20,000 of those, she said, would be eligible for MC+ if the rights of new legal immigrants were restored.

As the crackdown on illegal immigration intensifies, legal immigrants are getting caught in the crossfire, Suarez said.

“Hyper talk about illegal immigration is now washing over onto the people who are here with documentation,” she said. “People see them as one and the same.”

The uninsured status of legal immigrants is a problem that extends far beyond the borders of Missouri. Under the current rules, there are 387,000 legal immigrant children being excluded from SCHIP or Medicaid coverage. These children’s families meet the income requirements of the programs, but because they have been in the country for fewer than five years, they are ineligible for public assistance.

“Unless we address these barriers, the insurance gap is going to grow,” said Jennifer Nu’gandu, senior health policy analyst at the National Council of La Raza, in a telephone interview. “Now, Congress has an opportunity to come back and rectify the mistake of leaving legal immigrant children out of the health care debate.”

Meanwhile, the Sandovals wait to see if they will be able to insure their nephew.

“We don’t have money to pay for a hospital visit or ambulance ride if Roberto gets hurt,” said Elia Sandoval, who emphasized that she and her husband always teach their nephew as well as their congregants the importance of obeying the law.

“If this country (wants) to have healthy people, and if this country gives aid to poor countries, then I think they can help the immigrants,” she said.

Eligible but not enrolled

Five-year-old Luordes Curiel doesn’t seem to mind the hot pink cast that is keeping her broken arm in place while it heals. After all, pink is her favorite color, and all her friends in her kindergarten class at Milan Elementary School have signed it.

Her father Javier, however, is less enthusiastic. As he stands at the cash register of the Flor de Mexico grocery store, which he opened in 2000, he begins to calculate the expenses behind Lourdes’s new brightly colored accessory.

“It was $400 just for the cast alone,” he said, “And it’s going to be another $400 for the hospital visit, I just got that bill…” he trails off and looks towards the ceiling. “And we still have to go back for a check up and X-rays. Who knows how much that is going to cost?”

Javier and his wife Maria are naturalized citizens, and their two children had been covered by Medicaid until a month ago, when they were “kicked off” the rolls for not completing the required paper work.

Javier had applied for an extension on his income taxes because of the extra work for an itemization that was needed to fill out self-employment tax forms. While this satisfied the IRS, the Department of Health and Human Services pulled the family from Medicaid because they could not confirm their eligibility without the tax returns.

“My accountant just didn’t have time (to file without an extension),” said Javier, who jokes without a smile about the inconvenient timing of becoming uninsured. “Of course, nothing ever happens when you actually have insurance.”

The Curiels said that they will probably not go back to Medicaid because of the complicated paperwork that is required to keep benefits. As the Curiels’ situation illustrates, the arduous process of applying for public assistance is a barrier to many low-income people.

The added obstacle of a language barrier presents further problems for the immigrant parents of children who are born in the U.S. and have a right to insurance.

“Not all the forms or all parts of the forms are available in Spanish,” said Sandoval, who provides free help for Hispanic families in filling out the necessary paperwork to get MC+ and Medicaid. “Plus, hiring an interpreter to help you fill out forms can be too expensive. At the (Department of Family Services) office in Mexico, no one speaks Spanish.”

Sandoval also pointed to the issue of paperwork needing to be filled out every six months. She knows many families who, like the Curiels, have fallen off the rolls for missing deadlines.

Because of the many rules that govern the program, many Latino families who are eligible either assume that they wouldn’t be eligible or fear that enrolling eligible children will put their families at risk.

“A mixed-status family, where the child is here legally but the parent is here illegally, is not likely to apply for assistance,” said Catherine Martarella, program director for Citizens for Missouri’s Children, the child advocacy group that publishes the popular child welfare updates. “Those parents might be afraid that the whole family might get deported. People become very resistant to ask for help.”

Changes at the state level have created even more complications in insuring low-income children. In 2005, Governor Matt Blunt tightened eligibility restrictions for MC+: parents had to show they could not find affordable private insurance at a rate that was less than 9 percent of the family’s income.

“The federal government has established that low-income families can’t afford to pay more than 5 percent of their incomes towards health insurance,” Martarella said.

The month after the new rule was initiated, 16,000 children became uninsured in Missouri. Now, 70,000 fewer are enrolled in MC+ than in 2004. Recent state legislation has tried to reverse these negative effects, primarily by overturning the 9 percent rule and lowering the requirement to 3 percent.

But it remains to be seen if the trend can be corrected or if the 2005 rules contributed to the stigma of government assistance being too mired in rules, regulations and paperwork to be worth the trouble.

“When the government starts tinkering with the rules and excluding families who can’t afford insurance, that’s when Latinos start suffering,” said Sister Louise Benecke, a nurse with Migrant Whole Health clinic in Kennett. “We see people all the time with chronic diseases and not enough coverage to help them get better.”


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