by Alexandra Vita, Michigan Advance
September 26, 2023
Almost 30 years ago, my mom was overjoyed that she was approved to work in the United States. Though it was difficult to move halfway across the world and be apart from her parents, her siblings and her friends, she was grateful for this new chapter. Her story echoes the experiences of many immigrants: she wanted to pursue a better life in the United States.
The first couple of years, however, held challenges. Although she worked as hard as she could, she could not afford health or dental insurance. She told me that every day, she lived in fear of becoming sick. This was especially difficult as she worked in a health care facility and was constantly exposed to different illnesses as she took care of others.
If she fell ill, she hoped it would pass by itself soon — paying for a doctor’s visit and medication was out of the question. She already felt overwhelmed paying for rent, buying food and providing financial support to her relatives. She postponed dental care even though she had conditions that needed regular visits.
Throughout medical school, I have been thankful for the chance to meet patients and listen to their experiences and hardships. But it is disheartening to hear how closely many of my patients’ stories mirrored my mom’s experience. Some patients couldn’t afford medications they needed. Other patients were worried a hospital visit would upend their family’s savings.
Though insurance makes affording health care possible, many people in Michigan are not eligible for Medicaid due to their immigration status alone.
Since 1996, lawfully present immigrants who meet Medicaid or Children’s Health Insurance Program (CHIP) residency and income requirements must have also resided in the United States for five years before they are eligible to access these programs. Since 2009, the Immigrant Children’s Health Improvement Act (ICHIA) option has allowed states to waive the five-year waiting period for Medicaid and CHIP for lawfully present pregnant people and children.
However, despite having the option for 14 years, Michigan did not adopt this policy.
Throughout my pediatric and OB-GYN rotations, it was evident that both childhood and pregnancy are times of immense physiological changes. Pediatricians have the unique opportunity to participate in the care of children from the days following their birth until they are 21. They guide parents in discussions about nutrition and safety as a child grows, and help teenagers through changes in puberty and mental health.
OB-GYN physicians partner with pregnant patients to manage conditions like diabetes or high blood pressure that significantly influence health outcomes. They answer questions about birthing plans, and are there during deliveries to address any complications that occur.
Knowing how crucial access to care is for vulnerable populations in these times of changes, I was overjoyed that Michigan recently funded the adoption of the ICHIA option to waive the five-year waiting period for Medicaid and CHIP for lawfully residing children and pregnant people.
The impact of this change is unmistakable — advocates in different disciplines and practices have joined together in celebration.
Jeremy Lapedis, executive director of the Washtenaw Health Project, works to connect clients to health coverage.
“I’m excited because this makes Michigan a more welcoming state for immigrants and makes sure those who need care are able to access it. People often had to make the choice between putting food on the table and purchasing expensive private insurance on the marketplace, and I’m hopeful ICHIA provides relief to these families,” he said. Photo courtesy of MIRC
The Michigan Immigrant Rights Center (MIRC) provides legal resources for immigrant communities and is also celebrating the funding of the ICHIA option.
“MIRC has watched this issue for several years because we regularly interact with people lawfully residing in the United States who are harmed by lack of access to programs like Medicaid and CHIP,” said Elly Jordan, Training & Impact Supervising Attorney at the Michigan Immigrant Rights Center.
“Many young adults we serve are victims of child abuse and neglect who are on a lawful path towards citizenship, but are currently unable to access health care benefits. They also face long wait times when seeking a work permit, which makes earning income to cover the cost of health care a challenge. Prior to 1996, eligible immigrant children had access to Medicaid without a five-year waiting period, and since 2009 Michigan has had the option to reinstate some of that coverage for lawfully residing children. In the meantime, immigrant children and families have paid the price of the waiting period in the form of crushing debt, deferring medical care or often both. We are glad that Michigan’s lawmakers have finally ended that anguish for some lawful residents and encourage them to continue to look for ways to protect immigrant families.”
This budget win is also celebrated by OB-GYN physicians. Between 2015 and 2019, over 400 new parents died from pregnancy-related deaths and pregnancy-associated deaths in Michigan. According to the Michigan Maternal Mortality Surveillance Program, the majority of these deaths were preventable.
Dr. Rosalyn Maben-Feaster, a practicing OBGYN physician who represents ACOG on the Michigan Council for Maternal and Child Health (MCMCH) board of directors, said, “We know that there can be short- and long-term consequences to complications with pregnancy. Expanding coverage helps ensure that all patients have access to care to help reduce these risks.”
Dr. Lindsay Admon is a practicing OBGYN physician whose research focuses on addressing racial and ethnic disparities in medical care and understanding how insurance coverage influences maternal and child health outcomes.
“Postpartum Medicaid eligibility extensions have tremendous potential to address preventable maternal morbidity and mortality, and improve maternal health equity,” she said.
These stories from community organizations and physicians highlight the immense impact the adoption of the ICHIA option will have. According to the Michigan League for Public Policy, thousands of new parents and 3,000 to 4,000 children will have increased access to health care with this change.
This is especially meaningful to me, as this population’s experiences share similarities with my mom’s journey.
When my mom reflects on the differences in her life thirty years ago compared to now, she exhales a long sigh of relief. She feels reassured knowing our family has access to health care, and remembers the stress when that was an uncertainty. Though there is still much work to be done, I’m grateful to be part of a state that took an important step in addressing health disparities that immigrant populations face.
With this important change in policy, I’m hopeful that many immigrant parents and children can have that sigh of relief, too.
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