This issue brief from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) describes the multiple barriers that immigrants face in accessing federal, state, and locally-funded health and human services programs. While there are some barriers to access based on eligibility restrictions based on immigration status, there are many health and human services programs that do not have such immigration status eligibility restrictions. The issue brief was prepared by the Urban Institute under a contract from ASPE.

22 states and the District of Columbia have used a federal option to provide Medicaid and Children’s Health Insurance Program (CHIP) to immigrant children and/or pregnant women who are lawfully present (i.e., regardless of their date of entry into the United States), with most providing coverage to both children and pregnant women. Additionally, states may use CHIP to provide prenatal care, labor, and postpartum care to pregnant women without regard to immigration status, and 14 states have adopted this option. Using state-only funds, 14 states and the District of Columbia provide some public health insurance coverage to selected groups of qualified immigrants during the five-year ban on federally funded benefits. Moreover, 16 states and the District of Columbia provide some health insurance coverage to select groups of nonqualified immigrants.

Based on interviews and site visits with state and local public administrators, service providers, and advocates several factors were identified as contributing to lower application and take-up rates among eligible immigrants, including: (1) the complexity of the application process and eligibility rules; (2) related administrative burdens such as documentation required to support applications for services; (3) language, literacy, and cultural barriers; (4) transportation and other logistical challenges; and (5) climates of fear and mistrust. The issue brief also describes the additional complexities for immigrant families where family members have different immigrant statuses.

The wide range of barriers that many immigrants face poses challenges for immigrant families’ abilities to meet their basic needs and improve their well-being. Overcoming the barriers and improving access for immigrants will likely require sustained attention by both program administrators and immigrant community leaders.

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