17,000 immigrant children and parents in Washington state have lost public health coverage

In 2002, the Washington state legislature eliminated a state-funded medical assistance program for about 25,000 immigrant children and parents (both documented and undocumented) who did not qualify for Medicaid because of their immigrant status. The eliminated program had provided these families with health coverage comparable to Medicaid. The children and parents who were enrolled in the eliminated program were supposed to end up in reserved "slots" within the state's Basic Health program, which costs more for enrollees and provides fewer benefits than Medicaid. The new report examined the impact of eliminating this immigrant medical assistance program.

"A tremendous number of very low-income people have lost health coverage as a result of this change, " said Janet Varon, executive director of Northwest Health Law Advocates and co-author of the report. "Basic Health, with its substantial premiums, copayments, and limited coverage, is not accessible for these families. Before the change, so many could barely afford basic necessities like food and rent. When they were offered Basic Health, there was no way they could take on a new monthly health care bill."

The report's authors based their findings on analyses of state data, as well as interviews with providers and affected families. The report says that despite significant efforts in the state to help families transition to Basic Health, more than 12,000 residents, representing nearly half the group who lost their medical assistance coverage, did not make the initial transition. This, in large part, appeared to be due to problems meeting documentation requirements and completing the application process, as well as difficulty affording premiums.

As one parent interviewed for the report stated, "There was always some requirement we didn't meet, a piece of information we didn't provide. Every time we thought we had complied with their requests, there was something else missing."

Many of those who initially enrolled in Basic Health were not able to maintain the coverage, the report says. On average, 520 people from the immigrant transition group lost Basic Health coverage each month over the first 10 months after the transition. This represented an attrition rate of 4.4 percent per month -- nearly double the rate for this group when they were in the medical assistance program. In later months, exit rates increased further, nearing 9 percent. Application, documentation, and affordability issues were by far the largest reasons for disenrollment, with nearly 40 percent losing Basic Health coverage because of an incomplete application and over a third being dropped because of unpaid premiums.

It also appears that some families who remained enrolled in Basic Health experienced problems. Although some families were able to enroll in Basic Health and receive adequate care, the report finds that others, especially those with special health care needs, encountered difficulties obtaining needed care. Outreach workers, health plan staff, and providers identified instances in which individuals were no longer covered for needed services after transitioning to Basic Health. Some children with chronic conditions lost coverage for treatment of life-threatening and debilitating conditions. For example, Basic Health does not cover physical therapy for cerebral palsy, seizures and other disorders. It also does not cover certain kinds of feeding tubes and supplements for children with severe digestive disorders.

April 2004 enrollment data, gathered since the report's analysis was completed, show that only 8,000 of the original 25,000 immigrants who were not eligible for Medicaid were still enrolled in Basic Health. As such, it appears that over 17,000 children and parents from the transition group are no longer enrolled in public coverage, and it is likely that many of them have become uninsured.

Enrollment reports from the state's Medical Assistance Administration reveal that the loss of the immigrant medical programs, combined with other cost-cutting changes, pushed a total of 45,000 children off public coverage between October 2002 and December 2003.

This report was released by the Kaiser Commission on Medicaid and the Uninsured. For a full copy of the report, go to http://www.kff.org/medicaid/7079a.cfm.

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