State lawmakers have an unprecedented opportunity to help thousands of undocumented children in Minnesota gain access to health insurance coverage this year.
Under state law, undocumented individuals are barred from enrolling in Minnesota’s Medicaid and Children’s Health Insurance Program (CHIP) programs – known as Medical Assistance and MinnesotaCare, respectively – due to their immigration status. These two programs, funded jointly by the federal and state governments, provide health insurance coverage to Minnesotans with low incomes. Every year, Medical Assistance and MinnesotaCare together cover half a million children under age 20.
Members of the 2023–24 Minnesota Legislature should expand Medical Assistance and MinnesotaCare to cover undocumented children by eliminating immigration status as an eligibility criterion. In doing so, Minnesota would join a dozen other states that have enacted so-called “Cover All Kids” programs, which aim to close child insurance gaps and give all kids a healthy start in life no matter their origin.
Cover All Kids programs are funded with state-only dollars, a legal workaround to federal law that prohibits undocumented immigrants from enrolling in federally-funded public health insurance programs like Medicaid and CHIP. In designing their Cover All Kids programs, states have used state-only dollars to either expand their existing Medicaid/CHIP programs (as in California and Oregon) or create separate “look-alike” programs (as in Vermont and the District of Columbia) that deliver equivalent Medicaid/CHIP benefits to undocumented children.
Cover All Kids programs date back to the 1990s when Massachusetts and New York created state-funded programs (the Children’s Medical Security Plan in Massachusetts and the Child HealthPlus program in New York) providing coverage to children not eligible for Medicaid, including undocumented children. In the spring of 2000, the District of Columbia launched a pilot program, now known as the Immigrant Children’s Program, to “provide medical assistance to not more than 500 immigrant children not eligible to be covered under Medicaid”. Former Illinois Governor Rod Blagojevich’s landmark All Kids initiative, signed into law in November 2005, marked the nation’s first state-funded universal coverage program for all Illinois children regardless of immigration status. Less than two years later, Washington enacted a similar law providing comprehensive health coverage to all children, including those without legal status.
Democratic majorities have played a critical role in the creation of Cover All Kids programs. With the exception of New York, all states with Cover All Kids programs enacted these programs via a democratically-controlled legislature (or, in the case of the District of Columbia, a democratically-controlled council). All but three states – Massachusetts, New York and Vermont – enacted their Cover All Kids programs under government trifectas in which democrats controlled the governorship and both chambers of the legislature.
Arguably, there has never been a more opportune time than the current legislative session to make Cover All Kids a reality in Minnesota. Over the next two years, Minnesota democrats will have full control of the state government – only the second DFL trifecta in the past 40 years. State lawmakers will also have a record-setting $17.6 billion budget surplus during the 2023–24 session with which to fund various legislative priorities. These historic circumstances present what Gov. Tim Walz recently called “the golden opportunity that we have to make Minnesota an even better and fairer and more inclusive and more prosperous state”.
Returning DFL lawmakers who tried unsuccessfully in the 2021–22 session to expand MinnesotaCare to undocumented immigrants should capitalize on their party’s government trifecta by legislating a Cover All Kids program, the cost of which is well within the state’s financial means. To insure the estimated 12,000 undocumented Minnesotans under the Medicaid/CHIP child age limit of 21, lawmakers would need to appropriate about $3,308 per enrollee, totaling $40 million. This amount is a small fraction – less than 0.3 percent – of the massive $17.6 billion budget surplus.
Expanding Medical Assistance and MinnesotaCare eligibility to undocumented children would benefit individuals, communities, and the general state population in terms of cost savings, economic productivity, and public health. Studies show that providing Medicaid/CHIP coverage to uninsured children improves child health status, increases use of preventive services, reduces family financial burden and missed school and work days, and saves thousands of dollars per child each year in government spending. Insured children are more likely than uninsured children to receive needed health care, which increases their chances of growing into healthy and productive adults. By enacting a Cover All Kids program, Minnesota lawmakers would help our state address persistent health care disparities among immigrants and invest in a safer, healthier, and more equitable future for our children.
Hannah Geressu is a graduate researcher and Master of Public Health candidate at the University of Minnesota School of Public Health.