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Health Care Access Outcomes for Immigrant Children and State Insurance Policy
Katherine E Douglas1, Michael C Monuteaux1, Katherine R Peeler2
1Divison of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
JAMA Network Open
|December 1, 2025
Summary
State policies significantly impact health insurance access for immigrant children. Inclusive policies improve access, reducing disparities compared to US-born children.
Area of Science:
- Public Health
- Health Services Research
- Health Policy
Background:
- State policies offer variable health insurance coverage for 3 million US immigrant children.
- Limited understanding exists regarding the association between these policies and healthcare access for this population.
Purpose of the Study:
- To examine disparities in health insurance and healthcare access between immigrant and US-born children.
- To analyze how state insurance policies influence healthcare access outcomes for immigrant children.
Main Methods:
- Population-based, retrospective cross-sectional study using the National Survey of Children's Health (2016-2022).
- Analysis included 277,386 children (3,097,329 immigrant children).
- Multivariable logistic regression models assessed associations between immigration status, state policies, and healthcare access outcomes.
Main Results:
- Immigrant children had lower odds of uninterrupted health insurance and usual sources of care compared to US-born children.
- Immigrant children experienced increased odds of forgoing medical care and facing referral difficulties.
- In states with the most inclusive policies, immigrant children showed increased odds of uninterrupted health insurance and having a primary care provider.
Conclusions:
- Significant disparities in healthcare access exist for immigrant children compared to their US-born peers.
- Inclusive state insurance eligibility policies may mitigate these disparities and improve healthcare access for immigrant children.
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