The number represents approximately 20 percent of all uninsured children in California.

Of those children, up to 40,000 may be eligible for coverage but may not apply, due to confusion about new rules governing access to both the California Health Benefit Exchange and the state's expanded Medi-Cal program.

The Patient Protection and Affordable Care Act of 2010 (ACA) restricts its health insurance expansions in ways that exclude many uninsured children in California who are immigrants or have immigrant parents. And the policy brief's authors note that immigrant parents, potentially misinterpreting eligibility requirements for these new programs, may not enroll their eligible citizen children.

"Health care reform restrictions raise some very unpleasant questions about our willingness as a society to let children go without care," said the study's lead author, Ninez Ponce, a faculty associate with the center and an associate professor at the UCLA School of Public Health. "And confusion over the rules may result in even eligible children being cut off from coverage."

Who's excluded?

Using data from the 2007 California Health Interview Survey (CHIS), the study's authors estimate that under the ACA, approximately 30,000 undocumented immigrant children will be barred from participating in the Health Benefit Exchange, a newly established marketplace for health care plans with subsidies for lower-income Californians. Although their parents will be able to purchase private insurance outside of the exchange, they would not benefit from its protections or competitive prices.

In addition, approximately 150,000 uninsured children will be excluded from the ACA-funded Medi-Cal expansion due to their status as either undocumented immigrants or legal immigrants who have lived in the U.S. for fewer than five years.

An estimated additional 40,000 children who are legal citizens of the U.S. also may be excluded from the ACA coverage expansions as a result of confusion over their parents' citizenship status. Specifically, parents who are non-citizens without a green card -- who are themselves excluded from public programs and the exchange -- may perceive that the documentation restrictions also apply to their qualified citizen children, the study's authors predict.

Community clinics and budget cuts

Without coverage, parents and children alike will likely fall back on community clinics, which have long been a source of care for undocumented and new immigrant children.

"It is neither prudent nor fair to lock immigrants out of purchasing coverage through the exchange," said Daniel Zingale, senior vice president of The California Endowment, which funded the study along with The California Wellness Foundation. "The politicization of health care access for immigrants is unsound policy. Everyone needs access, and we know people generally have better access to preventive care when they have health coverage. This helps prevent costly health conditions."

Although public coverage programs such as Medi-Cal and Healthy Families provide a safety net for more than 1 million immigrant children, including undocumented children, state funding to cover this population may soon dry up due to California's ongoing budget crisis.

"Our health care system works best when everyone has access to -- and utilizes -- ongoing preventive care that keeps simple problems from turning into costly emergencies," said Gary L. Yates, president and CEO of The California Wellness Foundation. "To do otherwise, presents a public health risk."

Note: If no author is given, the source is cited instead.

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