In Michigan, immigrants have to wait years for public health insurance. That’s about to change.

By Anna Gustafson / July 31, 2023

A few years ago, Susan Reed, the director of the Michigan Immigrant Rights Center, was working with an immigrant family who had a child with Type 1 diabetes. 

The family was struggling. They were navigating life in an entirely new country and were trying to access health care for their child while uninsured. No matter where they turned, they faced barrier after barrier. Devastated, they were told: You have to wait. You and your child won’t be able to receive public health insurance for another five years.

“You can imagine the anguish of being in a new country, having a child with a chronic condition and knocking on every door and being told to wait five years,” said Reed, whose organization provides legal resources to immigrants across Michigan. “A child with juvenile diabetes cannot wait five years.”

The reason the family had to wait five years to receive public health insurance – which includes Medicaid and Children’s Health Insurance Program (CHIP) and covers about one-third of Michiganders – is rooted in the so-called “welfare reform” legislation that was passed by a Republican-led Congress and signed into law by Democratic President Bill Clinton in 1996. 

The “Personal Responsibility and Work Opportunity Reconciliation Act of 1996” – which was sponsored by former U.S. Rep. John Kasich (R-Ohio) – made sweeping changes to the country’s safety net. The legislation undid a welfare structure that had been created as part of the New Deal in 1935 and permitted low-income parents to access federal cash with no limits on how long those payments could continue. 

As part of the changes enacted in 1996, it became federal law that legal non-citizens – immigrants who are living in the U.S. with documentation but are not yet citizens – would have to reside in the country for five years before being able to access a variety of public assistance programs, including Medicaid, CHIP, Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF).

In 2009, the Children’s Health Insurance Program (CHIP) Reauthorization Act gave states the option to waive that five-year waiting period for Medicaid and CHIP for children up to 21 years old and pregnant people.

Now, 14 years after the law was enacted, Michigan’s Fiscal Year 2024 budget – which was passed by the state’s Democratic-led House and Senate last month – is poised to eliminate the requirement that non-citizen children and pregnant individuals must live in the country for five years before being able to access Medicaid and CHIP. 

The omnibus general government budget, which is expected to soon be signed by Gov. Gretchen Whitmer, includes about $26.4 million to implement this change. Once the policy goes into effect, there will be 14 states remaining with the five-year waiting requirement for Medicaid and CHIP.

Whitmer’s budget proposed in February included $32.1 million to implement the change, which was reduced to $26.4 million due to the state House and Senate agreeing on a change in the allocation of federal funds. The $26.4 million for this policy change includes about $20 million in federal funds and $6.4 million from the state’s General Fund.

When asked to comment on the Medicaid policy change, Whitmer spokesperson Stacey LaRouche wrote in a statement to the Advance that the governor “has a robust record of supporting women at each stage of life and ensuring all Michiganders have access to quality, affordable healthcare is central to her mission.

“Prioritizing the health and well-being of every Michigander ensures our state has a strong and healthy workforce and attracts workers and businesses to our state,” LaRouche continued. “That’s why the governor has focused on expanding reproductive care for women, including funding her Healthy Moms, Healthy Babies initiative, which aims to reduce the disproportionate racial impacts of maternal and infant mortality and improve care. Governor Whitmer will always support women at each stage of their life and will continue to make sure that Michigan remains a place where a woman’s ability to make her own medical decisions with her trusted health care provider is respected.”

Eliminating the five-year period is expected to impact about 4,000 children and thousands of pregnant people in Michigan, said Simon Marshall-Shah, a senior policy analyst with the Michigan League for Public Policy (MLPP). The MLPP has for years advocated for the state to end its five-year wait for public health insurance.

“We’re really excited to see this made it fully through,” Marshall-Shah said. “It will reduce the rate of uninsured among non-citizens.

“These are children and families and adults who have lived in our country for years and are otherwise income eligible [for Medicaid],” he continued.

In Michigan, 10.6% of immigrants in the state are uninsured, compared to 5% of Michiganders born in the United States. Among that 10.6%, more than 70% are non-citizens, according to data from the MLPP.

Since the 1996 law went into effect, immigrants in Michigan and across the country have had to use federally qualified health centers and “cobble together charity care” to access health services, Reed said. Often, immigrants would have to take on “massive medical bills” because they were unable to access health insurance, Reed said. Prior to 1996, immigrants with documentation did not have to wait to access Medicaid or other public benefits programs like food assistance.

“The complicated way that being a non-citizen affects eligibility for public programs and benefits is something that’s not well understood by the public,” Reed said. “If you’re a green card holder, who does it benefit to leave people without primary care? It’s a tremendously impractical policy.” 

But this policy has meant that, for decades now, immigrant children and families have not been accessing the care that they need – which, Marshall-Shah said, can lead to more serious health diagnoses and significant financial strain.

“Children are postponing well visit checks; they’re not getting conditions diagnosed because they’re not going to the doctor,” Marshall-Shah said. “For adults, it means only seeing a doctor if there’s an acute care need.

“People who are able to get their health care needs met early will be treated earlier, diseases won’t progress, and they won’t have to utilize the emergency room, which is very expensive,” he continued.

Additionally, accessing care at emergency rooms is not sustainable when it comes to addressing health needs, Reed noted. 

“You can’t go to an emergency room and get insulin every day,” Reed said. 

Though the impending change regarding the five-year waiting period is “really important” for thousands of Michigan families, it’s “also short of the changes we’d like to see,” Reed said. 

“We want to get all people covered in Michigan,” Reed explained. 

The 2009 law permits states to waive the five-year waiting period for Medicaid for children up to the age of 21 and pregnant people, but it does not allow them to eliminate the requirement for other adults. 

At the federal level, there are attempts to expand access to public benefits for non-citizens. This year, U.S. Rep. Pramila Jayapal (D-Wash.) and U.S. Sen. Mazi Hirono (D-Hawaii) introduced the LIFT the BAR Act, which would restore access to such programs as Medicaid and SNAP for all legal residents, including people with green cards, Deferred Action for Childhood Arrivals, and others. The bills – H.R. 4170 and S.2038 – were introduced in June and remain in committee.

While the policy change in Michigan doesn’t cover all legally residing Michiganders, it is welcome news, Reed emphasized.

“We want new immigrant families to thrive,” Reed said. “Anything we can do to make access to something as basic as health care – both primary care and more complicated levels of care – for kids who are just starting their new lives in the U.S. is something we should do.”

It also begins to rectify federal policies rooted in “the desire to divest in families and children of color,” which is in part why the 1996 welfare reform legislation passed, Reed said.

Still, Reed added, much more needs to be done to address racism within the country’s immigration system.

“We still live in an environment where the narrative that immigrants are getting things that others are not getting is generally being stoked,” Reed said. “Our presidential politics and national conversation is still very basic about who’s taking and who’s deserving and it’s just not reality-based when it comes to what immigrants contribute.”

Marshall-Shah said the Medicaid change in Michigan will help to further racial equity in a state where Hispanic and Latino children are more likely to be uninsured than other racial and ethnic groups. With the policy change, more Hispanic and Latino children will be able to receive health insurance, Marshall-Shah pointed out. 

Both Marshall-Shah and Reed noted that this policy change will likely retain and draw families – something that will help to address the population decline that Michigan has experienced in recent years. 

“We’re talking about how to increase population here in Michigan,” Marshall-Shah said, adding that policies like eliminating the Medicaid wait “make it so families know they can access what they need here, that policies are not as restrictive as they used to be, that kids can thrive here, and families can get the care and coverage they need.”

Right now, Reed said Michigan is losing out on people coming to the state specifically because of the five-year wait for health insurance.

“I frequently get calls from colleagues; they want to bring their husband’s parents from Canada and want to know, how do they get health care?” Reed said. “And it’s like, hmm, they better drive back to Canada.”