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Federal health care program targets low-income children

Eduardo A. de Oliveira

Marcela Villarosa, 9, of Boston, is feeling weak these days.  Since she developed asthma last winter she needs constant medical attention. Marcela has already missed school a couple of times, and her mother admits that the $400 medication monthly cost is tough for the family’s limited budget.

But Marcela’s parents had no idea they could take advantage of the Children’s Health Insurance Reauthorization Act (CHIPRA), a federal law that extended government-run health coverage to kids of low-income households.

“I didn’t know my children had the right to have a health insurance paid for by the government,” said in Spanish Maria Villarosa, Marcela’s uninsured mother, who before signing up for CHIPRA had to make cuts in the family’s food budget to pay for the girl’s medication. “The health bills were a constant strain.”

Marcela is among 4.1 million children the Congressional Budget Office (CBO) estimates that are missing out on medical care that the government is willing to provide for them. In 2009, 29 million children were enrolled in Medicaid and seven million in CHIPRA, which is funded by the federal dollars.

Forty-four states already cover children in families with incomes at or above 200 percent of federal poverty level, like the Villarosas who make under $17,000 a year.

President Barack Obama signed the CHIPRA law last year, expanding a 1997 law that already provided government-covered health care for the poorest children. The update struck down a provision in the original bill that required states to observe a five-year grace period before covering children of legal immigrants.

However, many parents — especially foreign-born ones — are still facing barriers to enrolling their kids. Among the most common obstacles are lack of English language knowledge, immigration status and transportation difficulties.

But according to Roseanne Pawelec, a spokeswoman for the Centers for Medicare and Medicaid Services (CMS), some children are ineligible.

“The program only permits coverage of children of legal immigrants and also all children born in this country even if their parents are undocumented,” said Palwlec.

In Massachusetts, many health centers aren’t demanding that parents show proof of their kids’ legal status in the country.

“Those who think children of undocumented parents should not get access to health services need to understand we’re all human beings deserving of having fair treatment and access to a doctor,” said Adelina Vega, a case manager at the South End Community Health Center, Boston-based clinic where Latinos make up about 60 percent of all patients.

Raque Del Villar, a Dominican mother, is a migrant parent who relies solely on programs like CHIPRA to get health coverage for her three children. Del Villar has been living in the U.S. without papers for only three months but so far her kids have attended two doctors appointments.

“We need help because without this program we have nowhere to go,” said Del Villar, who says she has never being asked to produce legal papers.

But even Massachusetts, hailed by many as the model for national health care reform, has its homework to do.

According to Bob Johnson, executive director at the South End Center,  Massachusetts has covered 95 percent of its citizens. The remaining five percent are mostly children, immigrant kids and the homeless. In Boston, Johnson estimates, 15,000 Latino children are uninsured.

A lot of those children are considered by federal officials as “very hard to reach.” To remedy that, from January to April, the federal government awarded 59 grants of $304,385 to non-profits and medical institutions for a two-year outreach program.

Since January, non-profit Health Care for All, one of the only Massachusetts institutions awarded a federal grant, enrolled 222 kids in a state subsidized health insurance paid for by the CHIPRA program. Of those, the vast majority of new enrollees are Portuguese and Spanish speaking children.

Health Care for All had a key role in helping pass the Massachusetts Health Reform in 2006, and remains an important player in educating migrant families about their health choices. Currently the non-profit employees dozens of language interpreters to make it easier to navigate the local health system.

“The response has being very satisfactory. But mis-information is everywhere,” said Dayanne Leal, a program coordinator at Health Care for All. “Many parents didn’t even know the program existed. This is a government support that comes in a moment in people’s lives when they really need help while forming a family.”

Natalia Souza, a pregnant single mother of two girls, fits perfectly in the change signed into CHIPRA by President Obama. The original law, which was called SCHIP, signed by President Clinton, and expired in 2007, did not cover pregnant women.

“Now my girls can see their primary doctor regularly,” said Souza waiting for a pre-natal appointment at Nashua Community Health Center, in New Hampshire.  “And my baby will be taken care of,” she added while her 2-year-old girl held the tip of her skirt.

While the CHIPRA outreach program was launched at the South End Center, many immigrants are frightened to access any government service and shy away from any contact with government officials.

Even in Massachusetts, their fears are newly heightened by the national uproar over a new Arizonan law that gives police the power to question anybody’s immigration status on the streets if they “suspect the person is living in the state illegally.”

The national debate already made an impact on Carlos Medeiros, a father of two boys from Hartford, Conn., for whom fear is an influential component in the decision of accessing health care.

“I know the government can track us down, if it wants. The best way to stay safe is keeping away from any emergency room,” said Medeiros, who as an undocumented worker is ineligible to get subsidized health insurance in his state. Medeiros, a construction worker, did not know his two American sons were covered under CHIPRA.

“I’ll get informed about my kids’ health service before I put myself at risk,” he said with suspicion lingering.

Pawelec, of CMS, says that the participating health centers are a good place for outreach because parents can seek out their local health clinics inconspicuously.

“These professionals already know their community, they are only here to help … Their only goal here is to ensure their own community has health insurance … There’s nothing to fear here,” she said.

Pawelec also said she’s absolutely convinced CHIPRA will save federal dollars in the long-run.

“Making sure that a child stays healthy from birth, through school years and adolescence, is a way to prevent costly health interventions in the future. It’s a no brainer,” she concluded.

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