Examining the effect of CHIPRA expansion on health of immigrant children under five-year bar

摘要 移民儿童在获得医疗补助和儿童健康保险方面面临独特的困难 因为各州可以在他们法律的居住的前五年内将他们排除在资格之外 （这一规则被称为“五年酒吧”）。2009年儿童健康保险计划再授权法案 （CHIPRA）允许各州选择取消五年的禁令限制。然而，人们对此知之甚少。 CHIPRA对目标人群的健康、卫生保健获得和利用的影响。此外，担心 项目参与将导致移民执法可能会抑制项目的接受。这种担心很可能 在有非法移民的家庭中被宣告。 利用准实验差异中的差异方法，该方法利用 政策环境，我将研究CHIPRA的资格扩大到移民儿童的影响， 在美国待了不到五年。使用1997- 2018年全国卫生代表性数据 访谈调查，包括国家标识符，我将研究CHIPRA对健康保险覆盖面的影响， 五岁以下移民儿童获得和利用卫生保健的情况。接下来，我将评估效果 CHIPRA关于五岁以下移民儿童身心健康的报告。作为子目标，我将 确定CHIPRA扩张的影响是否因预先存在的保险计划而变化， 低收入移民儿童在五年以下。此外，我将研究保险的接受情况是否因 家庭移民身份。该项目的重点是AHRQ的一个优先群体--低收入家庭的儿童。 少数民族家庭。拟议的项目直接符合AHRQ的使命，即评估战略， 使医疗保健更容易获得、公平和负担得起。结果将填补文献中的一个重要空白 通过确定将公共保险扩大到新移民儿童的直接影响， 描述家庭移民身份如何影响公共福利的获得。结果将有助于国家 联邦决策者根据证据做出决策，权衡项目收益和项目成本。

Abstract Immigrant children face unique hardships in accessing Medicaid and the Children’s Health Insurance Program (CHIP) because states can exclude them from eligibility during their first five years of legal residency (a rule known as the “five-year bar”). The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) gave states the option to eliminate the five-year bar restriction. However, little is known about the effect of CHIPRA on the targeted population’s health, health care access and utilization. Furthermore, fear that program participation will lead to immigration enforcement may depress program take-up. Such fears are likely pronounced in families with undocumented immigrants. Utilizing quasi-experimental difference-in-differences methods that leverage state-by-year variation in the policy environment, I will examine the impacts of CHIPRA’s eligibility expansion to immigrant children that have been in the US for less than five years. Using nationally representative data from 1997- 2018 National Health Interview Survey that includes state identifiers, I will study effects of CHIPRA on health insurance coverage, health care access and utilization of immigration children under the five-year bar. Next, I will evaluate the effect of CHIPRA on the physical and mental health of immigrant children under the five-year bar. As a sub-aim, I will determine if effects of CHIPRA expansion varied by the presence of pre-existing insurance programs covering low-income immigrant children under the five-year bar. Further, I will examine if insurance take-up varied by household immigration status. This project is centered on an AHRQ priority population—children in low-income and minority families. The proposed project is directly in line with AHRQ’s mission to evaluate strategies that make health care more accessible, equitable and affordable. Results will fill an important gap in the literature by determining the direct effects of expanding public insurance to recently arrived immigrant children and by describing how household immigration status impacts the take-up of public benefits. The results will help state and federal policymakers make evidence based decisions that weigh program benefits against program costs.