Why thousands of undocumented children deserve comprehensive MassHealth coverage

From a health equity standpoint, the Legislature should extend coverage to undocumented kids via the Cover All Kids bill. It’s smart policy to invest in their health care now to avoid much larger costs down the road.

Eight-year-old Dylan Raudales Gomez was born without eyes, is partially deaf, and has serious developmental disabilities. Lacking legal status, he has limited health care coverage under MassHealth.Ruth Gomez

Massachusetts has the highest rate of health insurance coverage in the nation.

How many times have you heard that? The Commonwealth has earned those bragging rights, of course. Nearly every year, the state ranks near or at the top among all states. In 2019, only 3 percent of its residents were uninsured, the lowest rate in the country.

And yet, those bragging rights, oddly, might make lawmakers complacent. Indeed, such impressive coverage rates sometimes mask small yet important gaps that are nonetheless urgent to fill.

Case in point: More than 30,000 children and young adults without legal status are eligible only for limited health coverage through safety net programs. A bill pending in the Legislature would expand comprehensive MassHealth coverage to all children and young adults under 21 who are eligible, regardless of their immigration status.

Currently, these young people typically have coverage with limits, such as a $200 annual cap on prescription drugs; no access to in-home care, which is important for children who have complex disabilities; no coverage of durable medical equipment such as wheelchairs and feeding tubes; no coverage of eyeglasses or other vision aids, among other limitations.

“If you are an undocumented kid, you have access to some safety net services and some preventative care — like you could go to your annual visit with a doctor and the emergency room, but there are strict caps on outpatient mental health services,” said Suzanne Curry, behavioral health policy director at Health Care for All, which is advocating for the bill.

Ruth Gomez has a son, 8-year-old Dylan, who is part of the population with limited health care coverage under MassHealth because they lack legal status. Dylan is blind (he was born without eyes), partially deaf, and has serious developmental disabilities. He needs Gomez’s assistance for practically all of his basic functions. Gomez told me in an interview that she can’t work because she is Dylan’s primary caretaker.

“His coverage includes only the basics: emergency services, some medicines, etc.” said Gomez, who lives in Everett. “But we don’t have access to occupational or physical therapy. He was prescribed medication to control his excessive drooling. But it costs $400 a month. We can’t afford that. So we have to get by without it.”

Nine other states, including Connecticut, Maine, and Vermont, and Washington, D.C., have enacted similar measures to expand their Medicaid programs to cover children regardless of their immigration status.

The policy was recommended by the Massachusetts Health Equity Task Force. Established by the Legislature in the summer of 2020 to tackle the racial inequities exposed by the COVID-19 pandemic, the group released “A Blueprint for Health Equity” a year ago with recommendations to target those health disparities. The task force drew attention to the limited MassHealth coverage that undocumented children and youth currently receive as a “major health equity barrier.” Passing the bill “will make a significant difference in the health and well-being for this underserved population,” wrote the task force members.

The main question that expanding MassHealth coverage raises is about resources. MassHealth already accounts for a large share of the total state budget: 36 percent in fiscal 2022. But its share drops to 22 percent when counting only state dollars. In other words, the program is partially paid for by the federal government — in fact, the feds cover more than half of the cost of MassHealth, according to a policy brief from the Massachusetts Budget and Policy Center. Health Care for All estimates that enacting the bill carries a cost of approximately $110 million, which, at a time when the state coffers are awash in cash, is not a lot to ask for.

Consider the long-term impact of denying enhanced health coverage to this young population. Eventually, “this [cost] shows up . . . maybe in schools or even in the juvenile justice system. It takes a long time to see a return on investments in health care, including pediatrics generally,” said Curry.

From a health equity standpoint, the Legislature should extend coverage to undocumented kids like Dylan via the passage of the Cover All Kids legislation, as the bill is known. It’s also smart policy to invest in their health care now to avoid much larger costs down the road.