Disparities in coverage and access to care between Latino children and their peers persist. Latino children with immigrant parents experience the greatest health care disparities and represent the fastest growing demographic in the United States. Most (60%) of these 10 million children belong to mixed-status families in which members have different citizenship/documentation statuses that confer different rights, benefits, and vulnerabilities. Parental status may be even more important than a child's own status for because children rely on parents to access the health care critical for a healthy childhood. Indeed, 25% of children of undocumented immigrants are uninsured compared to 14% of children of legal immigrants and 8% of children of U.S.-born citizens. These disparities suggest that policies intended to restrict access for immigrant adults may ultimately exclude their children, most of whom are U.S.-born citizens. Federal restrictions on public coverage eligibility for certain groups of immigrants ultimately delegate the bulk of immigrant healthcare policymaking to states, and these restrictions are maintained under the ACA. Thus, states remain the primary facilitators of public coverage for these excluded groups. Children's coverage rates have also historically varied greatly across states, and even more so for Latino children. In 2010, uninsurance among Latino children ranged from 1.9% in Massachusetts to 29.2% in Mississippi. Previous quantitative research examining parental documentation status is limited in rigor and/or generalizability and further qualitative work is needed. First, previous studies have yet to empirically isolate the direct effect of parental status on children's coverage within a nationally representative sample. Consequently, we do not know whether differences in coverage among the children of immigrants are attributable to parental status, a child's own status, or both. My model, using a measure of parental documentation status from the Survey of Income &Program Participation, allows me to isolate the direct effect of parental status over and above the indirect effect of differences in coverage attributable to a child's own status (AIM 1). Second, my study will be the first to examine the effect of parental documentation status at the state level;specifically, I explore how parental documentation status is modified by state policies that either enable or inhibit access (AIM 2). Finally, I explore immigrant parents'experiences navigating children's coverage and care to identify underlying mechanisms in the relationships examined above (AIM 3). My research lies at the intersection of two critical areas of policymaking in 2013 and beyond. In coming years and under constrained budgets, states will be making key decisions on coverage eligibility for the millions of immigrants excluded from ACA coverage expansions. My exploration of state policies highlights their vital role in facilitatig or restricting access for immigrant families, and the indirect impact on children. Moreover, renewed bipartisan attention to immigration reform heightens the need to understand the implications of the precarious status of millions of undocumented immigrants and their children.

Public Health Relevance

This mixed-methods study seeks to measure the effect of parental documentation status on health insurance coverage for the children of Latino immigrants, evaluate if and how this effect [is modified by state policies on] immigrant access to public coverage, and identify the mechanisms underlying the relationship between parental legal status and children's access to coverage and health care. My proposed research contributes to the literature by considering the family- and state-level effects of parental documentation status within a nationally representative sample and contextualizes and expands upon these findings via qualitative semi- structured interviews that will explore the mechanisms through which parental documentation status may lead to disparities in coverage and health care.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Dissertation Award (R36)
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HSR Health Care Research Training SS (HCRT)
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Willis, Tamara
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University of Minnesota Twin Cities
Public Health & Prev Medicine
Schools of Public Health
United States
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