Image: Florida resident Irina Flores-Montalban is on a five-year waitlist to receive subsidized medical care for her ailing son.
MIAMI — About seven months after they moved to Florida, Irina Flores-Montalban found out that her 11-year-old son, Jose, had a blood clot in his heart and needed an operation. Without health insurance, she was advised to enroll him in the state’s Medicaid program in order to get immediate treatment.
But her situation became more dire when the 38-year-old Sarasota mother was told that Jose — as well as his two siblings — was not qualified. Although they have a green card, the family did not meet the state’s five-year residency requirement.
“I didn’t know that every state is different,” Montalban, an Ecuadorian immigrant, said in Spanish. “In New York, where we used to live, they just asked me to fill out the form and soon I got the medical cards in the mail.”
Desperate, she asked one of her children to go online and look for a cardiologist. At the time, Jose had already been experiencing frequent nosebleeds. “I was getting frustrated but [I was] determined to get my son treated. I was willing to pay the consultation fees,” Montalban said.
When they arrived at the doctor’s office, the doctor informed her that Jose had a congenital heart condition and was like “a ticking time bomb.” Because he needed to have an operation right away, the doctor’s aide helped put Jose in an emergency care program, but the post-operation medical bills were not covered.
In Florida, lawful immigrants are eligible for public benefits such as Medicaid and the State Children’s Health Insurance Program (SCHIP) only if they have been residing in the United States for five years. Under the 1998 welfare reform law -- which introduced restrictions for federal income-based benefits related to immigration status and length of U.S. residency -- 22 other states, including Washington, D.C. enforce the same eligibility requirement.
Confusion among immigrants limited in their English ability and unfamiliar with the nation’s health care system is common.
“It’s just not right,” said Diana Ragbeer, director of public policy and communications at the Children’s Trust of Miami-Dade County. “We’re not even talking here about undocumented adults; we’re talking about lawful children.”
Filling the Coverage Gap
In Florida, the law impacts somewhere between 20,000 and 40,000 immigrant children across the state, according to a Florida Center for Fiscal and Economic Policy (FCFEC) report. Health care advocates there say getting rid of the five-year waiting period would go a long way toward closing that gap.
“The only way to [cover these children] is for the state to lift the five-year ban,” said Nicholas Duran, health care coordinator for the non-partisan Children’s Movement of Florida, which works to expand coverage for children in the state. “Even Obama’s Affordable Care Act won’t change or impact the ban.”
Since 2009, with passage of the Children’s Health Insurance Program Reauthorization Act (CHIPRA), states have had the option of extending eligibility for Medicaid and CHIP to all lawful immigrant children residing in the United States, with no waiting period.
Florida, however, has yet to change any provisions in its law.
Legislation to lift the ban was introduced last year. The bill, known as the Flordia Kidcare Program (SB 704), is currently being considered by the state legislature. Opponents of the bill say it will lead to increased state spending and that it aims to include undocumented immigrant children, charges that supporters roundly dismiss.
“It is important to note that SB 704 does not seek to open up eligibility for undocumented immigrant children or those who are temporarily residing in the country,” Duran said. “And it [SB 704] also took into account the enhanced federal matching dollars” that would come from CHIPRA if the state does away with the waiting period.
The maximum cost to the state of extending coverage to all legal immigrant children, the FCFEC findings also showed, would be $17.6 million. Most of this budget is already available, supporters of SB 1294 contend, as it would use unspent state funds already earmarked for children’s coverage.
They add that with the federal government’s 71 percent funding increase for Florida’s CHIP program, an additional $3.8 million will flow into the state.
Choosing One Among Her Children
After separating from her husband, Montalban and her three young children – Margarita (17), Emilio (9) and Jose – moved from New York to Florida to start a new life. Her brother bought a house in Sarasota, and asked her to take care of the house and have their mother live with them.
It was an opportunity for her to save rent and, at the same time, her kids would be closer to their grandmother, she said.
Montalban works part-time at the clothing retailer Forever 21 and earns about $600 a month, enough to cover food costs and other basic needs. Several days a week she attends an ESL class at a local community center.
But that routine was upended the day she registered Jose for school. When he took the required physical exam, nurses discovered that his blood pressure was well above normal. They later learned of clots in his aorta. His condition is congenital, Montalban said, meaning he may need a cardiologist for the rest of his life.
Aware that her kids were ineligible for Medicare, she found herself facing a painful dilemma: choosing which of them to insure.
In retrospect, the choice was clear.
“I had no choice but to get health insurance only for Jose. I pay $141 a month for his insurance. I would not be able to afford insuring my other children, so I pray that they won’t have the same health problems.”
Montalban then added that passage of SB 704 would be “more than a blessing” for her and her children. “If they qualify for Kidcare, I’ll only be paying $20 a month to cover their health insurance,” she said. “I know that there are a lot of people who are in my situation.”
Liz Gonzalez of New America Media in San Francisco, CA and Ryan Morris of Florida CHAIN in Tampa, FL contributed to this report. This story was written as part of a series on healthcare reform funded by the Atlantic Philanthropies.