Some reasons why children who could receive CHIP/Medicaid benefits are uninsured These reasons are common to most States. Even immigration concerns are no longer limited to the Border States: The family has applied for Medicaid before, and been denied Many parents do not really know why their application was denied. Often it is because they did not provide all the verification documents requested by their eligibility worker. Parents have the right to an explanation of a denial, and may be able to appeal it. Also, if they have more children now, their situation may have changed. Larger families have higher income eligibility limits. Family did not complete the Medicaid application process the last time In Texas, if they applied less than 2 years ago, they do not have to start from scratch, but can just update their information. Many parents do not know this. Parent believes their child(ren) would not be eligible Some parents believe their income is too high, or that their child must actually be sick in order to qualify. Local organizations are available to help them understand the process and the rules. Parent believes they don’t need it: their children are healthy This is important: CHIP and Medicaid are also for healthy children, and can help to keep them healthy. Not having to worry about paying for doctor bills means the parent can get care even when the child is not very sick – they don’t have to wait, and hope their child gets better. This can save them a lot of worrying, it’s easier on their child, and it also saves the government money! Parent prefers not to deal with the government (they don’t want "welfare," or have immigration issues) Sometimes the reason is pride or fear. Medicaid is no longer tied to welfare (TANF), but many people believe it is. The family does not have to be on welfare, or apply for it, in order to apply for Medicaid for their children. Immigration concerns are important (see below). Even people with "papers" are fearful of dealing with the government. It may take some time to overcome these feelings. Parent’s income is irregular, or they can’t get pay stubs to document income Pay stubs are preferred as a way to document income. Some parents think they cannot apply without pay stubs, but many other options are available .. If the parent’s employer refuses to sign a verification of employment, the parent still has other options. Documentation should not be a barrier. Parents prefer not to go through the Medicaid application process (they feel it is too difficult, demeaning) Many people feel the process asks too many personal questions. Some questions on the current multi-purpose application form are not used for Medicaid eligibility. Participating organizations can help parents understand which questions they must answer if they only want to apply for Medicaid for their kids. Medicaid in Texas still requires a face-to-face interview, but with proper preparation, it can be quick and may require only one appointment. Application assistance includes help in locating the right documents to complete the process. Immigration-related fears and Medicaid/CHIP Concerns tend to be in three areas. These are the facts, but you can expect that individuals may not believe you when you tell them: Impact of immigration status on Medicaid eligibility: only the child’s status is considered If parent is concerned about the effect of another family member’s status on a child’s eligibility, they should know that TDHS only considers the status of the child himself or herself. Nobody else’s status is considered. A child may be eligible if they are a citizen, or if they are a Legal Permanent Resident (LPR) who entered the U.S. before August 22, 1996. Confidentiality of applicant information Many parents will not apply for government programs because they believe the INS will get hold of information. TDHS policy is that information given for purposes of eligibility determination cannot be given to any other person or agency. However, if the INS or any other law enforcement agency approaches TDHS asking for information on a specific person by name, specific person by name, they must comply. "Public charge" ("carga pública") In cases of application for change of immigration status, the INS and State Dept. may consider whether the applicant is or may become dependent on the government (a "public charge"). Each case is considered individually; nothing will "automatically" make someone a "public charge." The policy on public charge was recently clarified. Several key points to emphasize about it: It does not affect the naturalization process It may affect an application for entry or residence, possibly (but rarely) deportation As of 5/22/99, only cash benefits (TANF, SSI) may be considered (or long term care) Most other benefits are never considered (Medicaid/CHIP, WIC, Food Stamps, housing)

Immigration lawyers and others are advising clients who have applications "en proceso" that they should not sign anything from the government ("no firme nada") because of public charge. This is unnecessary and unfair to children, but it will take time to overcome these fears. Agencies trained to do CHIP/Medicaid application assistance should have printed materials from the IRS explaining the new policies in black and white (disponible en español tambien).