By Dora Muhammad, VICPP Congregation Engagement Director —

Medicaid turns 55 tomorrow (July 30, 2020).  For more than half a century, this federal program has improved the health of millions by providing affordable health care options to people with low incomes.  But the fight continues to expand access to immigrants.

On the federal level, a five-year bar is in place on Medicaid applications. Enacted during the Clinton Administration in 1996, it requires five years of legal residence for immigrants to qualify. While states have the option to adopt broader eligibility requirements in order to ease these restrictions, Virginia instead added additional restrictions to require legal residents to provide work history for 10 years before they can become eligible for Medicaid. This is known as the 40-quarter rule because the work history is reported every quarter over a span of 10 years. No health condition can wait that long to be treated.  It is unjust that immigration status has become a social determinant of health. We need to remove these arbitrary barriers to basic care.

COVID-19 has revealed why programs like Medicaid must be more accessible to all. The unjust tragedy is that while immigrants are forced to wait to get coverage for themselves, they are working on the front lines in hospitals, clinics, and health centers providing care during the pandemic.

This past May, the Health Equity and Access under the Law (HEAL) for Immigrant Women and Families Act was introduced for the first time in the U.S. Senate since its first introduction in the House of Representatives in 2017. Among its proposed rule changes, it would remove the unnecessary federal five-year waiting period.

During the 2020 Virginia General Assembly session, state legislators passed a budget amendment that would eliminate the 40-quarter rule.  However, funding for the measure ($4.46 million) was unallotted due to the budget adjustments made in response to the COVID-19 pandemic. State legislators will once again have an opportunity to fund this budget amendment when they reconvene on August 18th for a Special Session to address the crisis.

A new COVID-19 budget amendment may also be introduced to extend Emergency Medicaid to all Virginia residents regardless of immigration status; it will be a few weeks before the bill and its cost estimates are released. Currently, Emergency Medicaid in Virginia is only available to all pregnant immigrant women—but only at the time of their labor, another rule that VICPP seeks to change.  Providing prenatal care to all pregnant women regardless of immigration status would help reverse the alarmingly high percentage of maternal deaths of women of color who would otherwise be eligible for Medicaid.  Healthy pregnancies are an essential factor in safe deliveries and healthy babies, both of which have become even more treacherous due to COVID-19.

The Virginia Interfaith Center for Public Policy advocated this health equity issue during the past General Assembly session through a budget amendment ($1 million) to Virginia’s Children’s Health Insurance Program (CHIP), which provides prenatal care coverage through Medicaid and our state-funded program (FAMIS).  The amendment died in committee, but it may be reintroduced during the upcoming special session.

These budget measures all reinforce access to Medicaid as a priority and must be funded now, not later.  They are vital to the public health of all communities in the Commonwealth.