When Rama and her family won the green card lottery two years ago, they envisioned a perfect life in the United States. Leaving almost all their family behind in Palestine was not easy, but they were committed to securing a better future for their children.

Life in the United States is much better, indeed. They lived in Illinois for almost two years and recently moved to Florida after her husband secured a higher-paying job. “I recently learned that I’m 8 weeks pregnant. Since I’m a permanent resident, I started applying for Medicaid, but quickly learned that I didn’t meet the citizenship requirements. It’s very different here in Florida”, Rama shared.

Rama has been calling the health department and even private clinics to determine how she can access healthcare. “I’m losing sleep over this, trying to find a solution. Emergency Medicaid is only for labor and delivery, but you have to see a doctor several times during the pregnancy. Sometimes we regret moving to Florida because we didn’t expect to have this challenge”, she added. She’s right to focus on this. Timely healthcare is linked to better pregnancy outcomes for moms and babies.

According to federal law, lawfully residing immigrants are ineligible to receive Medicaid until they have lived in the U.S. with a qualifying legal status for five years. But federal law also offers the states the option to carve out two special populations from this five-year bar: pregnant women and children. In 2016, the Florida legislature passed bipartisan legislation to end the five-year bar for children. Now is the time to do so for pregnant women to ensure that Rama and others in her situation have coverage during the critical months of pregnancy.

Lifting the five-year bar will also have significant economic benefits for individuals, health systems, and the state. Individuals with coverage shoulder less medical debt and are more likely to seek the care they need because they don’t fear unpaid medical bills. Further, access to coverage results in decreased emergency room utilization and costly care such as surgery and hospitalization. Hospitals gain when patients are covered, as uncompensated care costs decrease. This eases the economic strain on safety-net institutions, hospitals, and their providers.

“Coming from Palestine, where it is not safe, we were thinking about our children and their future. We always thought if anything happens, and they have their American citizenship, they can go away. Seeing what is happening in Gaza, it makes us reflect on how lucky we are to be here, and not in the war. And even though we don’t have insurance, we are going to stay here until we get citizenship for our kids, but it’s not easy. I thought it would be easier here”, Rama concluded.

Under federal law, Florida has the option to provide pregnancy-related Medicaid to lawfully residing, income-eligible immigrant women, regardless of the length of time they have been in the United States. This option, established by the Legal Immigrant Children’s Health Improvement Act (ICHIA), has been adopted in twenty-five states. Extending pregnancy-related Medicaid coverage would provide essential care throughout the prenatal and postpartum periods to lawful residents and their U.S. born citizen children.

NOW IS THE TIME FOR FLORIDA TO END THE FIVE-YEAR BAR FOR PREGNANT WOMEN

The ICHIA option for pregnant women will improve maternal and infant health outcomes while saving the state and our hospital systems money. Florida recognized the importance of extending health coverage to lawfully residing immigrant children regardless of the duration of residency when it took up the ICHIA option for children in 2016. With preterm birth in Florida receiving a “D” from the March of Dimes, it is time to take this critical step for pregnant women and their babies, as we re-commit to improving outcomes for our most vulnerable mothers and infants