February 2023 Health Care Briefing: One in Four Texas Children

Medicaid outreach to mixed-immigration-status families is a “must-have” for enrolling eligible uninsured children.

View this fact sheet as a PDF here.

U.S. Census data (2018) indicated that 5.6 million Texans lived in a family that includes at least one non U.S. citizen (of any immigration status: lawfully present or undocumented). About 1.9 million of these Texans were children and teens age 17 or younger, of whom the great majority — about 1.65 million — were U.S. citizen children. That’s more than one in every four Texas children. 


HHSC Medicaid outreach and informing shall include updated materials that clearly explain eligibility rules for non-citizens and their U.S. citizen family members, and inform parents that eligible children’s use of health care services will not harm a parent’s immigration status. Updated HHSC eligibility staff training on these topics will also be necessary to minimize errors in processing applications and renewals.

Every Texan and the Children’s Health Coverage Coalition (CHCC) endorse this recommendation for the 88th Texas Legislature.

Fear of accessing government services in the immigrant community caused families to drop coverage for tens of thousands of U.S. citizens and lawfully present children in recent years. This fear factor was the likely largest cause of the 237,000 decline in covered children in Texas Medicaid and CHIP from December 2017 to February 2020. 

Texas soon begins the major task of renewing/verifying eligibility for over 4 million children as pandemic continuous Medicaid coverage ends after 3/31/2023. Making sure families of more than a quarter of Texas children have solid accurate information reassuring them that they can safely enroll lawfully present immigrant and U.S. citizen children in Medicaid and CHIP will be critical to Texas’ success. Without it, eligible children will remain uninsured. 

Every Texan, the Seguro Texas campaign, the organizations of the Children’s Health Coverage Coalition (CHCC), and numerous other stakeholders are all eager to partner in spreading accurate information to families, but the greatest impact will be achieved if HHSC — Texas’ Medicaid-CHIP-SNAP agency — is also in a strong leadership role.


  • SB 630 by Menéndez calls for a public outreach and education campaign for mixed-status families regarding eligibility for Medicaid and the child health plan program (see also SB 2069 by Menéndez, 87th Legislature). 
  • Federal Medicaid officials have called on state Medicaid programs to lead in the effort to remove barriers for eligible children. 
  • Texas HHSC has in past years provided very clear and understandable language regarding immigration status and benefits, but it is currently both outdated and hard to locate. 
  • In its 2019 CHIP report, Wyoming emphasized the state’s use of outreach to mixed-immigration status families “to help those families and caretakers’ fears about how much information they need to provide to apply for eligible children,” and “sent a notification to immigration attorneys and organizations that assist immigration populations to share with their immigrant clients explaining that the (public charge) rule will not affect the permanent resident eligibility for children enrolled in Kid Care CHIP or Medicaid.”

For additional information, contact Anne Dunkelberg at dunkelberg@everytexan.org. Learn more about the Seguro Texas campaign here, and learn more about the Children’s Health Coverage Coalition here

View this fact sheet as a PDF here.

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