182 Harvard Law & Policy Review [Vol. 13
beyond preventative care.
151
Even with health insurance, specialized care can
be expensive and hard to access.
152
Workers who have health insurance reported that they utilized health-
care services more frequently.
153
The main sources of health insurance for
farmworkers are employer-provided health insurance, Medicaid/CHIP (the
Children’s Health Insurance Program), and the Affordable Care Act (ACA)
marketplaces.
154
Thirty-seven percent of farmworkers are enrolled in Medi-
caid.
155
Under the Personal Responsibility and Work Opportunity Act
(PRWORA) of 1996, eligibility for federal benefit programs, including but
not limited to Medicaid and the Supplemental Nutrition Assistance Pro-
gram (SNAP, also commonly referred to as food stamps), was restricted to
individuals who are U.S. citizens or “qualified aliens.”
156
Therefore, while the
majority of farmworkers do not qualify for Medicaid or SNAP, the majority
of their children, who are U.S. citizens, do qualify for these programs. Ac-
cording to the NAWS, while only 37% of workers have health insurance
through the government, 82% of their children have government-provided
coverage.
157
Furthermore, some states use their own funds to expand Medi-
caid eligibility to immigrants who do not meet the “qualified alien” defini-
tion but are lawfully present.
158
These states include New York and
California,
159
which also have large farmworker populations.
151
See Kate Samuels et al., Transforming Rural Health Care: High-Quality, Sustainable Ac-
cess to Specialty Care, B
ROOKINGS
I
NSTITUTE
: H
EALTH
A
FFAIRS BLOG
(Dec. 5, 2014), https:/
/www.brookings.edu/opinions/transforming-rural-health-care-high-quality-sustainable-ac-
cess-to-specialty-care/ [https://perma.cc/7C28-NZR6].
152
Health insurance deductibles and co-pays, especially for out-of-network services, can
result in high out-of-pocket costs for specialty care services. See Mabel C. Ezeonwu, Specialty-
care Access for Community Health Clinic Patients: Processes and Barriers, 11 J. M
ULTIDISCIPLI-
NARY
H
EALTHCARE
109, 112–113 (2018), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
5826087/pdf/jmdh-11-109.pdf [https://perma.cc/ZH82-8X2W].
153
See DOL NAWS 2013-2014, supra note 18, at 43.
154
See id. at 42. Note that NAWS data does not distinguish between Medicaid/CHIP and
ACA marketplaces. The NAWS data was collected at the beginning of ACA implementation.
NAWS data was collected from 2013 to 2014. Full ACA implementation, including the mar-
ketplaces, began in January 2014.
155
See id.
156
See 8 U.S.C. §§ 1641(b), 1642(a)(1) (2012).
157
See DOL NAWS 2013-2014, supra note 18, at 42–43.
158
Under Section 214 of the Children’s Health Insurance Program Reauthorization Act
(CHIPRA), states have the option to provide Medicaid and CHIP coverage to “lawfully resid-
ing” children and pregnant women. See Children’s Health Insurance Program Reauthorization
Act of 2009, Pub. L. No. 111-3, 123 Stat. 56 § 214 (2009) (codified as amended at 42 U.S.C.
§ 1396b(v) (2012)). Some states have gone beyond CHIPRA, using state funds to expand
Medicaid eligibility to additional groups of immigrants. For example, California’s Medicaid
program (Medi-Cal) is open to all lawfully residing adults up to 138% of the Federal Poverty
Level, pregnant women up to 322% of the Federal Poverty Level, and children up to 266% of
the Federal Poverty Level. See T
HE
H
ENRY
J. K
AISER
F
AMILY
F
OUND
., M
EDICAID IN
C
ALI-
FORNIA
(June 2017), http://files.kff.org/attachment/fact-sheet-medicaid-state-CA [https://
perma.cc/E8T8-CQVJ].
159
In May 2016, California further expanded Medi-Cal eligibility to undocumented chil-
dren (SB 75). See SB 75 - Full Scope Medi-Cal for All Children, C
AL
. D
EPT
. H
EALTH
C
ARE
S
ERVICES
(Aug. 31, 2017), http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/sb-
75.aspx [https://perma.cc/AG3U-ABRQ]. According to data from the UC Berkeley Labor