Almost 140,000 Latino children in California aren’t covered by health insurance, even though they’re eligible to enroll in Medi-Cal, the state’s safety-net health care program.

Three quarters of the state’s uninsured Latino children ages 18 and under are missing out on health coverage, analysts at the UCLA Center for Health Policy Research found. It’s likely these children aren’t going to the doctor regularly or getting routine checkups, the researchers said.

Unlike adults, low-income children in California are eligible for Medi-Cal regardless of their immigration status. But Susan Babey, a research scientist at the center, said some Latino parents may still be afraid of enrolling their kids.

“I suspect that some of them, particularly those who are undocumented, are hesitant to enter into that system because of fear of drawing attention to their undocumented status,” Babey noted.

The UCLA report uses data from the 2015-16 California Health Interview Survey, an annual statewide survey of more than 20,000 Californians. Data from the 2017 survey shows similar results, Babey said.

Mike Odeh, director of health policy at Children Now, an organization that advocates for improving children’s access to health care, said fearfulness among immigrant families has likely increased since these surveys were taken.

Last month, the Trump administration officially published a new “public charge” rule. The rule allows federal immigration authorities to deny permanent residency to immigrants who use Medi-Cal, food stamps, and some other public assistance programs. News of the rule has reportedly prompted many immigrant families to drop Medi-Cal and other benefits.

“My hypothesis is if we had the current data it would probably be an even higher percentage of eligible uninsured kids not enrolled,” he said. 

Language barriers may also play a role in discouraging Medi-Cal signups. Latino residents with low English proficiency are three times more likely to be uninsured than those who speak only English, the UCLA report found.

Overall, non-elderly Latino residents of all ages in California are more than twice as likely to be uninsured compared to other racial and ethnic groups. More than 1 in 10 lack health insurance, compared to about 1 in 20 non-Latino white residents, the research showed.

Whether or not Latino Californians have health insurance has wide-ranging implications for health care and family wellbeing in the state. Latino residents are California’s largest ethnic group, making up almost 40 percent of the state’s population.

“Health insurance means better access to health care services that kids need to be healthy and to develop on track,” Odeh said. “It also provides financial security, so if families are not enrolling in coverage they’re eligible for—and often times that Medi-Cal coverage is free or very low cost—then not only are the kids missing out on the health services, but the families are exposed to more medical risk.”

Lack of legal residency or U.S. citizenship is a major barrier to Latino adults seeking health coverage. About 860,000 Latino adults—more than half of the state’s uninsured Latino population—have incomes low enough to qualify for Medi-Cal, but they can’t access the program because they’re undocumented, the report found.

Perhaps unsurprisingly, these uninsured Latino residents are more likely than those with coverage to report being in poor health. About half hadn’t had a routine check-up or seen a doctor in the past year. They were also more likely than their insured counterparts to delay medical care because of cost.

“I think it is likely to put a bigger burden on California’s health care safety net, and possibly emergency rooms,” Babey said. “If you’re not getting this sort of routine care or you’re delaying needed care, you’re more likely to require some urgent care or emergency care.”

It’s not all bad news. More Latino residents have gained health coverage since implementation of the Affordable Care Act, which expanded access to health insurance through Medi-Cal and subsidies. But Latino residents’ overall insurance coverage rate remains lower than average, the report concludes.

Babey said California can address the problem by expanding Medi-Cal coverage to all income-eligible state residents, regardless of immigration status. Working to expand employer-based insurance would also help, she said, since fewer Latino residents get coverage through their place of work.

Odeh said the state should continue to fight federal policies that threaten immigrant’s access to health care, and invest in more outreach and education to encourage Latino enrollment in Medi-Cal.