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SALT LAKE CITY — The Medicaid application for the baby is in the diaper bag.
For Alessander and Yessica Aldana, who have been trying to get coverage for 2-month-old Lyssvel and 4-year-old Lyssander for months, the pile of paperwork is a virtually impossible obstacle.
"They were asking us for so many things," said Aldana, as his daughter dozed under a pink blanket in the Central City Community Health Center where they've come to get her shots. "We applied before she was born, but they denied us."
In a state that touts itself as one of the best in the country for families and personal health, about 85,000 children remain uninsured, according to a recent report from Georgetown University's Center for Children and Families.
That's 9.4 percent of Utah's children — a figure puts Utah behind only Alaska, Texas, Arizona and Nevada in terms of children without health insurance.
Behind those statistics is another one: Many of those children are Hispanic.
Luis Garza, the executive director of Comunidades Unidas (Communities United), a health nonprofit for the Latino community, said many Latino families in Utah are unaware their children may qualify for help or are discouraged by fear.
In Utah, 22.2 percent of Hispanic children do not have health coverage — nearly double the national average, and the highest rate in the nation.
"The employees of these eligibility agencies don't reflect the community that they serve. The phone line staff might not have speakers of our languages. That creates a kind of disconnect that we have seen," Garza said. "The message is just not getting to these communities."
Jacqueline Montoya, the manager at Community Health Centers' Central City clinic, said 1 in 5 children seen at the low-cost clinic are uninsured. Most are Hispanic, and many have an undocumented parent or family member.
"Rumors get started — that it gets reported to immigration," Montoya said.
That means that parents often don't sign up their kids for Medicaid or the Children's Health Insurance Program, known as CHIP. Together, the two programs cover health care costs for most children from low-income families earning up to 200 percent of the federal poverty level — about $48,500 for a family of four.
The consequences of not having insurance for kids can be wide-ranging and severe, Montoya said. Some are behind on vaccines. Parents miss work to care for them rather than take them to a doctor. Then kids miss school because they've let a cough worsen or an infection fester.
Cescilee Rall, a lead nurse at several middle and high schools in the Granite School District, said school nurses are often the only health care provider that uninsured students see.
A student at one of her schools recently broke his arm playing soccer. But because he wasn't insured, his parents wrapped his arm in a bandage and prayed it would get better, Rall said.
It didn't. That student is losing range of motion in his wrist and will likely have to get his bones rebroken and reset.
"The mom is heartsick," Rall said. "And I'm not the only one that sees that. I know that other school nurses around the state, this is a typical day of what we see."
Lack of awareness is a problem, according to Randal Serr, the director of Take Care Utah. More than 66 percent of uninsured children in Utah qualify for Medicaid or CHIP based on their family's income but aren't signed up, according to the Utah Department of Health.
At registration drives and schools, Serr said he often meets families who didn't know the program existed or didn't think they would qualify.
While other health departments in states such as Wisconsin and Georgia have heavily advertised their Medicaid or CHIP programs, the Utah Department of Health's outreach budget was slashed during the recession and never restored.
"There's nobody from the state telling them that it's OK to apply, telling them that they're wanted in the program, there's no sort of advertising campaign," said Serr. "It's kind of left them to word of mouth and people having to figure it out on their own."
Kolbi Young, a spokeswoman for the health department, said the outreach program used to include TV and radio spots and a van that traveled to schools and community events. Now, the department largely relies on insurance companies and community organizations to pick up the slack.
But, Young said, "Even with those significant marketing and outreach efforts, it's not a silver bullet. Outreach is an easy target … but even in all of our efforts, that was never the only reason why people were not applying."
Sometimes the problems can be due to miscommunication and paperwork.
Carmen Toledo, a Syracuse resident who left Mexico 21 years ago to come to Utah, has tried so many times to get her daughter on Medicaid that she's given up. "They denied every single time when I apply," Toledo said.
Her daughter, who has asthma, requires medication that costs $52 a month, even with discounts.
The Medicaid office told Toledo that her husband earned too much income to qualify for Medicaid, based on a construction project he completed years ago.
In fact, Toledo said, he was never paid for it — and it bankrupted the family. There are times when she and her husband have been unable to come up with the $25 fee to get her daughter in the door at the low-cost Community Health Centers clinic in Central City.
"We don't have nothing," Toledo said. "We worked really hard for other people — not for us."
The authors of the report, who partnered with representatives from the Salt Lake-based nonprofit Voices for Utah Children, argue that expanding Medicaid would help. States that expanded Medicaid saw greater improvement in the uninsured children rate than states that didn't, according to the report.
Utah's neighbor to the west, Nevada, had the highest rate of uninsured children in the country in 2013. But between 2013 and 2014, when Nevada expanded Medicaid, the state showed the largest improvement in the country. Its rate of uninsured children dropped 5 percentage points in one year.
Researchers call that phenomenon, which has been documented in previous research, the "welcome mat effect": When parents get covered, they're more likely to seek coverage for their children.
For Aldana and his wife, who works but does not receive health insurance through her employer, they know all too well the dangers of remaining uninsured. Last year, a series of throat and ear infections landed Lyssander in the emergency room and racked up $8,000 in unpaid bills for the family.
Their application for Lyssander and Lyssvel was just denied because they were missing a document from Aldana's last employer. That employer laid off Aldana on bad terms, he said, and won't help him fill out the missing form.
Asked how often he worries about his children — about Lyssander breaking a bone, about Lyssvel catching a fever — Aldana paused.
"Seriously," he said, "every day."
Daphne Chen is a reporter for the Deseret News and KSL.com. Contact her at dchen@deseretnews.com.
