One in every five American is a member of an immigrant family. (1) Despite their substantial numbers, these are much less likely to have health insurance and ready access to health care than in native-born citizen families. Family immigration status is, in fact, one of the most important risk factors for the lack of health care coverage among in the United States. About one-third of the nation's low-income. (2) uninsured live in immigrant (see Figure 1). Almost all of these meet the income requirements for eligibility for Medicaid or the State Children's Health Insurance Program (SCHIP), but for various reasons they are not enrolled. For example, some of these are ineligible for Medicaid and SCHIP because of immigrant eligibility restrictions. Many others are eligible but not enrolled because their encounter language barriers to enrollment, are confused about program rules and eligibility status, or are worried about repercussions if they use public benefits. Not only are of immigrants more likely to be uninsured and less likely to gain access to health care services than in native families, but communication barriers can also result in immigrant receiving lower-quality services. The linguistic, cultural, legal, and socioeconomic circumstances of immigrants pose special challenges and opportunities for policy officials and health care practitioners seeking to provide health care and health insurance coverage to in immigrant families. And because in immigrant constitute such a large share of the nation's uninsured, successfully reducing the total number of uninsured depends in large measure on how well the needs of immigrant are addressed. Furthermore, immigrants are increasingly a concern for every state. Although immigrants traditionally have been concentrated in a handful of states--California, Florida, New Jersey, New York, and Texas--an increasing number are relocating throughout the country in pursuit of employment. Seventy percent of immigrants still reside in California, Florida, New Jersey, New York, and Texas, but the immigration growth rate during the 1990s was highest in southern and central states such as Iowa, Nevada, North Carolina, and Virginia. (3) Health care and social service providers across the country are learning how to adjust their services to accommodate the needs of immigrant families. Federal, state, and local policies and practices can either promote or undermine insurance coverage and access to care for this large but underserved population. This article discusses the barriers immigrant face in securing health coverage and quality care and describes strategies that have been adopted to overcome these barriers. The article concludes with policy recommendations and suggestions for future steps to improve public health insurance programs for immigrant children. Children in Immigrant Families--A Diverse Population with Shared Concerns Speaking of children in immigrant families as a homogeneous group is misleading because these are extremely diverse. Immigrant come from every country in the world, speak a multitude of languages, and bring a host of cultural traditions to their new homeland. Most in immigrant are U.S.-born and therefore are native citizens whose parents are immigrants, but many other are foreign-born noncitizens. Despite this diversity, immigrant have shared challenges and concerns. This section details some of the most common barriers that impede immigrant families' access to health coverage, including federal eligibility rules and fear of jeopardizing immigration status. The section also describes communication barriers that can influence the quality and cost of health care that immigrant receive, as well as their use of health services and satisfaction levels with their health care. …