Amid Pandemic-Fueled Need for Medicaid, MPI Estimates Nearly Half of Income-Eligible Immigrant Adults Do Not Qualify Because of Immigration Status

WASHINGTON — Since the onset of the COVID-19 pandemic, the need for public health insurance has surged in the United States. Between February 2020 and January 2021, almost 10 million working-age adults and children signed up for Medicaid and its companion Children’s Health Insurance Program (CHIP). Yet millions of noncitizens with incomes that meet state eligibility thresholds for Medicaid did not qualify due to their status as recent green-card recipients, international students, temporary workers, nonimmigrant visa holders or unauthorized immigrants, a new Migration Policy Institute (MPI) analysis finds. These working-age immigrants, who are more likely to be low-income, are also more likely to be workers and parents than U.S.-born income-eligible adults.

The issue brief, Medicaid Access and Participation: A Data Profile of Eligible and Ineligible Immigrant Adults, outlines the number and characteristics of noncitizen adults who are excluded from Medicaid and how this varies by state of residency.

Drawing on a unique MPI methodology that assigns immigration status to noncitizens and models income according to Medicaid rules, the analysis finds that 9.5 million working-age immigrant adults (19 to 64) had incomes that met state eligibility thresholds in 2019. But 45 percent of them did not qualify for Medicaid due to immigration-status restrictions, including a 1996 law that made lawful permanent residents ineligible for Medicaid for the first five years after they receive a green card. Green card holders represented 13 percent of income-eligible noncitizens who were excluded from Medicaid in 2019, while the rest were comprised of unauthorized immigrants (75 percent) and those on nonimmigrant visas (12 percent).

However, even among immigrants who met income and immigration eligibility requirements, participation in Medicaid was 10 percentage points lower than for U.S.-born adults, the MPI researchers found. Complex eligibility rules and fears that participation in government programs could result in unintended consequences may have depressed participation for eligible immigrants, the brief’s authors Valerie Lacarte, Mark Greenberg and Randy Capps suggest.

Among the brief’s other findings:

• State rules have a strong influence on who can participate in Medicaid. The Medicaid income threshold ranges from 0 to 221 percent of the federal poverty level, with 38 states and the District of Columbia expanding their thresholds as allowed under the Affordable Care Act. Non-expansion states typically have very low income limits and reduced pathways for adults to access Medicaid. As a result, while 1.3 million foreign-born adults were income eligible in New York, fewer than 426,000 and 407,000 were eligible in Texas and Florida, respectively.
• Five states and the District of Columbia fund health coverage similar to Medicaid for groups of immigrants excluded from the federal program due to their status. The programs analyzed in California, Massachusetts, Minnesota, New York, Pennsylvania and D.C. boosted eligibility by 18 to 48 percentage points among income-eligible immigrant adults in 2019.
• Federally excluded income-eligible immigrant adults are more likely to be Latino or Asian than income-eligible U.S.-born adults. Latinos comprised more than six in 10 immigrants who were federally excluded from the program. Moreover, 42 percent of ineligible immigrant adults were parents, compared with 22 percent of similarly situated U.S.-born adults, and 43 percent were employed versus 36 percent of their U.S. counterparts.

“The public-health and massive unemployment crises triggered by the COVID-19 pandemic have underscored deep-rooted racial and ethnic health disparities across the country,” said Lacarte, who is a policy analyst with MPI’s Human Services Initiative. “Immigrants, especially Latinos, are over-represented in essential occupations that, simultaneously, have been critical to sustaining U.S. communities during the pandemic and that frequently lack employer health coverage. Because of their immigration status, many are also excluded from Medicaid eligibility.”

You can read the brief here: www.migrationpolicy.org/research/medicaid-immigrant-adults. A forthcoming companion piece will examine access and participation of immigrant children in the Medicaid and CHIP programs.

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The Migration Policy Institute (MPI) is an independent, non-partisan, non-profit think tank in Washington, D.C. dedicated to analysis of the movement of people worldwide. MPI provides analysis, development and evaluation of migration and refugee policies at the local, national and international levels. For more on MPI, please visit www.migrationpolicy.org.