Estimates of Medicaid Expansion Coverage Omit Ineligible Immigrants

A recent study by the Robert Wood Johnson Foundation (RWJF) estimates that about 17 percent of low-income, uninsured adults included in the published projections of the number of people who would benefit from the Medicaid expansion actually would be ineligible for benefits because of their immigration status. The study was performed for the State Health Access Data Assistance Center (SHADAC), which develops research to inform state health care policy making; it is the first to break down the projections by state.

The Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) provides for states’ expansion of Medicaid to cover childless, nonpregnant adults under age 65 who have not been determined disabled and whose incomes do not exceed 138 percent of the federal poverty level (FPL). The Supreme Court decision in National Federation of Independent Businesses v Sebelius made the expansion optional. Nevertheless, as states continue to consider whether to expand eligibility, it would be helpful for them to know the number of people who would likely be affected.

Immigrants Ineligible for Assistance

Two groups of immigrants are ineligible for Medicaid: (1) individuals who have had lawful resident status for less than five years; and (2) immigrants without authorization to live in the United States, who are ineligible regardless of length of residence. SHADAC and the RWJF note that both groups of recent immigrants are more likely to have low incomes and be uninsured than other immigrants; the study does not distinguish between the two groups.

The Medicaid-ineligible immigrants comprise about 6 percent of the nonelderly population, but are 10 percent of the nonelderly who have low incomes, and 17 percent of the nonelderly adults who both are uninsured and have low incomes. In addition, they are not evenly distributed among the states. Ineligible immigrants make up more than 10 percent of the low-income nonelderly in 11 states. When the analysis includes those who are both low income and uninsured, the percentage of ineligible immigrants ranges from 3 percent in Mississippi to 34 percent in Nevada; in 26 states the percentage exceeds 10 percent of the low-income, uninsured nonelderly population.