March 18, 2013: A new SHADAC brief is the first analysis providing state-specific estimates of the percent of low income uninsured nonelderly adults who will be ineligible for the ACA Medicaid expansion as a result of their immigration status. Unauthorized immigrants are ineligible for the ACA Medicaid expansion altogether, and legal resident immigrants are, in most circumstances, barred from Medicaid coverage for the first five years after they are granted permanent U.S. residency.
The report emphasizes that recent legal residents and unauthorized immigrants are much more likely to be low-income and uninsured than their non-immigrant and more established immigrant counterparts. As a result, in a state such as Minnesota, where unauthorized immigrants and recent legal residents compose a relatively small share of the overall population (3%), this group composes a relatively large share of the low-income uninsured (10%). In fact, while the unauthorized immigrant and recent legal resident population composes over 10 percent of the overall population in just four states (Arizona, Texas, California, and Nevada), this group makes up more than 10 percent of the low-income uninsured population in 26 states.
Most population surveys include non-legal residents in their estimates of the distribution of the uninsured. States should take note when monitoring changes in levels in uninsurance recognizing that many of the uninsured are not eligible for the ACA coverage expansions. In addition, there is a need to recognize that safety-net health care providers such as public hospitals, community health centers, and free care clinics are likely to continue to be key providers for this population after health reform, and the need for safety-net care will not be spread evenly across states. The challenges will be particularly difficult for safety-net providers in states with large numbers of immigrants who will not be eligible for Medicaid.
Read the brief: “State Estimates of the Low-Income Uninsured Not Eligible for the ACA Medicaid Expansion.”