Impact of medicaid policy changes on immigrant parents
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Impact of medicaid policy changes on immigrant parents Aig Unuigbe1,2 Received: 13 July 2017 / Accepted: 22 January 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract During the 1990s and early 2000s many states expanded Medicaid eligibility for parents particularly after the 1996 welfare reform. At the same time, welfare reform also put in place policies that limited the eligibility of recent immigrants for public programs including Medicaid. This paper evaluates the effects of these changes in Medicaid eligibility policy on the private and public health insurance coverage of immigrants as well as the overall insurance rate. It also looks at the effect on health care use and measures of health status. The findings indicate a significant increase in Medicaid coverage and an increase in the proportion insured overall with negligible crowd-out of private insurance. There is also an increase in the use of health care services. In the case of permanent residents, there is a diminished response to Medicaid eligibility changes possibly due to a “chilling effect”. Keywords Health insurance · Health policy · Medicaid · Immigrants JEL Classification I12 · I13 · I18 · J15
Introduction Immigrants are a substantial portion of the population in the United States and this proportion has grown over time. The immigrant share of the US population increased from 11.1% in the year 2000 to 12.9% in 2010 (Nwosu et al. 2014). However, a relatively large percentage of this group, compared to native born citizens, is in poverty and without health insurance. As of 1999, one-third of immigrants did not have health insurance and 16.8% lived in poverty (Camarota 2001). This uninsured rate varies by immigration status and length of stay. In the case of recent immigrants (noncitizens who have lived in the United States for 6 years or less), 52% of those in this group had no health insurance in 2003. In the same year, 43% of noncitizen immigrants with a longer tenure and 21% of naturalized citizens were also uninsured. This compares with a 15% rate for native citizens (Fremstad and Cox 2004).
* Aig Unuigbe [email protected] 1
The Graduate Center, City University of New York, New York, USA
2
Present Address: The University of Washington, Seattle, USA
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A. Unuigbe
One of the possible major contributors to the relatively low rate of insurance for immigrants is the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). This welfare reform legislation established new eligibility rules for various public programs such as Medicaid. In addition to meeting all other requirements, recent immigrants who were permanent residents had to be present in the US for at least 5 years before they could be eligible for federally funded Medicaid coverage. Immigrant citizens were not subject to this additional constraint. In response to this change, a number of states provided health coverage to some of these immigrants that were not eligible for federally funded Med
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