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Health Coverage for Immigrants: Addressing the Gaps in Healthcare

In a country as diverse as the United States, access to healthcare should be a fundamental right for all residents, regardless of their immigration status. However, the reality is that noncitizen immigrants, especially those who are undocumented, often face significant barriers to accessing health coverage and care. As of 2022, there were approximately 21.2 million noncitizen immigrants residing in the U.S., constituting about 7% of the total population. Among them, six in ten are lawfully present immigrants, while the remaining four in ten are undocumented immigrants. This demographic faces higher uninsured rates compared to citizens, primarily due to limited access to private coverage and eligibility restrictions for federally funded coverage options.

 

The State of Coverage for Immigrants

 

Despite these challenges, there have been notable efforts by some states to expand coverage to immigrants, including immigrant adults. As of March 2024, 12 states and the District of Columbia provide fully state-funded coverage for income-eligible children regardless of immigration status. Additionally, six states plus D.C. extend fully state-funded coverage to some income-eligible adults regardless of status. Furthermore, most states have taken up options in Medicaid and the Children’s Health Insurance Program (CHIP) to expand coverage to lawfully present immigrant children and pregnant women.

 

Implications of Coverage Expansions

 

The expansion of coverage for immigrants has been associated with lower uninsured rates, with immigrant adults in states with more expansive coverage options being half as likely to be uninsured as those in states with less expansive coverage. Despite these positive developments, uninsured rates remain high among noncitizen immigrants, highlighting the need for continued efforts to expand coverage and ensure its sustainability over time.

 

Barriers to Coverage

 

Noncitizen immigrants face various barriers to accessing health coverage, including eligibility restrictions and waiting periods. For example, many lawfully present immigrants must wait five years before qualifying for Medicaid or CHIP, even if they meet other eligibility criteria. Undocumented immigrants are ineligible for federally funded coverage options and cannot purchase coverage through the ACA Marketplaces. While some states have taken steps to fill these coverage gaps, there is still work to be done to ensure that all immigrants have access to affordable healthcare.

 

State-Funded Coverage Initiatives

 

Several states have implemented fully state-funded coverage programs to address the needs of immigrants who are ineligible for federal programs. These initiatives provide coverage to lawfully present immigrants who are in the five-year waiting period for Medicaid or CHIP, Deferred Action for Childhood Arrivals (DACA) recipients, and undocumented immigrants. By offering comprehensive coverage regardless of immigration status, these states are taking proactive steps to improve health outcomes and reduce disparities among immigrant populations.

 

Impact on Healthcare Access and Use

 

Research indicates that state coverage expansions for immigrants have a positive impact on healthcare access and utilization. Immigrants residing in states with more expansive coverage policies are more likely to have health coverage, less likely to postpone or forgo care due to cost, and more likely to have a trusted healthcare provider. These findings underscore the importance of policy interventions in improving health outcomes and reducing disparities among immigrant populations.

Access to healthcare is a fundamental human right, yet many noncitizen immigrants in the United States face significant barriers to obtaining health coverage and care. While some states have taken steps to expand coverage options for immigrants, there is still much work to be done to ensure that all residents have access to affordable healthcare regardless of their immigration status. By implementing innovative strategies and investing in comprehensive coverage initiatives, policymakers, and healthcare providers can help address the gaps in healthcare and improve the well-being of immigrant communities across the country.

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