State Coverage of Immigrants: Overview and Impact on Health Care Access

The landscape of health coverage for noncitizen immigrants in the United States is complex and varied, with significant disparities in access to care based on immigration status. As of 2022, there were 21.2 million noncitizen immigrants in the U.S., accounting for about 7% of the total population. Among these individuals, about six in ten are lawfully present immigrants, while the remaining four in ten are undocumented immigrants. Noncitizen immigrants, especially those who are undocumented, face significant barriers to accessing health coverage and care, resulting in higher uninsured rates compared to citizens.

However, there have been recent efforts by some states to expand coverage for immigrants, including immigrant adults, in order to address these disparities. As of March 2024, 12 states and D.C. provide fully state-funded coverage for income-eligible children regardless of immigration status, while six states plus D.C. provide fully state-funded coverage to some income-eligible adults regardless of status. Additionally, most states have taken up options in Medicaid and CHIP to expand coverage to lawfully present immigrant children and pregnant women.

Research shows that these coverage expansions have been associated with lower uninsured rates among immigrant adults, with those in states with more expansive coverage being half as likely to be uninsured compared to those in states with less expansive coverage. These expansions have also led to increased access to care, lower costs, and improved health outcomes for immigrants. For example, California’s expansion to cover low-income children regardless of immigration status was associated with a 34% decline in uninsurance rates.

Overall, the impact of state coverage expansions on health care access and use for immigrants has been positive, with higher rates of health coverage, reduced delays in care, and increased access to preventive services. These efforts not only benefit the health and well-being of immigrant populations but also contribute to reducing overall health disparities in the U.S. It remains to be seen whether there will be continued movement to expand coverage for immigrants in the future and if existing expansions will be sustainable over time.