Jane Dotson
In the US, undocumented immigrants face significant challenges in accessing healthcare due to their limited eligibility for insurance coverage. They are generally unable to obtain Marketplace health coverage and encounter restrictions with federally funded programs such as Medicaid, CHIP, ACA Marketplace coverage, and Medicare. However, certain states like California have expanded health insurance coverage to include undocumented adults, and others have provided coverage for children and pregnant people regardless of immigration status. These expansions have been associated with improved health outcomes and reduced insurance costs. Despite these efforts, many undocumented individuals remain uninsured, encountering barriers such as confusion, language access, and fear of authorities, leading to delayed or forgone medical care.
| Characteristics | Values |
|---|---|
| Access to health insurance for undocumented immigrants | Undocumented immigrants face significant barriers to accessing health insurance and are more likely to be uninsured than citizens. |
| Health insurance options for undocumented immigrants | Some states have expanded coverage through Medicaid and the Children's Health Insurance Program (CHIP) to include lawfully present immigrants and/or established state-funded programs to fill gaps in coverage for undocumented immigrants. |
| Eligibility for federally funded coverage | Undocumented immigrants face eligibility restrictions for federally funded coverage options, including Medicaid, CHIP, Affordable Care Act (ACA) Marketplace coverage, and Medicare. |
| Impact of insurance status on healthcare access | Lack of insurance among undocumented immigrants leads to delayed or forgone healthcare, resulting in worse long-term health outcomes that are more complex and expensive to treat. |
| State-specific initiatives | Certain states, like California and Maryland, have enacted legislation to extend health coverage to undocumented immigrants, while others provide fully state-funded coverage to fill gaps in federal programs. |
| Prenatal and postpartum care | Expanding Medicaid and CHIP coverage to pregnant individuals regardless of immigration status improves prenatal care, increases average gestation length and birth weight, and enhances postpartum care utilization. |
| Cost implications of expanded coverage | Providing insurance to immigrant adults through Medicaid expansion costs less than half the per-person cost of doing so for U.S.-born adults. |
| Emergency medical treatment | The Emergency Medical Treatment & Labor Act (EMTALA) mandates Medicare-participating hospitals to provide screening and stabilization services in emergency rooms, regardless of insurance or residency status. |
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What You'll Learn
- Lawfully present immigrants may qualify for Medicaid and CHIP but are subject to eligibility restrictions
- Undocumented immigrants are ineligible to enroll in Medicaid or CHIP or to purchase coverage through the ACA Marketplaces
- A growing number of states are offering taxpayer-funded health insurance to immigrants without legal status
- Noncitizen immigrants have high uninsured rates due to limited access to private coverage and eligibility restrictions
- Lawfully present immigrants can get Marketplace coverage and may qualify for premium tax credits and other savings
Lawfully present immigrants may qualify for Medicaid and CHIP but are subject to eligibility restrictions
In the United States, lawfully present immigrants may qualify for Medicaid and the Children's Health Insurance Program (CHIP) but are subject to eligibility restrictions. Lawfully present immigrants can get Marketplace coverage and may be eligible for lower costs on monthly premiums and extra savings on out-of-pocket costs based on their income.
The term "lawfully present" includes immigrants with "qualified non-citizen" immigration status, humanitarian statuses or circumstances (including Temporary Protected Status, Special Juvenile Status, asylum applicants, and victims of trafficking), valid non-immigrant visas, and legal status conferred by other laws (such as temporary resident status or LIFE Act).
To be eligible for Medicaid and CHIP, lawfully present immigrants must generally have a "qualified" immigration status and meet state income and residency rules. Many lawful permanent residents or "green card" holders are subject to a five-year waiting period after obtaining their qualified status before they can enrol in Medicaid and CHIP. However, some immigrants with qualified status, such as refugees and asylees, are exempt from the waiting period.
States have the option to waive the five-year waiting period and provide Medicaid and CHIP coverage to lawfully residing children and/or pregnant individuals. As of 2023, 35 states, the District of Columbia, and other territories have chosen to remove the waiting period and offer coverage to this population.
It is important to note that undocumented immigrants are not eligible for federally funded coverage programs, including Medicaid, CHIP, or Medicare, and they cannot purchase coverage through the ACA Marketplaces. However, a growing number of states are providing taxpayer-funded health insurance to immigrants, including those without legal status. As of 2023, eleven states and Washington, D.C., offer full health insurance coverage to more than 1 million low-income immigrants, regardless of their legal status.
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Undocumented immigrants are ineligible to enroll in Medicaid or CHIP or to purchase coverage through the ACA Marketplaces
Undocumented immigrants in the United States face significant barriers to accessing health coverage and care. They are generally ineligible to enroll in federal health insurance programs and must rely on state-level programs or other options for coverage.
At the federal level, undocumented immigrants are not eligible to enroll in Medicaid or the Children's Health Insurance Program (CHIP). These programs are restricted to lawfully present immigrants with "qualified" immigration status, such as refugees, asylees, and Lawful Permanent Residents (LPRs) or green card holders. Even for those who meet the eligibility criteria, there may be a waiting period of up to five years before they can enroll in Medicaid or CHIP.
Undocumented immigrants are also unable to purchase coverage through the Affordable Care Act (ACA) Marketplaces. While lawfully present immigrants may qualify for coverage and receive tax credits, undocumented immigrants are not eligible for these plans. However, it is important to note that Deferred Action for Childhood Arrivals (DACA) recipients and certain other immigration statuses may no longer be eligible for Marketplace coverage due to recent court orders.
Despite these restrictions, some states have taken the initiative to expand coverage for undocumented immigrants. Eleven states and Washington, D.C., provide full health insurance coverage to over 1 million low-income immigrants, regardless of their legal status. These states include Utah, New York, and California. The expansion of coverage is driven by factors such as the pandemic, which highlighted the importance of insurance coverage to control the spread of infectious diseases, and the goal of reducing the uninsured rate. Additionally, states have responded to pleas from hospitals to reduce the financial burden of treating uninsured patients.
While state-level programs offer some coverage options for undocumented immigrants, they still face challenges in accessing health care. Undocumented immigrants have higher uninsured rates and often face barriers such as fear, confusion about eligibility policies, language access issues, and higher costs. As a result, they may delay or go without needed care, leading to worse health outcomes in the long term.
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A growing number of states are offering taxpayer-funded health insurance to immigrants without legal status
In the United States, a growing number of states are offering taxpayer-funded health insurance to immigrants without legal status. As of 2023, half of undocumented immigrant adults and one in five lawfully present immigrant adults are uninsured, compared to less than one in ten naturalized citizens and U.S.-born citizens. Noncitizen immigrants face more barriers to accessing healthcare and are more likely to skip or postpone care.
Undocumented immigrants are more likely to be uninsured due to limited access to private coverage and eligibility restrictions for federally funded programs such as Medicaid, the Children's Health Insurance Program (CHIP), and Medicare. Even when eligible, they face enrollment barriers, including fear, confusion about eligibility rules, and language access challenges.
Several states, including GOP-led Utah, New York, and California, are expanding coverage for immigrants regardless of legal status. These states provide full health insurance coverage to over a million low-income immigrants, most of whom lack authorization to live in the U.S. The expansion of coverage is driven by the recognition that immigrants are part of the community and should have access to regular and reliable healthcare. Additionally, the pandemic highlighted the importance of insurance coverage to control the spread of infectious diseases, and reducing the uninsured rate further helps lower the financial burden on hospitals treating uninsured patients.
While some critics argue that providing health insurance to undocumented immigrants will encourage more people to enter the country illegally, supporters of the expansion point to the lower healthcare expenditures among immigrants due to their younger age and overall better health. Furthermore, undocumented immigrants contribute billions of dollars in insurance premiums and taxes, subsidizing the U.S. healthcare system.
States have the option to remove the five-year waiting period for Medicaid and CHIP coverage, and some have chosen to provide coverage to lawfully residing children and pregnant people without the waiting period. California, for instance, started covering immigrants regardless of status in 2016, beginning with children. The expansion of coverage to all immigrants in California is also projected to reduce poverty among non-citizen immigrants and their families.
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Noncitizen immigrants have high uninsured rates due to limited access to private coverage and eligibility restrictions
Noncitizen immigrants, especially those who are undocumented, face significant barriers to accessing health coverage and care. They are more likely than citizens to be uninsured. This is due to limited access to private coverage and eligibility restrictions for federally funded coverage options. Undocumented immigrants are often employed in jobs that are less likely to provide health benefits. They also face eligibility restrictions for federally funded coverage options, including Medicaid, the Children's Health Insurance Program (CHIP), Affordable Care Act (ACA) Marketplace coverage, and Medicare.
Even when noncitizen immigrants are eligible for coverage, they face a range of enrollment barriers, including fear, confusion about eligibility rules, and language access challenges. These barriers contribute to their higher uninsured rate and lead to difficulties in accessing healthcare. As a result, noncitizen immigrants are more likely to report skipping or postponing healthcare services, which can result in worse long-term health outcomes that are more complex and expensive to treat.
While the majority of uninsured people in the United States are citizens, noncitizen immigrants have significantly higher uninsured rates. As of 2023, half of undocumented immigrant adults reported being uninsured, compared to one-fifth of lawfully present immigrant adults, 6% of naturalized citizens, and 8% of U.S.-born citizens. This disparity in uninsured rates is a significant concern, as it can lead to delayed or inadequate access to healthcare for noncitizen immigrants.
However, there are efforts to address this issue. Eleven states and Washington, D.C., provide full health insurance coverage to over 1 million low-income immigrants, regardless of their legal status. States like California, New York, and Utah are expanding eligibility to cover more adults and children, regardless of their immigration status. Research has shown that expanding coverage for immigrants can effectively reduce uninsured rates, increase healthcare utilization, lower costs, and improve health outcomes.
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Lawfully present immigrants can get Marketplace coverage and may qualify for premium tax credits and other savings
To be considered a "qualified non-citizen," one must meet state income and residency rules. Lawfully present immigrants who are "qualified non-citizens" may be eligible for Medicaid and the Children's Health Insurance Program (CHIP). However, there is typically a 5-year waiting period for many qualified non-citizens, such as Lawful Permanent Residents (LPRs) or green card holders. This means they must wait 5 years after receiving "qualified" immigration status before they can get Medicaid and CHIP coverage.
Exceptions to the 5-year waiting period include refugees, asylees, or LPRs who previously held refugee or asylee status. Additionally, states have the option to waive the waiting period and provide Medicaid or CHIP coverage to lawfully residing children and/or pregnant people. As of 2023, 35 states, the District of Columbia, and several U.S. territories have chosen to do so.
Lawfully present immigrants who make less than 100% of the federal poverty level may be eligible for premium tax credits and other savings on Marketplace plans if they are not eligible for Medicaid due to their immigration status. Federal poverty levels are used to determine eligibility for certain programs and benefits, including savings on Marketplace health insurance.
It is important to note that applying for or receiving Medicaid or CHIP benefits, or obtaining savings for Marketplace health coverage, does not affect one's ability to become a Lawful Permanent Resident or U.S. citizen. This is because these actions do not make one a "public charge," which refers to someone who relies primarily on government assistance for their income maintenance. The only exception is for individuals receiving long-term care in an institution at government expense, such as a nursing facility, who may face barriers in obtaining a green card.
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Frequently asked questions
Undocumented immigrants in the US cannot get Marketplace health coverage. However, some states have expanded coverage to include undocumented immigrants, and children of undocumented immigrants are more likely to be covered. As of 2024, California covers undocumented adults, and Oregon covers undocumented residents regardless of age.
Noncitizen immigrants are more likely to be uninsured and face barriers to accessing healthcare. They may skip or postpone care, leading to worse long-term health outcomes. Undocumented immigrants are also more likely to suffer from mental distress and self-report poor health.
Some states, like California and Oregon, have expanded their Medicaid programs to cover undocumented residents. Additionally, children of undocumented immigrants may be covered by Medicaid/CHIP regardless of their immigration status.
