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Covering New Americans: A Review of Federal and State Policies Related to Immigrants' Eligibility and Access to Publicly Funded Health Insurance

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Publication Date: November 2004

Publisher(s): Center on Budget and Policy Priorities (Washington, D.C.)

Author(s): Laura Cox; Shawn Fremstad

Funder(s): Henry J. Kaiser Family Foundation

Funder(s): Henry J. Kaiser Family Foundation

Special Collection: John D. and Catherine T. MacArthur Foundation

Topic: Health (Health services for non-citizens)

Keywords: International migration; Economic projections; Health care costs; Health insurance

Type: Brief


Prior to the passage of the Personal Responsibility and Work Opportunity and Reconciliation Act of 1996—known as the 1996 welfare law—legal immigrants were eligible for Medicaid on the same basis as U.S. citizens if they met financial and other eligibility requirements. The welfare law imposed unprecedented restrictions on legal immigrants’ eligibility for various public benefits, including Medicaid. These restrictions also applied to the State Children’s Health Insurance Program (SCHIP), which was implemented in 1997.

Since the passage of the eligibility restrictions, the number of legal immigrants receiving Medicaid coverage has declined significantly and the gap in overall health insurance coverage between low-income U.S. citizens and immigrants has widened. In response to the restrictions, many states established programs—funded solely with state dollars—that provide the same or very similar health care coverage as Medicaid to some or all legal immigrants who were made ineligible by the restrictions.

Some states have also undertaken efforts to encourage enrollment of immigrants who remain eligible for Medicaid and SCHIP and to improve access to care among immigrants. This brief provides an overview of health coverage challenges facing immigrants, the federal rules regarding immigrants’ eligibility for Medicaid and SCHIP, and state efforts to provide replacement coverage for immigrants who are ineligible for Medicaid and SCHIP. It also reviews actions states can take to encourage enrollment of eligible immigrants in public health coverage and to improve immigrants’ access to care.