Millions of people lack comprehensive health coverage, and half of undocumented adult immigrants are uninsured, Georgetown University’s Justin Giovannelli and Rachel Schwab report on Feb. 8 for The Commonwealth Fund. Some states are expanding coverage for undocumented immigrants.
The high uninsured rate comes from inequalities, which include legal barriers to coverage for noncitizens. “Some states have reduced these disparities; typically, by providing Medicaid-equivalent benefits to some populations of undocumented residents. These efforts have increased take-up of comprehensive coverage among people with the fewest resources, but still leave many low- and moderate-income undocumented residents without affordable health insurance options,” Giovanelli and Schwab say.
While the Affordable Care Act (ACA) expanded health insurance access, there are still holes, especially for immigrants, as eligibility is limited on immigration status. The health insurance options for undocumented immigrants are limited. “Absent access to employer-sponsored insurance, undocumented residents’ only option for a comprehensive health plan has been unsubsidized private coverage available outside of the marketplace — often at a prohibitively expensive price,” Giovanelli and Schwab write.
Some states are expanding access to private coverage for undocumented immigrants who have incomes just above the Medicaid eligibility threshold. California and Oregon fund full Medicaid benefits for all low-income residents, including immigrants who would be eligible for the program were it not for their residency status.
OmniSalud is a program in Colorado through which undocumented immigrants can apply for health insurance separate from the state’s ACA marketplace. “In 2023, funding enabled 10,000 undocumented Coloradans with incomes up to 150 percent of the federal poverty level ($20,385 for an individual, $41,625 for a family of four that year) to enroll in a plan with no monthly premium and substantial cost-sharing assistance; in 2024, the state is funding financial assistance for up to 11,000 people,” per Giovanelli and Schwab.
The state of Washington has a new initiative for 2024 allowing undocumented immigrants to enroll through its ACA marketplace through a federal waiver. The state is providing up to $250 a month in assistance for premiums.
New York and Minnesota operate a Basic Health Program (BHP), which is an optional program by the ACA that subsidizes coverage to citizens and permanent residents with incomes between 133 percent and 200 percent of poverty. Per the Commonwealth Fund, “Since 2017, Minnesota has used state dollars to extend eligibility to income-eligible Deferred Action for Childhood Arrivals recipients. New York intends to do the same with its Essential Plan later this year. In 2025, Minnesota will use additional state funds to expand MinnesotaCare to more undocumented residents.”
The efforts of states that have stepped up for coverage for undocumented immigrants are modest to need, Giovanelli and Schwab argue. They suggest a change in federal law is required to help a population that is left out of federal coverage expansions.
