Individuals eligible for Medicaid who live in households with undocumented immigrants appear less likely to enroll in the public health insurance program in some states.
The Yale School of Public Health study shines light on why approximately 1 in 4 of the uninsured in the
United States was eligible for, but not enrolled in, the Medicaid program in 2016—two years after the expansion of Medicaid eligibility under the Affordable Care Act (ACA). The researchers used U.S. Census Bureau data from 2009 to 2015 to identify Medicaid-eligible individuals in mixed-status households—those that likely included at least one undocumented immigrant—and examined trends in their Medicaid coverage over time.
The researchers found that in states that expanded Medicaid eligibility, the rate of Medicaid enrollment was statistically indistinguishable between Medicaid-eligible individuals living in households with mixed immigration status and those in households without mixed immigration
status. In states that did not expand Medicaid, however, the rate of enrollment was significantly lower for eligible individuals living in mixed-status households. While Medicaid enrollment increased in these states for individuals in households with non-mixed immigration status, similar increases in enrollment were not evident among individuals in households with mixed immigration status.
“Our findings suggest that living in a mixed-status household may have dampened the so-called ‘woodwork effect’ after the ACA improved knowledge about Medicaid availability and increased enrollment in the program, even in non-expansion states,” said Michael Cohen, a Ph.D. candidate in the Department of Health Policy and Manage- ment and a study co-author. The study was co-authored by William Schpero, a Ph.D. candidate in the same department.
The research was supported by funding from the Agency for Healthcare Research and Quality and the National Institute on Aging and published in the journal Health Affairs.