The Unintended Impact of Welfare Reform on the Medicaid Enrollment of Eligible Immigrants

Authors

  • Namratha R. Kandula,

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    • Address correspondence to Namratha R. Kandula, M.D., M.P.H., Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 200, Chicago, IL 60611. Dr. Kandula is also with the Department of Medicine, University of Chicago Hospitals. Colleen M. Grogan, Ph.D., is with The University of Chicago, School of Social Services Administration. Paul J. Rathouz, Ph.D., and Diane S. Lauderdale, Ph.D., are with The University of Chicago, Department of Health Studies.

  • Colleen M. Grogan,

  • Paul J. Rathouz,

  • Diane S. Lauderdale


  • This research was supported by a grant from the Robert Wood Johnson Foundation.

Abstract

Background. During welfare reform, Congress passed legislation barring legal immigrants who entered the United States after August 1996 from Medicaid for five years after immigration. This legislation intended to bar only new immigrants (post-1996 immigrants) from Medicaid. However it may have also deterred the enrollment of legal immigrants who immigrated before 1996 (pre-1996 immigrants) and who should have remained Medicaid eligible.

Objectives. To compare the Medicaid enrollment of U.S.-born citizens to pre-1996 immigrants, before and after welfare reform, and to determine if variation in state Medicaid policies toward post-1996 immigrants modified the effects of welfare reform on pre-1996 immigrants.

Data Source/Study Design. Secondary database analysis of cross-sectional data from 1994–2001 of the U.S. Census Bureau, Annual Demographic Survey of March Supplement of the Current Population Survey.

Subjects. Low-income, U.S.-born adults (N=116,307) and low-income pre-1996 immigrants (N=24,367) before and after welfare reform.

Measures. Self-reported Medicaid enrollment.

Results. Before welfare reform, pre-1996 immigrants were less likely to enroll in Medicaid than the U.S.-born (OR=0.55; 95 percent CI, 0.51–0.59). After welfare reform, pre-1996 immigrants were even less likely to enroll in Medicaid. The proportion of immigrants in Medicaid dropped 3 percentage points after 1996; for the U.S.-born it dropped 1.6 percentage points (p=0.012). Except for California, state variation in Medicaid policy toward post-1996 immigrants did modify the effect of welfare reform on pre-1996 immigrants.

Conclusions. Federal laws limiting the Medicaid eligibility of specific subgroups of immigrants appear to have had unintended consequences on Medicaid enrollment in the larger, still eligible immigrant community. Inclusive state policies may overcome this effect.

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