Recent Immigrants' Health Service Utilization and the Coverage of State Medicaid in the United States

Background: As of 2016, 19 states had chosen not to expand Medicaid coverage under the 2010 Affordable Care Act and estimated 2.6 million adults nationwide were uninsured since their state was reluctant to expand Medicaid. How does Medicaid coverage affect health service utilization among the immigrant population? Despite its significance, few studies have been conducted to answer this question. To address this gap, this study investigated the association between the Medicaid coverage and immigrants’ utilization of health services, after controlling for the demographic, acculturation, financial and health condition factors.

Methods: The study analyzed the sample of 1,402 principal immigrants who were not covered by private medical insurance, using the New Immigrant Survey 2003 Wave 2 data (NIS-2003-2). The NIS-2003-2 is a multi-cohort prospective-retrospective and nationally representative panel study of new legal immigrants to the United States conducted from June 2007 to December 2009. This subset of 1,402 was 16.3 % out of the original sample (N=8,573). Individuals in this subset were either covered by State Medicaid or did not have any health insurance. The descriptive analysis and generalized linear models (GLM), including binary logistic regression, negative binomial regression and multinomial logit regression models were performed to examine the relationship between immigrants’ Medicaid coverage and their health service utilization, defined by dental visit (whether the immigrant visited a dentist the year prior to the survey), frequency of doctor visits (times the immigrant visited a doctor the year prior to the survey), and usual place of health service (medical institution the immigrant most often used to access health services).

Results: 19.7% of immigrants in the sample were covered by Medicaid, whereas 80.3% did not have any health insurance. 44% did not have regular dental visits. Averagely, immigrants visited doctors 3.2 times in the year prior to the survey (SD=8.27). 46.58% of immigrants did not have a usual place to access health services and 44.94% went to clinic, health center or doctor’s office most often to access health services. The results of the GLM analysis revealed that the Medicaid coverage increased the likelihood to have a regular dental visit (p<.001) by 2.39 times and increased the expected outcome of frequency of visiting doctors by 2.16 times (p<.001). Furthermore, the Medicaid coverage increased the odds of having “clinic, health center or doctor’s office” as the most usual place to access health service relative to “no usual place” by a factor of 4.91 (p<.001) and increased the odds of having “hospital emergency room and out-patient” as the most usual place to access health service relative to “no usual place” by a factor of 3.78 (p<.001).

Conclusions: Existing studies pointed out that immigrants, especially those who most recently entered in the United States, are generally healthier than natives due to positive health selection; however, their original health advantages disappear over time due to the lack of appropriate health services. The results of the current study highlighted the importance of the Medicaid coverage on immigrants’ health service utilization. Additional implications will be discussed.