Medicaid Expansion and State-Funded Health Care: Immigrant Inclusion in California, Illinois, and Oregon

Background: Undocumented adults are prohibited from accessing federally funded healthcare coverage, including Medicare and Medicaid, due to their immigration legal status. Towards the end of the Biden administration, The Affordable Care Act (ACA) Marketplace plans were made available only to Deferred Action for Childhood Arrivals (DACA) recipients, reflecting broader immigration policies that were age-segregated and favored younger adults. As of March 2024, six states (California, Colorado, Illinois, New York, Oregon, Washington) and D.C. have fully expanded state-funded coverage to some income-eligible adults regardless of immigration legal status.

Purpose: To examine the impact of state-funded coverage on healthcare access for Hispanics ages 19 and older with annual incomes less than $50,000.

Methods: We conducted two-way fixed effects models using pooled cross-sectional data from the 2016–2022 Behavioral Risk Factor Surveillance System. Four outcomes were examined: coverage, affordability, primary care provider, and routine checkup. The study focused on three states that expanded before others: California, Illinois, and Oregon.

Results: The expansion led to an 8.3 percentage point increase in insurance coverage for individuals ages 55-64 (95% CI: 0.027, 0.139). There was a 7.3 percentage point increase (95% CI: -0.004, 0.150) in perceived affordability for those ages 50-54. Access to a provider decreased by 12.7 percentage points for those 65 and older (95% CI: -0.223, -0.031). Routine checkups increased for those 65 and older by 3.5 percentage points (95% CI: -0.007, 0.077).

Conclusions and Implications: Results suggest that healthcare expansions are generally beneficial for older Hispanics, although the impact varies across age groups and income levels. In an era of increasingly restrictive federal immigration policies, state governments can continue to provide health care access. This access is crucial for the detection and treatment of both acute and chronic conditions, including potentially fatal illnesses that can dramatically impact an individual's quality of life. Increasing access to insurance and providers for preventive measures, screening, and treatment will reduce overall costs in the long-term. It is important to emphasize that healthcare access should be available to all people, irrespective of their age or immigration legal status.