Study: In nonexpansion states, people in homes with undocumented immigrants less likely to enroll in Medicaid

Healthcare coverage gains due to the ACA's Medicaid expansion were weakened in nonexpansion states for households likely including people with undocumented immigration status, suggests a study published by Health Affairs.

Using 2009-15 data from the American Community Survey, researchers identified households that likely included undocumented immigrants and looked at how household immigration status affected Medicaid enrollment in expansion and nonexpansion states. The study population was low-income adults older than 18 and younger than 65.

The study found similar proportions of Medicaid enrollees among households in expansion states from 2009-15, regardless of if these households likely included undocumented immigrants. Overall, the proportion of Medicaid enrollees in households likely including undocumented immigrants in expansion states increased during the study period, from 33.1 percent in 2009 to 46.3 percent in 2015. The study found the proportion of Medicaid enrollees in non-mixed-status households in expansion states was 30.3 percent in 2009 compared to 45.7 percent in 2015.

But differences existed in nonexpansion states. The study found people in those states in households likely including undocumented immigrants were "significantly less likely" to be Medicaid enrollees than households without undocumented immigrants from 2009-15. According to the study, the proportion of Medicaid enrollees in homes likely including undocumented immigrants was 15.9 percent in 2009, compared to 21.4 percent of people in households without undocumented immigrants. The study also found that in 2014, the Medicaid enrollment change in nonexpansion states for people in households likely including undocumented immigrants was 1.7 percent less than for those without undocumented immigrants.

"These findings suggest that household immigration status may have dampened the 'woodwork effect,' whereby the ACA enhanced knowledge about program availability, in turn increasing Medicaid enrollment in nonexpansion states among people previously eligible for the program but not enrolled in it," the study authors concluded.


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