Medicaid Access and Participation: A Data Profile of Eligible and Ineligible Immigrant Adults

Medicaid, the largest public health insurance program for the non-elderly, low-income population in the United States, has been an important lifeline for many since the pandemic began, with almost 10 million working-age adults and children signing up for it and the companion Children’s Health Insurance Program (CHIP) between February 2020 and January 2021. Immigrants are disproportionately low income, uninsured, and work in sectors that have suffered heavy job losses, but many noncitizens are ineligible for Medicaid due to their status as recent green-card recipients, international students, temporary workers, nonimmigrant visa holders, or unauthorized immigrants.

To support understanding of the size and characteristics of this population, this issue brief examines eligibility for and participation in Medicaid by foreign-born, non-elderly adults (ages 19 to 64). It uses a unique MPI methodology that assigns immigration status to noncitizens in the U.S. Census Bureau’s American Community Survey and models household size and income according to Medicaid rules.

This analysis finds that, as of 2019, 9.5 million non-elderly foreign-born adults had incomes that met state eligibility thresholds, but 45 percent of them (4.3 million adults) did not qualify for Medicaid due to immigration-status restrictions. This includes 3.25 million unauthorized immigrants, 536,000 legal permanent residents (also known as green-card holders) with fewer than five years in that status, and 523,000 nonimmigrants (e.g., international students and temporary workers). The brief also presents estimated participation rates for immigrant adults eligible for the program and looks at the parental status, race/ethnicity, and employment characteristics of those who are excluded.