by Leighton Ku and Bethany Kessler of The Urban Institute.
This report provides national and state-by-state estimates of the number and cost of noncitizen Medicaid beneficiaries. The analyses are based on the Medicaid Quality Control (QC) data base for the first half of 1994, with additional information about Supplemental Security Income (SSI) participants from the Social Security Administration (SSA).
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The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) made major changes in the eligibility of legally admitted immigrants for health insurance under the Medicaid program. In the past, immigrants were eligible for the full range of Medicaid benefits, like citizens.(1) In contrast, undocumented (illegal) aliens were eligible only for emergency medical benefits, not full coverage. Under the new welfare reform law, with certain exceptions, noncitizen immigrants who arrive in the U.S. after August 1996 will be barred from Medicaid, although they may still be covered for emergency services.
Assessing the impact of this change has been problematic because there are few data about the number and costs of immigrants on Medicaid. This report provides national and state-by-state estimates of the number and cost of noncitizen Medicaid beneficiaries.
Methods and Data.The analyses are based on the Medicaid Quality Control (QC) data base for the first half of 1994, with additional information about Supplemental Security Income (SSI) participants from the Social Security Administration (SSA). The QC data base includes verified data about 93,000 sampled Medicaid enrollees, roughly 2,000 per state, making it the largest known national sample of Medicaid beneficiaries. QC data include relatively detailed information about immigration status, as well as medical expenditures paid by Medicaid in the sample month. The QC sample represents the great majority of Medicaid beneficiaries, but in 31 states the QC sample excludes SSI recipients. Thus, SSA data are used to supplement information about elderly and disabled immigrants, although these data are more limited. Estimates of the number and costs of aged, blind and disabled Medicaid beneficiaries who are noncitizens were generated by combining QC and SSA data.
National Participation Estimates
Overall national estimates of the number of noncitizen immigrants on Medicaid, based on the combination of QC and SSA data, are presented in Table ES-1. About 2.4 million of the 32 million Medicaid enrollees in an average month in 1994 were noncitizens (including undocumented aliens with emergency coverage only). This is 7.5 percent of the total caseload. Measured another way, about 3.2 million immigrants were enrolled in Medicaid over the course of a year. Insofar as noncitizens are 12.6 percent of the population under poverty, according to the 1996 Current Population Survey, the number of immigrants on Medicaid is less than might be expected given their poverty. Adult and aged beneficiaries were more likely to be immigrants than were children or the disabled. A major reason for the low percentage among children is that immigrants' children areoften native citizens born in the U.S. The total Medicaid expenditures for noncitizens (excluding Disproportionate Share Hospital or DSH payments) were $8.1 billion, or 6.9 percent of total expenditures.
Table ES-1. National Estimates of Noncitizen Immigrants on Medicaid in 1994,
Based on Combined QC and SSA Data
|TOTAL||Children||Adults||Aged||Blind & Disabled|
|Number of Noncitizen Medicaid Enrollees (in Avg. Month, in 1000s)||2,415.5||655.0||1,059.3||262.1||699.1|
|Proportion of Enrollees in Category Who Are Noncitizens||7.5%||4.1%||16.0%||13.0%||4.9%|
|Medicaid Expenditures for Noncitizens (in millions of $)||$8,129.3||$504.0||$2,118.3||$2,567.5||$2,939.5|
Source: Urban Institute analyses of Medicaid QC and SSA data