Impact of medicaid policy changes on immigrant parents


During the 1990s and early 2000s many states expanded Medicaid eligibility for parents particularly after the 1996 welfare reform. At the same time, welfare reform also put in place policies that limited the eligibility of recent immigrants for public programs including Medicaid. This paper evaluates the effects of these changes in Medicaid eligibility policy on the private and public health insurance coverage of immigrants as well as the overall insurance rate. It also looks at the effect on health care use and measures of health status. The findings indicate a significant increase in Medicaid coverage and an increase in the proportion insured overall with negligible crowd-out of private insurance. There is also an increase in the use of health care services. In the case of permanent residents, there is a diminished response to Medicaid eligibility changes possibly due to a “chilling effect”.

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  1. 1.

    Sources include Aizer and Grogger (2003), Busch and Duchovny (2005), Guyer and Mann (1999) and publications by the Ross and Cox (2002, 2004).

  2. 2.

    Currie and Gruber (1996), Cutler and Gruber (1996), Ham and Shore-Sheppard (2005), Lo Sasso and Buchmueller (2004) and Buchmueller et al. (2007) for instance.


  1. Aizer, A., & Grogger, J. (2003). Parental Medicaid expansions and health insurance coverage. NBER Working Paper No. 9907.

  2. Baicker, K., et al. (2013). The Oregon experiment: Effect of medicaid on clinical outcomes. New England Journal of Medicine, 368(18), 1713–1722.

    CAS  Article  Google Scholar 

  3. Broaddus, M., et al. (2002). Expanding public coverage: States’ Medicaid eligibility policies for working families in the year 2000. Washington, DC: Center on Budget and Policy Priorities.

    Google Scholar 

  4. Bronchetti, E. T. (2014). Public insurance expansions and the health of immigrant and native children. Journal of Public Economics, 120, 205–219.

    Article  Google Scholar 

  5. Buchmueller, T., Lo Sasso, A., & Wong, K. (2007). How did SCHIP affect the insurance coverage of immigrant children. NBER Working Paper No. 13261.

  6. Buchmueller, T., Ham, J. C., & Shore-Sheppard, L. D. (2015). Medicaid. In R. Moffitt (Ed.), Means-tested transfer programs in the United States (Vol. 2). Cambridge: National Bureau for Economic Research.

    Google Scholar 

  7. Busch, S. H., & Duchovny, N. (2005). Family coverage expansions: Impact on insurance coverage and health care utilization of parents. Journal of Health Economics, 24, 876–890.

    Article  Google Scholar 

  8. Camarota, S. A. (2001). Immigrants in the United States—2000: A snapshot of America’s Foreign-Born population. Washington: Center for Immigration Studies.

    Google Scholar 

  9. Currie, J., & Gruber, J. (1996). Health insurance eligibility, utilization of medical care and child health. Quarterly Journal of Economics, 111(2), 431–466.

    Article  Google Scholar 

  10. Cutler, D., & Gruber, J. (1996). Does public insurance does public insurance crowd out private insurance. Quarterly Journal of Economics, 111(2), 391–430.

    Article  Google Scholar 

  11. Dubay, L., & Kenney, G. (2003). Expanding public health insurance to parents: Effects on children’s coverage under Medicaid. Health Services Research, 38(5), 1283–1302.

    Article  Google Scholar 

  12. Feld, P., & Power, B. (2000). Immigrants’ access to healthcare after welfare reform: Findings from focus groups in four cities. Suitland: The Kaiser Commision on Medicaid and the Uninsured.

    Google Scholar 

  13. Fremstad, S., & Cox, L. (2004). Covering new Americans: A review of federal and state policies related to immigrants’ eligibility and access to publicly funded health insurance. Suitland: The Kaiser Commision on Medicaid and the Uninsured.

    Google Scholar 

  14. Gruber, J. (2000). Medicaid. NBER Working Paper No. 7829.

  15. Gruber, J., & Simon, K. (2008). Crowd-out 10 years later: Have recent public insurance expansions crowded out private health insurance? Journal of Health Economics, 27, 201–217.

    Article  Google Scholar 

  16. Guyer, J., & Mann, C. (1999). Employed But Not Insured: A State-by-State Analysis of the Number of Low-Income Working Parents Who Lack Health Insurance. Washington, DC: Center on Budget and Policy Priorities.

    Google Scholar 

  17. Ham, J., & Shore-Sheppard, L. D. (2005). The effect of medicaid expansions for low income children on medicaid participation and private insurance coverage: Evidence from the SIPP. Journal of Public Economics, 89(1), 57–83.

    Article  Google Scholar 

  18. Kaestner, R., & Kaushal, N. (2003). Welfare reform and health insurance coverage of low-income families. Journal of Health Economics, 22, 959–981.

    Article  Google Scholar 

  19. Kaushal, N., & Kaestner, R. (2005). Welfare reform and health insurance of immigrants. Health Services Research, 40(3), 697–721.

    Article  Google Scholar 

  20. Lurie, I. Z. (2008). Welfare reform and the decline in the health insurance coverage of children of non-permanent residents. Journal of Health Economics, 27, 786–793.

    Article  Google Scholar 

  21. Lo Sasso, A. T., & Buchmueller, T. C. (2004). The effect of the state children’s health insurance program on health insurance coverage. Journal of Health Economics, 23, 1059–1082.

    Article  Google Scholar 

  22. Nwosu, C., Batalova, J., & Auclair, G. (2014) Frequently requested statistics on immigrants and immigration in the United States. Migration Policy Institute Newsletter.

  23. Ross, D. C., & Cox, L. (2002). Enrolling children and families in health coverage: The promise of doing more. Suitland: The Kaiser Commision on Medicaid and the Uninsured.

    Google Scholar 

  24. Ross, D. C., & Cox, L. (2004). Beneath the surface: Barriers threaten to slow progress on expanding health coverage of children and families. Suitland: The Kaiser Commision on Medicaid and the Uninsured.

    Google Scholar 

  25. Schlosberg, C., & Wiley, D. (1998). The impact of INS public charge determinations on immigrant access to health care. Washington: National Immigration Law Center.

    Google Scholar 

  26. Watson, T. (2014). Inside the refrigerator: Immigration enforcement and chilling effects in Medicaid participation. American Economic Journal: Economic Policy, 6(3), 313–338.

    Google Scholar 

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Correspondence to Aig Unuigbe.

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Unuigbe, A. Impact of medicaid policy changes on immigrant parents. Int J Health Econ Manag. 19, 395–417 (2019).

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  • Health insurance
  • Health policy
  • Medicaid
  • Immigrants

JEL Classification

  • I12
  • I13
  • I18
  • J15