Some states have taken steps to improve access to affordable health insurance by using state funding to extend public health insurance and subsidized Affordable Care Act-compliant health insurance to noncitizens. In this study, we provide a brief overview of the current landscape of state-funded public coverage for noncitizens and summarize findings from interviews with national- and state-level stakeholders knowledgeable about such coverage. We conclude with a summary of the interviewees’ key priorities for research on state-led coverage expansions for noncitizens. 

WHY THIS MATTERS

Expanding access to health insurance coverage for noncitizens who are currently ineligible for publicly subsidized coverage is one avenue for reducing uninsured rates for noncitizens and improving access to and affordability of care. Addressing knowledge gaps about state-led expansions for noncitizens will be important for reducing inequities in health insurance access for this population.

WHAT WE FOUND

• As of January 2024, 12 states (California, Connecticut, Illinois, Maine, Massachusetts, New Jersey, New York, Oregon, Rhode Island, Utah, Vermont, and Washington) plus DC provide state-funded Medicaid-like coverage or primary and preventive care to income-eligible children regardless of their immigration status. Four states (California, Illinois, New York, and Oregon) plus DC have extended Medicaid-like coverage to some or all income-eligible adults. Colorado and Washington subsidize noncitizens’ purchase of private coverage.
• Overall, interviewees shared that no single set of policy conditions facilitated coverage expansions in states that have done so. Sources of momentum for these expansions reportedly included prior expansions to noncitizens within the state, health and health care inequities for noncitizens that were exposed during the COVID-19 pandemic, the public health benefits of ensuring access to health care for all population groups, and the potential for moving states closer toward universal coverage.
• Stakeholders shared that a wide range of research is needed to inform decisions about implementing or maintaining state-led coverage expansions for noncitizens. Research gaps and key research priorities identified related to the following:
  • projections related to state-led coverage expansions, including appropriate budgets
  • best practices for implementation of expansions
  • assessments of short- and long-term impacts of expansions
• Stakeholders shared warnings on the potential for research to stall progress on state action or harm noncitizens. For instance, stakeholders argued for the importance of including context for research, such as pairing estimates of costs for expansions with the benefits and return on investment that could follow. They also suggested acknowledging the complexities of understanding health care needs and projecting health care costs for a population facing unique stressors and who may have long-term unaddressed health issues. Finally, they cautioned that some research could reinforce negative stereotypes of noncitizens or unintentionally diminish their value and warned about the need to protect people’s confidentiality.

HOW WE DID IT

First, we conducted a rapid scan of the current landscape of state-funded public coverage for immigrants and assessed the available literature on the impacts of public coverage expansions to immigrants. Then, in the fall of 2023, we conducted virtual semi-structured interviews with national and state-level stakeholders knowledgeable about state-led coverage expansions to immigrant populations. Members of the research team analyzed the interviews to identify themes and illustrative quotes.