Health Services Research
Volume 39, Issue 5, 2004, Pages 1509-1526
The unintended impact of welfare reform on the medicaid enrollment of eligible immigrants (Article)
Kandula N.R.* ,
Grogan C.M. ,
Rathouz P.J. ,
Lauderdale D.S.
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a
Div. of General Internal Medicine, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Chicago, IL 60611, United States, Department of Medicine, University of Chicago Hospitals, United States
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b
University of Chicago, Sch. of Social Serv. Administration, United States
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c
University of Chicago, Department of Health Studies, United States
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d
University of Chicago, Department of Health Studies, United States
Abstract
Background. During welfare reform, Congress passed legislation barring legal immigrants who entered the United States after August 1996 from Medicaid for five years after immigration. This legislation intended to bar only new immigrants (post-1996 immigrants) from Medicaid. However it may have also deterred the enrollment of legal immigrants who immigrated before 1996 (pre-1996 immigrants) and who should have remained Medicaid eligible. Objectives. To compare the Medicaid enrollment of U.S.-born citizens to pre-1996 immigrants, before and after welfare reform, and to determine if variation in state Medicaid policies toward post-1996 immigrants modified the effects of welfare reform on pre-1996 immigrants. Data Source/Study Design. Secondary database analysis of cross-sectional data from 1994-2001 of the U.S. Census Bureau, Annual Demographic Survey of March Supplement of the Current Population Survey. Subjects. Low-income, U.S.-born adults (N = 116,307) and low-income pre-1996 immigrants (N = 24,367) before and after welfare reform. Measures. Self-reported Medicaid enrollment Results. Before welfare reform, pre-1996 immigrants were less likely to enroll in Medicaid than the U.S.-born (OR = 0.55; 95 percent CI, 0.51-0.59). After welfare reform, pre-1996 immigrants were even less likely to enroll in Medicaid. The proportion of immigrants in Medicaid dropped 3 percentage points after 1996; for the U.S.-born it dropped 1.6 percentage points (p = 0.012). Except for California, state variation in Medicaid policy toward post-1996 immigrants did modify the effect of welfare reform on pre-1996 immigrants. Conclusions. Federal laws limiting the Medicaid eligibility of specific subgroups of immigrants appear to have had unintended consequences on Medicaid enrollment in the larger, still eligible immigrant community. Inclusive state policies may overcome this effect.
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https://www.scopus.com/inward/record.uri?eid=2-s2.0-4844229397&doi=10.1111%2fj.1475-6773.2004.00301.x&partnerID=40&md5=3f849857f9281d6779116d460fca6875
DOI: 10.1111/j.1475-6773.2004.00301.x
ISSN: 00179124
Cited by: 45
Original Language: English