New Research: Medicaid “Unwinding” Losses Hit Counties With Larger Immigrant Communities Harder
EL PASO, Texas — A new analysis released today by the Protecting Immigrant Families coalition (PIF) finds that state Medicaid eligibility policies and practices resulted in 1.37 million people in counties with larger immigrant shares of county population losing Medicaid, compared to counties with the smallest immigrant share of county population. The analysis, completed for PIF by the non-profit behavioral science research firm ideas42, focuses on declines in Medicaid enrollment as states worked to “unwind” Medicaid’s pandemic-era continuous coverage requirement.
“State and federal failures have denied more than a million people health care access under Medicaid,” said PIF director Adriana Cadena. “And because immigrant families are largely families of color, these failures are widening racial health disparities.”
The PIF/ideas42 analysis compared state-published Medicaid enrollment data for counties with larger (as high as 36%) average immigrant shares of county population against disenrollments for counties with the smallest (averaging less than 4%) immigrant population shares. The analysis focused on states with relatively large immigrant shares of state population: Arizona, California, Colorado, Florida, Michigan, New Jersey, New York, North Carolina, Pennsylvania, and Texas. These 10 states include 50% of the total U.S. population and 68% of the foreign-born population. Most states were not included in the study because they did not report county-level data, so the nationwide impact is likely much greater than the 1.37 million people cited by the research.
The research finds a correlation between state Medicaid disenrollment and immigrant share of county population. Counties with the “highest” immigrant shares of county population accounted for about half (617,520 or 45%) of additional Medicaid coverage losses. Counties with a “high” immigrant share of county population accounted for an additional nearly 30% (383,119 or 28%).
“Our results indicate that high immigrant share communities have lost Medicaid coverage at substantially higher rates than counties with low immigrant shares. After an unprecedented increase in insurance coverage during the pandemic, more people today—especially in immigrant communities—face unnecessarily complex eligibility requirements and struggle to obtain and afford healthcare,” said Jeremy Barofsky, who led the analysis as Director of Research and Evaluation at ideas42.
The analysis also shows that Texas performed the worst at mitigating Medicaid coverage losses. Florida and Colorado were second and third worst. In Texas, counties with the highest immigrant share had a drop in enrollment that was nearly five percentage points higher (totalling more than 460,000 people) than the counties with the lowest immigrant share. In California, this difference was only 2.5 percentage points.
Before Medicaid unwinding began, PIF developed a set of policy recommendations to mitigate known barriers to keeping eligible people in immigrant families covered. Subsequent research by PIF and partner organizations found that states had largely failed to implement these best practices. PIF shared its findings with the U.S. Centers for Medicare and Medicaid Services (CMS) in November, urging CMS to require states to address performance shortfalls.
“This research shows that states dropped the ball during Medicaid unwinding, costing more than a million people the health care every family needs,” said Cadena. “Our national and state leaders must not allow this abject failure to become the new normal.”
Additional quotes from PIF partners in states covered by the analysis
“The loss of Medicaid coverage disproportionately harms immigrant families, who already face significant barriers to accessing healthcare. When families lose this essential lifeline, the ripple effects are felt in every aspect of their lives—from the health of children to financial instability,” said Nicole Loy, Policy Manager with the Colorado Immigrant Rights Coalition. “This report shows the devastating impact that state-level policy failures have on families who simply want the care they deserve. We must ensure that no family is left behind in accessing basic healthcare.”
“The Pennsylvania Immigration Coalition consists of sixty organizations working across twenty seven counties across the state,” said PICC executive director Jasmine Rivera. “One of the top issues our members named for the communities they serve was healthcare access. With a declining and aging population, Pennsylvania is facing a population cliff; ensuring more families can access health care under Medicaid is an investment in the next generation and in our collective future in the state.”
“Every individual, regardless of their background and immigration status, deserves access to healthcare,” said Wayne Ho, President and CEO of the Chinese-American Planning Council (CPC). “The challenges immigrant families face, including language barriers and concerns about jeopardizing their immigration status through Medicaid enrollment, have been exacerbated by COVID-19, leading to millions losing coverage. CPC is dedicated to working with elected officials and partners to educate immigrant families and address racial health disparities to ensure equitable access to healthcare for all.”
"Even though California performed better than other immigrant-rich states, the sheer size of our population underscores the critical importance of doing all we can to keep California children and families covered by implementing policy changes like continuous coverage for young children," said Mayra E. Alvarez, president of The Children's Partnership based in California. "Nearly half of California's 9 million children are part of immigrant families, making Medicaid disenrollments that lead to gaps in coverage even more concerning. As we've heard from many families around the state over the past year, the Medicaid unwinding process has been problematic, especially for people seeking help with renewals in languages other than English. Keeping coverage requires a program that works for all who depend on it, and we can do more to strengthen Medicaid for all families."
"The greatest challenge facing marginalized communities in accessing benefits is not just that they were removed unnecessarily. The reality is that we have a significant number of eligible children who have never applied, even during the pandemic,” said Yesenia Cuello, executive director of North Carolina’s NC FIELD, Inc. “Misinformation about public charge, the chilling effect, language barriers, lack of navigation assistance, and limited rural infrastructure remain major contributors to preventable illness in North Carolina. Achieving true equity will require substantial investment and direct service collaborations across systems."
“The findings from the PIF study highlights some promise, but also serves as a reminder that our work is not complete,” said California Primary Care Association (CPCA) President and CEO Francisco J. Silva, Esq. “One of CPCA’s top priorities has been to secure state funding for Health Enrollment Navigators to ensure that all Medi-Cal eligible Californians, including the one in three Medi-Cal members served by community health centers, successfully retain their Medi-Cal coverage. CPCA Advocates was able to secure $20 million in funding allowing community health center grantees to perform critical outreach and enrollment services ensuring that income eligible individuals keep their Medi-Cal health coverage. Although California’s disenrollment numbers are high, the smaller percentage decline in Medicaid enrollment when compared to other states shows that California’s strategies and partnerships have had a significant impact and must be continued. We will continue to work with key state and federal stakeholders to invest the resources needed to ensure that all individuals, regardless of immigration status, have meaningful access to care.”
“This research reflects what we consistently hear from immigrant families,” said Christine Sauvé, Policy and Communications Manager for the Michigan Immigrant Rights Center. “Foreign-born Michiganders encounter so many difficulties accessing benefits for which they are eligible, from lack of translation to fear of how it will affect their immigration status. We call on our state and federal government partners to take more proactive steps to ensure immigrant families aren’t left behind.”
“The inequitable unwinding of Medicaid is apparent in the numbers, when over 22,000 individuals in Michigan alone lost Medicaid coverage, disproportionately impacting immigrant communities. It is not surprising to see the major impact that losing coverage has on these immigrant households, when they have to worry about meeting their basic needs,” said Sara Ismail, State Policy Manager of the National Network for Arab American Communities (NNAAC).
“The loss of Medicaid coverage disproportionately harms immigrant families, who already face significant barriers to accessing healthcare. When families lose this essential lifeline, the ripple effects are felt in every aspect of their lives—from the health of children to financial instability,” said Nicole Loy, Policy Manager with the Colorado Immigrant Rights Coalition. “This report shows the devastating impact that policy failures have on families who simply want the care they deserve. We must ensure that no family is left behind in accessing basic healthcare.”
“The Medicaid unwind was devastating for huge numbers of Floridians, with systems failures at nearly every level, many of which were the results of deliberate policy choices,” said Alison Yager, executive director of the Florida Health Justice Project. “This report reveals with certainty what we might have guessed – that the pain was borne most acutely in counties with higher numbers of immigrants. Because of the myriad barriers that make accessing the social safety net more challenging and more frightening for immigrants, it is incumbent upon the state to ensure that immigrant families have access to the information and supports needed to ensure that all those who are eligible for Mediciad and other benefits are affirmatively enrolled in those programs. When families have health insurance, it's good for them, for their communities, and for the state economy. Win, win, win!”
“Regular access to health care during childhood lays the foundation for a healthy future, so going without health insurance jeopardizes children’s long-term health and wellbeing by placing routine medical care out of reach and undermining their families' financial stability,” said Trudy Taylor Smith, Esq., Senior Administrator of Policy and Advocacy at Children’s Defense Fund - Texas. “More than a quarter of all children in Texas—including U.S. citizens—live in a household with at least one family member who is not a U.S. citizen, so when immigrants lose access to health care, Texas children bear the brunt of the harm. That is why Children's Defense Fund - Texas remains committed to enrolling eligible children and their families in CHIP and Medicaid, combatting misinformation to reassure families that accessing these programs will not threaten their immigration status, and pushing for policies that address the unique barriers to renewal facing immigrants and their children.”
“No family should struggle to keep members enrolled in coverage to which they are legally entitled due to immigration status or history,” said Erin O'Malley, Senior Policy Analyst at Every Texan. “Loss of access to health coverage can have multigenerational health and health system impacts so the barriers to coverage and care faced by our immigrant neighbors touch all of us. One in ten children in the United States is growing up in Texas, and this makes systemic issues in accessing coverage and care in Texas a national problem, too.”
