Public Health Insurance Coverage for Immigrants during Pregnancy, Childhood, and Adulthood: A Discussion of Relevant Policies and Evidence

Context: Despite major expansions in public health insurance under Medicaid and the Children's Health Insurance Program over the last 60 years, many immigrants remain ineligible for coverage. Methods: The authors discuss the existing federal and state policies that extend public health eligibility to low-income pregnant immigrants, children, and nonelderly adults. They also conduct a literature review and summarize quasi-experimental evidence examining the impact of public health insurance eligibility expansions on insurance coverage, health care use, and health outcomes among immigrants. Findings: Public health insurance eligibility for immigrants varies widely across states because of the implementation of different federal and state policy options. Previous studies on expanded eligibility identified positive effects on insurance coverage and health care utilization among pregnant and child immigrants as well as some evidence indicating improved health outcomes. Additional research is required to understand the longer-term impacts of expanded coverage and to examine impacts of recent state expansions for adults. Conclusions: A complicated patchwork of federal and state policies leads to major differences in immigrant access to publicly funded insurance coverage across states and population groups. These policies likely have important implications for immigrant access to health care and health.