Coverage Among Lawfully Present Immigrants Increased Briefly After Medicaid Threshold Met In Florida, Georgia, And Texas

Lawfully present noncitizen immigrants face persistent coverage gaps due to federal restrictions on Medicaid eligibility, including the five-year bar under the 1996 Personal Responsibility and Work Opportunity Reconciliation Act, and upcoming federal changes will place additional restrictions on eligibility. Using 2014-19 American Community Survey data, this study examined changes in health insurance coverage as lawfully present immigrants in Florida, Georgia, and Texas became Medicaid eligible after five years of US residence. Meeting the five-year threshold was associated with an 11.8-percentage-point increase in overall coverage and an 8.2-percentage-point increase in Medicaid coverage. Still, these gains were short-lived, with coverage declining sharply in later years and lawfully present immigrants mainly remaining uninsured. No significant changes were found for employer-sponsored or private insurance coverage. The findings suggest that even under existing rules, federal Medicaid provides only limited and temporary coverage gains, indicating that upcoming eligibility and reporting requirements may exacerbate coverage gaps.