News Release

Four States Expand Insurance Coverage to Immigrant Populations


Four states have recently expanded medical insurance coverage to immigrants through the private marketplace, part of a larger push to expand coverage to all low-income residents.

    Giovannelli is an associate research professor at the Center on Health Insurance Reforms at the McCourt School of Public Policy at Georgetown University’s Health Policy Institute. 

In a recent blog post for the Commonwealth Fund, Giovannelli and his co-author note that half of undocumented adults in the U.S. are uninsured––more than five times the uninsured rate of U.S. citizens. This is partly because “programs that make health insurance more affordable, including Medicaid and subsidized coverage available through the ACA marketplaces, limit eligibility based on citizenship and immigration status.” Four states––Colorado, Washington, Minnesota, and New York––have tried to fill the gap “by expanding access to private coverage for undocumented residents with incomes just above the Medicaid eligibility threshold.”

Giovannelli told the Institute for Public Accuracy: “There have been great gains in having folks get access to comprehensive health coverage. But because of federal law, among other reasons, one population still has hard-and-fast rules that keep them from accessing coverage––and that’s folks that are undocumented. Unless and until there is a change in federal law, it’s up to the states to decide whether this is a problem they want to fix or not. A handful of states are seeing where they can use state dollars to extend coverage to undocumented folks who are very low on the income scale. There’s a lot to be said for that approach, [since] people who are undocumented are disproportionately low on the income scale, so [that approach] helps the folks who are in the most dire straits. But there are a lot of other folks who make just more than the Medicaid threshold but have all these barriers to coverage and to accessing care. And when folks don’t access coverage and care, there are other costs to society at large… If people don’t have access to coverage, they’re experiencing worse [health] outcomes and those costs tend to spread and get picked up elsewhere.”

These four states are now addressing the population making just above the Medicaid threshold. “They have chosen to focus on this group of people who are by no means well off––they’re at, for instance, 150 percent of the federal poverty level––and [finding] ways to extend private health coverage with state dollars. They’re doing this as part of a much broader strategy to improve access and affordability to comprehensive coverage in ways that benefit citizens and non-citizens who are documented and lawfully present.” These states are putting together “larger packets of improvements that help folks, no matter [their status], be a little better off.” 

Colorado is in its second year of the program. In the first year, they extended coverage to 10,000 people and had 10,000 people sign up. In the second year, they extended to 11,000 people, and have already had 11,000 people sign up. Colorado is “reaching people within the extent of their resources,” Giovannelli said. All of these programs are “indefinite changes,” he added. “They will continue as long as there is funding. There is no sunset date for any of this.”