Online Tool Estimates Cost of State-Funded Health Insurance for Immigrants; Can Aid Discussions About Whether to Extend Coverage

A new online tool allows state policymakers and other stakeholders to estimate the potential cost of expanding state health insurance programs to include individuals who do not qualify solely due to immigration status, a strategy already adopted by many states as a way to extend health coverage to more people.

The RAND tool can generate state-level estimates of enrollment outcomes and costs under a number of scenarios, such as income eligibility criteria, age ranges, or different insurance programs.

Several states are pursuing efforts to expand health insurance options for immigrants, but information about this population—particularly undocumented immigrants—is lacking.

RAND researchers used a variety of public data sources to estimate the number of immigrants in each state and the demographic characteristics of those populations. The tool relies on assumptions on insurance take-up rates and medical spending among immigrants to generate estimates across a range of scenarios. .

“We hope this will fill a gap in the knowledge base by providing ballpark estimates in a quick and user-friendly way,” said Preethi Rao, lead author of the project and a senior economist at RAND, a nonprofit research organization. “This will be useful for states that are in early discussions about expanding coverage to immigrants or expanding programs to cover more immigrant groups.”

Undocumented immigrants cannot enroll in Affordable Care Act marketplace plans or receive Medicaid coverage. Legally present immigrants who have held qualified immigrant status for fewer than five years are also ineligible for Medicaid, although they can qualify for subsidies in ACA marketplaces. These exclusions are one reason that noncitizens represent about 30 percent of the uninsured population in the nation.

Thirteen states already have adopted programs to help immigrants get health care coverage, taking actions such as using state funds to expand Medicaid eligibility or extending individual marketplace subsidies to undocumented immigrants. These approaches do not use federal funds to extend coverage to immigrants.

Although the RAND tool calculates the costs of state-funded health insurance options for immigrants, it does not account for potential savings or any programs that are already in place.

Data sources for the RAND tool include the 2022 American Community Survey Public Use Microdata Sample from the U.S. Census Bureau, the 2019 Migration Policy Institute state-level data on undocumented immigrants, and the 2019 Center for Migration Studies state-level data on undocumented immigrants.

Support for the study was provided by the Robert Wood Johnson Foundation.

The tool, “Assessing Coverage and Costs Associated with State-Funded Health Insurance (ACCESS) for Immigrants Estimator,” is available at www.rand.org. Other contributors to the project are Federico Girosi, Cheryl K. Montemayor, Baqir Fateh, Kara Jia, Alyson Youngblood, and Christine Eibner.

RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.