Policymakers in Connecticut are considering various state-funded policy options to improve insurance coverage among undocumented and legally present recent immigrants in the state — almost 60 percent of whom lack health insurance. The authors use the RAND Corporation's COMPARE microsimulation model to estimate the impacts of each policy scenario on premiums, state spending, and hospital spending on uncompensated care.
Expanding Insurance Coverage to Undocumented Immigrants in Connecticut
Download eBook for Free
|PDF file||0.5 MB||
Use Adobe Acrobat Reader version 10 or higher for the best experience.
- How would policy options aimed at expanding Medicaid and individual marketplace subsidy eligibility to undocumented and legally present recent immigrants in Connecticut affect enrollment, premiums, state spending, and hospital spending on uncompensated care relative to current law?
Policymakers in Connecticut are considering various state-funded policy options to improve insurance coverage among undocumented and legally present recent immigrants in the state — almost 60 percent of whom lack health insurance. In particular, they are removing immigration status requirements from Medicaid eligibility. They are also considering whether to provide state-funded subsidies to undocumented immigrants enrolled in individual market plans.
A key challenge for this analysis was determining what share of undocumented immigrants would be likely to take up insurance coverage if it were available to them. Because few states have expanded coverage to their undocumented populations and because the denominator is uncertain, estimates of take-up rates are highly uncertain. There is similar uncertainty in estimating how much health care undocumented populations will use once they become insured. To address these uncertainties, the authors conducted sensitivity analyses that varied both the take-up and utilization rates.
Using the RAND Corporation's COMPARE microsimulation model, the authors estimate the impacts of each policy scenario on enrollment, premiums, state spending, and hospital spending on uncompensated care. Their analysis suggests that removing immigration status requirements for Medicaid and individual market subsidy eligibility would decrease uninsurance among the undocumented and legally present recent immigrant populations by 32 to 37 percent and could improve insurance coverage and affordability in Connecticut for these populations while not substantially impacting other Connecticut residents.
Enabling undocumented and legally present recent immigrant populations to enroll in Medicaid will increase total insurance enrollment among this population by approximately 21,400 individuals, or 43 percent, relative to current law
- Direct costs to the state to expand Medicaid eligibility for 2023 are $83 million.
- Expanding marketplace subsidies to undocumented immigrants would have a relatively small effect on coverage while having a larger effect on costs, which increase by 31 to 45 percent over the Medicaid-only scenario.
- These policies to expand Medicaid eligibility would have minimal effects on enrollment and premiums for Connecticut residents who are U.S. citizens or legally present immigrants who have lived in the United States for five or more years.
State cost estimates do not include three potential sources of savings
- Savings to hospitals from reduced spending on uncompensated care could amount to roughly $63 million to $72 million.
- Connecticut currently has an emergency Medicaid program that covers emergency care to individuals who qualify based on income, regardless of immigration status. The costs for this program (approximately $15 million in 2021) would presumably be substantially reduced by the decrease in uninsurance among undocumented and legally present recent immigrants.
- By offering Medicaid to legally present recent immigrants, the state would forego federal advance premium tax credit funding for the portion of this population that would have otherwise enrolled in marketplace coverage and been eligible for subsidies; these costs could be recouped via a Section 1115 waiver.
Table of Contents
Overview of the COMPARE Microsimulation Model
Results with ARP Subsidy Enhancements
Research conducted by
This research was funded by the Robert Wood Johnson Foundation and was carried out within the Payment, Cost, and Coverage Program in RAND Health Care.
This report is part of the RAND Corporation Research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.
This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.
The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.