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Medicaid expansion faces struggles over immigrants: report


By Paul Barr
Posted: March 19, 2013 - 2:00 pm ET
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A new report highlights the struggles certain states may face in expanding their Medicaid programs under healthcare reform because of high numbers of immigrant residents who won't qualify for the federal coverage.

Some states have relatively higher proportions of illegal and recent immigrants in the pool of adults under age 65 who are expected to gain Medicaid coverage in 2014 under the Patient Protection and Affordable Care Act, according to an analysis of U.S. Census Bureau data by the Robert Wood Johnson Foundation.

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The Patient Protection and Affordable Care Act's Medicaid expansion excludes illegal immigrants and Medicaid itself generally excludes immigrants who have been in the country legally for less than five years.

“Safety net healthcare providers are likely to continue to be key providers for this population after health reform, and the need for safety net care will not be spread evenly across states,” the authors wrote.

The variation is wide among certain states. The analysis found that in Nevada, 34% of low-income, uninsured adults under age 65 are likely to be immigrants who are ineligible for Medicaid expansion next year under reform. In Arizona, the number is 31% and in California and Texas it is 26%.

In Mississippi, meanwhile, only about 3% of potential recipients of Medicaid coverage under expansion are immigrants who likely wouldn't qualify, while in Missouri and Louisiana 4% won't qualify. The report defines low-income as a family earning 138% of the federal poverty level. The Affordable Care Act calls for states to raise Medicaid eligibility to at least 133% and as high as 138% of the federal poverty level.

In January, President Barack Obama and a bipartisan alliance of senators proposed an overhaul of U.S. immigration laws that envisions a temporary legal status for millions of residents living in the U.S. illegally who would qualify for a path to citizenship. Those immigrants would remain ineligible for healthcare coverage under the Affordable Care Act, though their advocates argue that continuing to exclude them would be a mistake.


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