As of 2023, the United States was home to 47.1 million immigrants, a significant portion of the nation’s fabric. This diverse group, comprising both noncitizen and naturalized individuals, faces unique challenges in accessing health care. Understanding the landscape of Health Care Programs For Immigrants is crucial for ensuring equitable health outcomes and fostering a healthy society for all. This article delves into the complexities of health coverage for immigrants, drawing on the 2023 KFF/LA Times Survey of Immigrants to highlight disparities and explore potential policy impacts, particularly in light of anticipated shifts in administration.
A stark reality emerges from the data: noncitizen immigrants are disproportionately uninsured compared to their citizen counterparts. In 2023, half of likely undocumented immigrant adults and 18% of lawfully present immigrant adults were uninsured, compared to less than 10% of naturalized and US-born citizens. This disparity stems from various factors, including limited access to employer-sponsored insurance due to job types, and restricted eligibility for federally funded health care programs for immigrants like Medicaid, CHIP, ACA Marketplace coverage, and Medicare. Furthermore, even when eligible, immigrants often encounter enrollment barriers such as fear, confusion about complex rules, and language difficulties. These coverage gaps directly translate to poorer health access, with noncitizen immigrants more likely to face barriers to care and postpone necessary medical attention. Despite lower healthcare expenditures overall, often attributed to younger demographics and reduced care utilization due to access barriers, the health needs of immigrant communities remain significant and underserved.
However, the landscape of health care programs for immigrants is not uniform across the nation. Progressive states are taking steps to expand coverage. State-level initiatives are increasingly embracing options to extend Medicaid and CHIP to lawfully present immigrant children and pregnant individuals. Moreover, a growing number of states are pioneering fully state-funded programs that offer coverage to low-income residents regardless of immigration status. While these state-level expansions are commendable, a significant portion of the immigrant population, particularly the undocumented, remains excluded from comprehensive coverage options.
Adding another layer of complexity is the pervasive fear within immigrant communities regarding accessing assistance programs, including vital health care programs for immigrants. Although the Biden administration reversed Trump-era “public charge” rules and bolstered Navigator programs to aid enrollment, deep-seated anxieties persist. In 2023, a staggering three-quarters of immigrant adults expressed uncertainty or misinformation about how utilizing non-cash assistance might affect their immigration status. This climate of fear has tangible consequences, with a substantial percentage of undocumented and even lawfully present immigrants avoiding applications for essential support like food, housing, and health care out of immigration-related concerns.
Looking ahead, potential policy shifts under a new administration raise concerns about further exacerbating these challenges. The possible reinstatement of stricter “public charge” policies and heightened immigration enforcement could amplify fears and significantly hinder healthcare access for immigrant families. Understanding these dynamics is crucial for developing informed and compassionate approaches to health care programs for immigrants, ensuring that everyone has the opportunity to live a healthy life, regardless of their immigration status.
Understanding the Immigrant Population in the U.S.
In 2023, the U.S. was home to a diverse population of 47.1 million immigrants. This figure includes 22.4 million noncitizen immigrants and 24.7 million naturalized citizens, each group representing approximately 7% of the total U.S. population. It’s important to note that “noncitizen” encompasses both lawfully present immigrants, such as green card holders and visa holders, and undocumented immigrants.
Many individuals live in families with mixed immigration statuses, including lawfully present immigrants, undocumented immigrants, and citizens. This interconnectedness underscores the broad impact of immigration policies and access to health care programs for immigrants on families as a whole. Children are particularly affected; in 2023, one in four children in the U.S. had an immigrant parent. The majority of these children are U.S. citizens, but a significant 12% are citizen children with at least one noncitizen parent.
Disparities in Uninsured Rates Based on Immigration Status
The 2023 KFF/LA Times Survey of Immigrants provides critical insights into health coverage and healthcare access experiences among immigrant adults, categorized by immigration status. While it’s true that the majority of uninsured individuals in the U.S. are citizens, noncitizen immigrants face significantly higher rates of uninsurance.
As of 2023, half of likely undocumented immigrant adults (50%) and nearly one in five lawfully present immigrant adults (18%) reported being uninsured. In stark contrast, only 6% of naturalized citizen adults and 8% of U.S.-born citizen adults were uninsured. This substantial difference underscores the critical need for effective health care programs for immigrants, particularly those in noncitizen categories.
These higher uninsured rates have direct consequences for healthcare access. Noncitizen immigrants, especially the undocumented, are more likely than citizens to report facing barriers to healthcare and to postpone or forgo necessary medical care. Research consistently shows that health insurance is a key determinant of access to timely and appropriate medical services. Uninsured individuals are more likely to delay or skip needed care, leading to potentially worse long-term health outcomes that are often more complex and costly to treat.
Likely undocumented immigrant adults are significantly more likely than lawfully present and naturalized citizen adults to report lacking a usual source of care other than the emergency room, not having seen a doctor in the past year, and postponing or skipping needed care. Lawfully present immigrant adults also experience higher rates of forgoing doctor visits compared to naturalized citizens. These disparities highlight the urgent need to address the barriers preventing immigrants from accessing health care programs for immigrants and essential medical services.
Interestingly, research indicates that immigrants, despite facing these access challenges, tend to have lower healthcare utilization and expenditures compared to their U.S.-born counterparts. This is partly attributed to immigrants being, on average, younger and healthier. However, it also reflects the significant barriers they face in accessing care, including higher uninsured rates, language access challenges, confusion about the healthcare system, and immigration-related fears. In fact, data reveals that immigrants contribute to subsidizing the U.S. healthcare system, as their lower healthcare use, coupled with their contributions through insurance premiums and taxes, helps offset the costs of care for U.S.-born citizens.
Access to Health Coverage Options for Immigrants
Navigating the landscape of health coverage for immigrants requires understanding the various pathways available, each with its own set of eligibility rules and limitations. Health care programs for immigrants can be broadly categorized into private coverage, federally funded programs, and state-funded initiatives.
Private Health Coverage
Employer-sponsored health insurance is a cornerstone of the U.S. healthcare system. However, despite high rates of employment among noncitizen immigrants, access to employer-sponsored coverage remains limited. Noncitizen immigrants are disproportionately employed in lower-wage jobs and industries that are less likely to offer health benefits. Furthermore, even when employer-sponsored coverage is available, lower incomes can make it unaffordable for immigrant families.
Federally Funded Health Coverage Programs
Federally funded health care programs for immigrants such as Medicaid and CHIP have complex eligibility rules based on immigration status. Lawfully present immigrants may qualify, but often face waiting periods and specific status requirements.
Generally, lawfully present immigrants need “qualified” immigration status to be eligible for Medicaid or CHIP. Many, including most lawful permanent residents (green card holders), must wait five years after obtaining qualified status before they can enroll. Certain immigrant categories, like refugees and asylees, and citizens of Compact of Free Association (COFA) nations, are exempt from this five-year wait. However, some lawfully present immigrants, such as those with Temporary Protected Status, lack “qualified” status and are ineligible for Medicaid or CHIP regardless of their time in the U.S. States have the option to eliminate the five-year wait for children and pregnant individuals, and many have adopted this policy. As of January 2025, 37 states and D.C. have waived the waiting period for children, and 31 states and D.C. have done so for pregnant individuals.
Congress has taken steps to restore Medicaid and CHIP eligibility for specific immigrant groups. In December 2020, eligibility was restored for citizens of COFA nations, and in March 2024, this was extended to include other federally funded programs like SNAP and TANF.
The ACA Marketplaces offer another avenue for coverage. Lawfully present immigrants can purchase plans through the ACA Marketplaces and may be eligible for tax credits to help with premiums and cost-sharing, similar to citizens. These tax credits are generally available to those with incomes starting at 100% of the federal poverty level (FPL) who are not eligible for other affordable coverage. Lawfully present immigrants with incomes below 100% FPL who are ineligible for Medicaid due to immigration status may also qualify for these credits. Notably, DACA recipients were previously excluded but, as of November 1, 2024, are now considered lawfully present for ACA Marketplace eligibility, although ongoing litigation in some states is impacting implementation.
Medicare, the federal health insurance program for seniors and people with disabilities, is also accessible to lawfully present immigrants who meet certain requirements. Those with sufficient work history may qualify for premium-free Medicare Part A. Others can qualify if they are lawful permanent residents residing in the U.S. for at least five years, although they may need to pay premiums for Part A.
Undocumented immigrants, however, are largely excluded from federally funded health care programs for immigrants. They are not eligible for Medicaid, CHIP, Medicare, or ACA Marketplace coverage. Emergency Medicaid can provide payments to hospitals for emergency services for individuals who would be Medicaid-eligible but for their immigration status, including both lawfully present immigrants in their five-year waiting period and undocumented immigrants. However, this is limited to emergency care and does not constitute comprehensive health coverage.
State-Funded Health Coverage Programs
Recognizing the gaps in federal health care programs for immigrants, a growing number of states are implementing state-funded initiatives to expand coverage, particularly for vulnerable populations.
As of January 2025, 14 states and D.C. offer comprehensive state-funded health coverage to children regardless of immigration status. These states are demonstrating a commitment to ensuring that all children have access to essential healthcare, regardless of their immigration status.
Furthermore, two of these states, New Jersey and Vermont, extend state-funded coverage to income-eligible pregnant individuals regardless of immigration status, with Vermont providing postpartum coverage for 12 months. Seven states (California, Colorado, Illinois, Minnesota, New York, Oregon, Washington) and D.C. have expanded fully state-funded coverage to at least some income-eligible adults regardless of immigration status, showcasing a growing trend towards more inclusive health care programs for immigrants at the state level.
Data strongly suggests that state coverage expansions for immigrants have a positive impact on their health coverage rates and healthcare access and utilization. Immigrant adults residing in states with more expansive coverage policies are less likely to be uninsured. Studies have shown significant reductions in uninsurance rates following state expansions, as well as improved healthcare access and outcomes, including increased prenatal care utilization and better birth outcomes. Moreover, providing insurance to immigrant adults through Medicaid expansion has been found to be cost-effective, and state-funded expansions have been linked to poverty reduction among immigrant families.
Enrollment Barriers and the Climate of Fear
Despite the availability of some health care programs for immigrants, enrollment barriers persist, preventing many eligible individuals from accessing coverage. These barriers include fear and confusion stemming from immigration policies, complex enrollment processes, and language access challenges.
Research indicates that changes in immigration policy, particularly during the first Trump administration, contributed to increased fear among immigrant families regarding enrollment in programs like Medicaid and CHIP, even for those eligible. The “public charge” policy changes likely played a significant role in decreased participation in Medicaid among immigrant families and their U.S.-born children. While the Biden administration reversed these changes and increased funding for Navigator programs to assist with enrollment, the climate of fear remains.
In 2023, nearly three-quarters of immigrant adults reported uncertainty or misinformation about how using non-cash assistance programs might impact their immigration status. A significant proportion of undocumented and lawfully present immigrants reported avoiding applications for assistance programs, including health care programs for immigrants, due to immigration-related fears.
Looking ahead, the potential reinstatement of stricter “public charge” policies and increased immigration enforcement under a new administration could exacerbate these fears and create a broader chilling effect within immigrant communities. Proposed policies such as mass deportations, the elimination of DACA, and changes to birthright citizenship could further limit healthcare access for immigrant families, negatively impact their well-being, and intensify anxieties about participating in assistance programs.
| Appendix A |
|---|
| ### Lawfully Present Immigrants by Qualified Status |
| Qualified Immigrant Category |
| Lawful permanent resident (LPR or green card holder) |
| Refugee |
| Asylee |
| Cuban/Haitian entrant |
| Paroled into the U.S. for at least one year |
| Conditional entrant granted before 1980 |
| Granted withholding of deportation |
| Battered noncitizen, spouse, child, or parent |
| Victims of trafficking and their spouse, child, sibling, or parent or individuals with pending application for a victim of trafficking visa |
| Member of a federally recognized Indian tribe or American Indian born in Canada |
| Citizens of the Marshall Islands, Micronesia, and Palau who are living in one of the U.S. states or territories (referred to as Compact of Free Association or COFA migrants) |
