Study: Medicaid enrollment among immigrant children higher in sanctuary states

(Press-News.org) Low-income immigrant children in sanctuary states were nearly 10% more likely to be enrolled in Medicaid in the years following the 2018 announcement of the revised “public charge” rule, according to a new national study. Researchers examined trends in children’s Medicaid enrollment in sanctuary states—states that limit collaboration with federal Immigration and Customs Enforcement personnel. The research will be presented at the Pediatric Academic Societies (PAS) 2023 Meeting, held April 27-May 1 in Washington, D.C. 

Researchers explored Medicaid enrollment rates among low-income immigrant children following a 2018 federal rule denying immigrants permanent residency based on participation in public programs, including Medicaid for adults but not for children.

Researchers found that Medicaid enrollment among low-income immigrant children in sanctuary states— Calif., Colo., Conn., Ill., N.Y., Ore., R.I., Vt., and Wash.—increased after the 2018 rule update. Medicaid enrollment rates among low-income immigrant children in non-sanctuary states decreased during the same period.

“Federal immigration policies can serve as political determinants of health, denying children in immigrant families access to health insurance and medical care,” said Marine-Ayan Ibrahim Aibo, medical student at Perelman School of Medicine at the University of Pennsylvania and presenting author. “States can break barriers to care that federal immigration policies create and ensure every child receives the care they need.”

The study looked at 3,943 immigrant children from the U.S. Census Bureau and U.S. Bureau of Labor and Statistics’ Current Population Survey to compare Medicaid enrollment in sanctuary and non-sanctuary states, adjusting for race, ethnicity, state, year, and Medicaid expansion status.

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EDITOR:

Ms. Ibrahim Aibo will present “Association of State Sanctuary Policies with Medicaid Participation Among Immigrant Children Following the Revised Public Charge Rule” on Monday, May 1 at 9:15 a.m. ET.

Reporters interested in an interview with Ms. Ibrahim Aibo should contact Amber Fraley at amber.fraley@pasmeeting.org.

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting is the premier North American scholarly child health meeting. The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit www.pas-meeting.org. Follow us on Twitter @PASMeeting and like us on Facebook PASMeeting.

Abstract: Association of State Sanctuary Policies with Medicaid Participation Among Immigrant Children Following the Revised Public Charge Rule

Presenting Author: Marine-Ayan Ibrahim Aibo, B.A.

Organization

Perelman School of Medicine at the University of Pennsylvania

Topic

Health Equity/Social Determinants of Health

Background

Immigration policies are political determinants of health that can impact children’s access to health-promoting government benefit programs. From 2011-2017, nine US states enacted statewide sanctuary policies designed to limit state collaboration with federal Immigration and Customs Enforcement and protect immigrants’ health and well being. In 2018, the Trump administration announced a plan to revise the federal “public charge” rule to deny legal permanent resident status to immigrants based on their participation in benefit programs, including Medicaid for adults but not children. 

Objective

To assess whether state-level sanctuary immigration policies may protect access to health care for immigrant children, we compared Medicaid participation among immigrant children in sanctuary vs. non-sanctuary states before and after the 2018 announcement of the revised public charge rule.

Design/Methods

We used 2015-2021 Current Population Survey nationally representative data to compare Medicaid participation among low-income immigrant children living in sanctuary vs. non-sanctuary states. Immigration status was determined by self report; documentation status was not assessed. We then used difference-indifferences regression modeling to assess the change in Medicaid participation among immigrant children in sanctuary relative to non sanctuary states, after adjusting for race, ethnicity, state, year, and Medicaid expansion status.

Results

Our sample included 3,943 immigrant children with household incomes < 150% of the federal poverty level. Sanctuary and non-sanctuary states had similar rates of child poverty, and sanctuary states had a greater baseline proportion of Latinx residents (Table 1). Although children’s Medicaid participation was not considered in the revised public charge rule, Medicaid participation among immigrant children in non-sanctuary states declined after the rule was announced. In contrast, Medicaid participation among immigrant children in sanctuary states increased during this time period (Figure 2). In adjusted difference-in-differences models, immigrant children in sanctuary states had a 9.8% greater probability of Medicaid participation (95% CI 2.9-16.6%, p=0.005) relative to children in non-sanctuary states, following the public charge rule.

Conclusion(s)

Following the revised public charge rule, low-income immigrant children in states with sanctuary immigration policies were more likely to receive Medicaid than children in non-sanctuary states. Sanctuary policies may protect against the harmful effects of federal legislation on immigrant children.

Tables and Images

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Table 1.png

Figure 2.png

 

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