The Cost of Immigrant Medicaid Coverage Under Current Policy

As presidential candidates debate whether illegal immigrants should receive government health benefits, it is important to understand how immigrants (both legal and illegal) currently benefit from Medicaid, the public healthcare program for the poor.

Using data from the Medical Expenditure Panel Survey, this report finds that 42 percent of immigrant-headed families had at least one member who was enrolled in Medicaid during 2016, compared to 26 percent of native-headed families. The average immigrant family created $2,796 in Medicaid costs, compared to $1,983 for the average native family.

Immigrants are costlier not because they have any special appetite for welfare, but because they tend to have less education and larger families that they struggle to support. All U.S. residents with those characteristics, foreign-born or native-born, are more likely to rely on government programs such as Medicaid. Immigrant welfare use can be reduced by changing selection criteria to favor immigrants who will have sufficient earning power to support their families without taxpayer assistance.

During their presidential debate on June 27, all 10 Democratic candidates on the stage raised their hands to affirm that they would open government healthcare benefits to illegal immigrants. When asked for specifics afterward, the candidates offered a range of proposals — from simply granting illegal immigrants unsubsidized access to the federal exchange, to giving them full public benefits under a "Medicare for All" system.1

In response to these proposals, the Center for Immigration Studies has issued two new reports. This first report details the participation rate and cost of Medicaid usage by immigrants under existing policy, which offers noncitizens less access to the program compared to citizens. A second report estimates the added cost of providing illegal immigrants full access to public health benefits, with most of the increase driven by exchange subsidies.2

Under existing policy, immigrant access to Medicaid is limited. Illegal immigrants, temporary immigrants (such as people on student or work visas), and immigrants who have been permanent residents for less than five years are generally not eligible. There are important exceptions to these rules, however. In many states, children and pregnant women can receive Medicaid without the five-year waiting period.3 Refugees and asylees are also eligible for Medicaid (or a similar program) without a waiting period, and all immigrants can receive emergency services regardless of status.

A final qualifier, and perhaps the most important one, is that U.S.-born minor children of immigrants are fully eligible for all public benefits, including Medicaid. As demonstrated in the results section below, immigrants and natives have similar rates of Medicaid use when considered as individuals, but immigrant families (which can include U.S.-born children) are significantly more likely than native families to have at least one member enrolled in Medicaid. Data and Methods

Several datasets are available to compare the Medicaid use of immigrants and natives. The most well known is probably the Current Population Survey's Annual Social and Economic Supplement (ASEC), which asks respondents whether they used Medicaid during the prior calendar year. The ASEC undercounts program participation, however, in part because it asks respondents to recall their participation over a period between three and 15 months before the interview takes place. In addition, the ASEC measures only participation in Medicaid, not the cost of medical care charged to the program on behalf of each respondent.4

Alternatively, the Survey of Income and Program Participation (SIPP) follows respondents over time, asking them about their monthly program participation at different points throughout the year. The result is a more complete picture of welfare participation compared to what the ASEC provides. However, like the ASEC, the SIPP does not measure the cost of Medicaid — only participation in the program.5

This report employs a third option, the Medical Expenditure Panel Survey (MEPS). Like the SIPP, the MEPS follows respondents over time to achieve a comparably accurate estimate of Medicaid participation. Unlike the SIPP, however, the MEPS supplements its interviews with information from medical providers on the costs generated by respondents throughout the year. These costs are categorized (such as a doctor visit or a prescription medicine) and assigned a payer (such as Medicaid or private insurance). This report focuses on Medicaid, which is the largest public health program for the poor.6

The MEPS is clearly the best dataset for comparing Medicaid costs between immigrants and natives. (The MEPS records place of birth, so that "immigrants" includes all those born abroad, regardless of citizenship.) An important caveat, however, is that Medicaid expenditures reported in the MEPS do not account for all of the program's costs. Because the MEPS is based on health events experienced by individuals in the survey, general Medicaid funds — such as administrative costs, disproportionate share hospital payments, and other grants — are not counted. Furthermore, the MEPS samples only from the civilian non-institutionalized population, meaning the costs generated by Medicaid enrollees in nursing homes and hospice care are omitted. Finally, no survey is perfect, and the MEPS does suffer from some underreporting of Medicaid costs that it was designed to capture, particularly costs associated with transients and the homeless.7

The fact that the MEPS covers only the non-institutionalized population and omits administrative costs is inherent to the study design and cannot be altered. However, it is possible to adjust the MEPS data to include the costs that the survey was designed to capture but missed. In a study that reconciles the 2012 MEPS with administrative data on health spending, researchers from the Department of Health and Human Services (HHS) found that overall Medicaid spending reported in the 2012 MEPS was 35 percent lower than it should have been given the MEPS target population and the types of medical events it covers. The undercounts ranged from 16 percent to 82 percent among the seven subcategories of Medicaid spending, such as doctor visits and hospitalization.8 This report uses the HHS undercount figures to adjust MEPS costs upward to match administrative records.

In the sections that follow, Medicaid usage rates and costs are presented at both the individual level and the family level, with immigrant and native families distinguished by the nativity of the head (or "reference person") of the family. An immigrant family can have some U.S.-born members — including, most critically, U.S.-born children of immigrants. A family-level analysis allows for Medicaid use by U.S.-born minor children of immigrants to be properly counted in the immigrant column, not the native column. Although this accounting is sometimes disputed by immigration advocates, the case for it is clear. Because adults have a legal obligation to provide medical care to their minor children (and to any other dependents), Medicaid spending on children is effectively a financial transfer to their parents. Furthermore, Medicaid eligibility is generally determined by family income and family size.9 Individual-level results are provided in the next section for reference, but the family is the most relevant unit of comparison. Main Results

Table 1 shows the percentage of Americans enrolled in Medicaid by immigration status, with the immigrant category further divided into subgroups. Despite restrictions on access, immigrant individuals use Medicaid at the same 23 percent rate as native individuals.10

Immigrant children (of whom there are relatively few) appear less likely to use Medicaid than native children, but the difference is not statistically significant.11 Immigrant adults are significantly more likely to enroll than native adults. An especially large and significant disparity exists among the elderly, probably because some immigrants are not eligible for Medicare. In general, immigrants from Latin America and immigrants without a college degree have above average rates of Medicaid enrollment, while enrollment rates for immigrants with a residency of at least 10 years do not substantially differ from rates among immigrants overall.

As discussed earlier, the most informative comparison is at the family level. The last row of Table 1 indicates that 42 percent of immigrant families had at least one member enrolled in Medicaid, compared to 26 percent of native families.

How do these enrollment rates translate to costs? Table 2 shows how much the average immigrant individual or family costs in Medicaid expenditures compared to natives. These costs are averaged across all individuals or families regardless of whether they were enrolled in Medicaid. (In other words, many $0 values are included in the averages.) In addition, the costs are adjusted upward to account for underreporting in the MEPS, as discussed in the "Data and Methods" section.

Native individuals cost insignificantly more than immigrant individuals on a per-capita basis. Among families, however, immigrants are significantly costlier, with an average Medicaid charge of $2,796 compared to $1,983 for native families. The costliest subgroup is Hispanic immigrant families at $4,411. Why Are Immigrant Families Costlier?

Do immigrant families consume more Medicaid dollars solely because of their higher enrollment rate, or do they also cost more once enrolled? Table 3 shows that among families that are enrolled, immigrant families are no more costly than native families.12 If anything, enrolled immigrant families cost less than enrolled native families, although the difference is not statistically significant.

It is clear that the higher enrollment rate among immigrant families drives their higher overall Medicaid costs, but why do immigrant families enroll so much in the first place? Immigrants do not appear to have a special appetite for welfare compared to natives; rather, they are simply more likely to have the demographic profile associated with native use of Medicaid — namely, less education combined with larger families that they struggle to support. Table 4 uses regression analysis to show how the difference between immigrant and native Medicaid costs shrinks when these characteristics are taken into account.

In the baseline estimate shown in the first row, immigrant families consume $813 more in Medicaid than native families, which is consistent with Table 2 above. The second row shows that the immigrant-native difference shrinks to $639 when controlling for the number of non-elderly adults in the family. The difference falls to $423 after adding a control for children in the third row. Finally, the fourth row shows that the difference becomes tiny and statistically insignificant when the education level of the family head (or reference person) is taken into account.

These results suggest that the problem of immigrants' reliance on Medicaid is not due to their foreign-born status per se; rather, it is the result of an insufficiently selective immigration policy that adds more people to the U.S. population who are less-educated and have larger families to provide for. As a result, a disproportionate share of immigrant families turn to the American taxpayer for support in the form of welfare programs, including Medicaid.13 Conclusion

As presidential candidates debate whether and to what extent illegal immigrants should receive government health benefits, the public should be aware of the Medicaid dollars that immigrants (legal and illegal) already consume, both for themselves and for their U.S.-born dependents. This report has shown that 42 percent of immigrant families had at least one member enrolled in Medicaid in 2016, compared to 26 percent of native families. The Medicaid cost per immigrant family (including non-enrollees) was $2,796, compared to $1,983 per native family.

The greater cost imposed by immigrants is entirely predicted by their relatively low levels of education and relatively large families. Whether they were born in Ohio or Guatemala, U.S. residents with those characteristics are at greater risk of relying on taxpayers to provide medical care to themselves, their dependents, or both. When immigration policy adds to the number of Americans who struggle to support their families, it adds to the welfare rolls as well.

[[Using data from the Medical Expenditure Panel Survey, this report finds that 42 percent of immigrant-headed families had at least one member who was enrolled in Medicaid during 2016, compared to 26 percent of native-headed families.]]

Nearly 3/4 of immigrants, legal and illegal, are on one type of government help or another- it’s a lie that immigrants are coming here to work- and ‘we need them because they do the jobs noone else will’- Sure, the greencard folks come here to work- the rest do NOT- they come here for free government handouts

immigrants, legal and illegal, are costing this country more than $600 BILLION DOLLARS every single year (When ALL costs are factored in- both direct costs, and incidental (ie, a drunk illegal alien kills a legal citizen- they get lawyers, keep getting retrials which are the direc t costs, but then the indirect costs are, the victim’s family has to keep going to court, probably need psychiatric help, insurance goes through the roof, lose work days because they gotta go to court- might get fired, etc etc etc)

Over $600 BILLION DOLLARS every single year going to immigrants, most of whom are on some kind of welfare help- many who are in prison, costing an average of $125 per day to house and feed- (many seniors have to get by on as little as $20 a day)-

Think about that- and the left are complaining about a $25 billion dollar wall which is a one time fee?

BUILD THE WALL!

That is why I refuse to donate to hospital charities. That charity money goes to cab fare and food for illegals, and losers who don't work. I saw it first hand. The waste of money donated by hard working people who thought they were helping others was insane.

[[Not to mention the free cab rides]]

Exactly- there are a ton of incidental costs that illegals are costing this country that go under the radar, but fortunately, back a decade or so ago- a couple of reputable businesses that do statistics did a count of all the direct costs, and estimates of the myriad incidental costs, and found that illegals and immigrants were costing this country between $400 BILLION DOLLARS and $600 BILLION DOLLARS every single year

You can read about one such study here:

http://www.usillegalaliens.com/the_costs_of_illegal_immigration.html

As well as see an decades old stats o nthe crimes illegals commit here: (It’s mind numbing just how many violent criminals coem across our borders, and the devestatign impact it’s havign on this country)

http://www.constitutionparty.com/illegal-alien-crime-and-violence-by-the-numbers-were-all-victims/

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