Covering the Uninsured: A National Scan of State-Based Coverage for Immigrants

Many states are trying to decide whether and how they should offer health coverage to immigrants with unsatisfactory immigration status (UIS), which includes people who are undocumented and some who are in the US legally but without full rights — green card holders and lawfully present immigrants. This paper is intended to provide policymakers, advocates, and other stakeholders with a snapshot of the options available to states up until now and how states have responded.

People with UIS have few choices for health coverage. Across the country, most undocumented immigrants cannot access federal programs like Medicaid and the Children’s Health Insurance Program (CHIP). Some immigrants here legally must meet certain requirements and often must wait five years before they can get benefits. In 2023, 50% of undocumented adults and 18% of lawfully present immigrant adults did not have health insurance.

Even with federal rules, states can take steps to help more people get coverage. Some of these steps include:

• Offering prenatal and pregnancy care through a special CHIP program, From Conception to End of Pregnancy, no matter a person’s immigration status.
• Using CHIP Health Services Initiatives to extend postpartum coverage.

Beyond federal options, some states pay for their own coverage programs for UIS immigrants. These often mirror Medicaid and CHIP or provide access via state marketplaces or basic health plans.