Personal Narrative Bank: IRI’s Four Years of Research on Immigrants’ Challenges to Medicaid Enrollment

Dec 2, 2024 Immigration Research Initiative

Enrolling in or renewing Medicaid can be a difficult process for anyone. Technical jargon, long wait times, and a lack of assistance can all be offputting. However, it is especially challenging for immigrants who may have to navigate additional challenges such as language access, documentation requirements, and experiences of prejudice against immigrants in addition to the bigotry that others may experience. To better understand the challenges that immigrants face when enrolling in or renewing Medicaid, Immigration Research Initiative (IRI) conducted four years of research to gather the experiences of immigrants in the United States.

IRI interviewed immigrants who resided in New York, to understand what some of the challenges to Medicaid enrollment are for immigrants in the state. IRI also conducted a state-level survey to understand the prevalence of the challenges for immigrants across the very different regions of New York State, from New York City to Long Island to Western New York.

To better understand the prevalence around the country of the issues these New York-based surveys and interviews surfaced IRI conducted two national surveys.

Our most recent survey, reported for the first time here, was national and gathered experiences of immigrants to add context to the three previous years of work. This new survey helps highlight the pervasiveness of these challenges for immigrants across the United States, and identify the stories of individual Medicaid applicants.

The survey gathered a total of 462 responses, with strong responses from immigrants in California (41 percent), New York (12 percent), Texas (7 percent) and Florida (6 percent). Most survey respondents (32 percent) preferred not to indicate their immigration status. However, 24 percent of survey respondents indicated they are undocumented, 15 percent have requested asylum, 8 percent have a green card, 3 percent have applied for a visa and are waiting for a new status, and one percent has already been granted asylum.

An overwhelming majority of survey respondents (88 percent) identified as Latino/a/x, followed by white (9 percent), and African American/Black (1 percent).

Altogether, the four years of research collected over 700 survey responses and stories from 40 interviews with immigrants who have applied for Medicaid, some with applications that were denied and some with applications that were accepted.

Although this sample cannot be considered representative it gives us a look into the experiences of immigrants when enrolling or renewing for Medicaid and helps bring individual experiences to life for policy-makers, media, and the general public.

Lessons About Making Application for Medicaid Easier: We Did It During the COVID Pandemic

During the COVID-19 pandemic, states enacted the Families First Coronavirus Response Act (FFCRA) which declared that for the length of the public health emergency, individuals covered by Medicaid, Child Health Plus (CHP) and the Essential Plan (EP) on March 18, 2020, as well as those who enrolled after that date, were allowed to remain enrolled without having to go through the usual annual renewal process until after the public health emergency was declared over. This meant that no one covered by these health insurance programs could have their Medicaid coverage reduced or terminated.

This provision worked well for enrollees. However, the unwinding of this rule brought back a host of challenges for people who rely on Medicaid, including all the specific challenges that immigrants face.

Problems that survey respondents reported included language access difficulties, poor translation, long wait times, experiences of race and gender discrimination, xenophobia, difficulty understanding the application, technology access challenges, and experiences of unprofessional interactions with Medicaid personnel.

We would like to give a special thank you to our many partners in New York State and across the United States who helped us conduct outreach and connect with community members over the past four years. We would also like to thank all the survey participants and interviewees for sharing their invaluable experiences that makes this research informative for policy change.