title: The unintended impact of welfare reform on the medicaid enrollment of eligible immigrants.
abstract: BACKGROUND
  During welfare reform, Congress passed legislation barring legal immigrants who entered the United States after August 1996 from Medicaid for five years after immigration. This legislation intended to bar only new immigrants (post-1996 immigrants) from Medicaid. However it may have also deterred the enrollment of legal immigrants who immigrated before 1996 (pre-1996 immigrants) and who should have remained Medicaid eligible.
  
  
  OBJECTIVE
  To compare the Medicaid enrollment of U.S.-born citizens to pre-1996 immigrants, before and after welfare reform, and to determine if variation in state Medicaid policies toward post-1996 immigrants modified the effects of welfare reform on pre-1996 immigrants.
  
  
  METHODS
  Secondary database analysis of cross-sectional data from 1994-2001 of the U.S. Census Bureau, Annual Demographic Survey of March Supplement of the Current Population Survey.
  
  
  METHODS
  Low-income, U.S.-born adults (N=116,307) and low-income pre-1996 immigrants (N=24,367) before and after welfare reform.
  
  
  METHODS
  Self-reported Medicaid enrollment.
  
  
  RESULTS
  Before welfare reform, pre-1996 immigrants were less likely to enroll in Medicaid than the U.S.-born (OR=0.55; 95 percent CI, 0.51-0.59). After welfare reform, pre-1996 immigrants were even less likely to enroll in Medicaid. The proportion of immigrants in Medicaid dropped 3 percentage points after 1996; for the U.S.-born it dropped 1.6 percentage points (p=0.012). Except for California, state variation in Medicaid policy toward post-1996 immigrants did modify the effect of welfare reform on pre-1996 immigrants.
  
  
  CONCLUSIONS
  Federal laws limiting the Medicaid eligibility of specific subgroups of immigrants appear to have had unintended consequences on Medicaid enrollment in the larger, still eligible immigrant community. Inclusive state policies may overcome this effect.
authors.affiliation: Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 200, Chicago, IL 60611, USA.
authors.forename: Namratha R
authors.initials: NR
authors.lastname: Kandula
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Grogan
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Rathouz
authors.forename: Diane S
authors.initials: DS
authors.lastname: Lauderdale
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004608:Eligibility Determination / Q000331:legislation & jurisprudence*; D004641:Emigration and Immigration; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D011632:Public Assistance / Q000331:legislation & jurisprudence*; D012946:Social Welfare / Q000191:economics / Q000331:legislation & jurisprudence*; D014481:United States