Immigration Policy Effects on Noncitizens in Medicaid: Evidence from the Public Charge Rule in California

• In Event: Student Panel: Insurance and poverty alleviation

Abstract

I examine the effects of the Trump administration’s “Inadmissibility on Public Charge Grounds” (or “Public Charge”) regulation, which would add utilization of Medicaid services to an immigration official’s considerations when evaluating a non-citizen’s green card application. I use claims data from 2015 to 2022 in California’s Medi-Cal program to examine changes in the utilization of “restricted-scope” Medicaid services - a limited set of emergency-only services that non-citizens are able to use in Medicaid. Utilizing an event study difference-in-differences approach, I estimate that non-citizens reduced their utilization of emergency room services by 21% when compared to other Medicaid enrollees. These reductions in service are seen from the time the proposed rule was leaked to after the finalization of the rule, indicating a significant and persistent “chilling effect” on service utilization over time. Additionally, other populations that would not be affected under the rule - such as legal permanent residents who have enrolled after the 5-year bar - see lesser but significant drops in ER utilization, suggesting spillover effects due to misunderstanding or fear of the rule. To cross-check against self-reported outcomes, I use California Health Interview Survey (CHIS) data over the same time period, finding similar reductions in care utilization for non-citizens across all medical services. These findings have implications for future administrations who may choose to revisit this type of regulation conditioning citizenship status on utilization of public healthcare services, as well as messaging towards non-citizens regarding these rules.

Author

• Jonathan Ian Palisoc, University of Michigan
  Presenting Author