State Estimates of the Low-Income Uninsured Not Eligible for the ACA Medicaid Expansion

The Affordable Care Act (ACA) will expand access to affordable health insurance for millions of Americans. However, a significant number will be excluded from the Medicaid expansion due to their immigration status. This brief provides the first state-specific estimates of the number of uninsured, low-income adults, that will potentially be excluded from the Medicaid expansion because of their immigration status. 

The brief concludes that safety-net health care providers are likely to continue to be key providers for this population after health reform, and the need for safety-net care will not be spread evenly across states. The capacity of safety-net providers to fill this gap will need to be assessed.

While all states will need to develop strategies for meeting the health care needs of these adults, the challenges will be particularly difficult for safety-net providers in states with large numbers of immigrants who will not be eligible for Medicaid.