By Lisa Rapaport

(Reuters Health) – States that expand public health benefits to cover low-income legal immigrants don’t appear to experience a surge in immigrants moving to get medical coverage, a U.S. study suggests.

Federal policy changes in 2002 and 2009 led some states to expand public health insurance coverage to some children born outside the U.S. and to certain pregnant women. For the study, researchers examined data on interstate moves between 2000 and 2016 for 208,060 immigrants who could qualify for health coverage in states that expanded public insurance.

On average, 3% of the immigrants moved each year.

The proportion of immigrants making interstate moves within the first five years of U.S. residency didn’t appear to be influenced by expanded public health benefits, the study found.

“Our study showed that recent public health insurance expansion was not associated with a discernable increase in migration between states among eligible immigrants,” senior study author Jens Hainmueller of Stanford University in California and colleagues write in JAMA Pediatrics.

“Despite immigrant families being more responsive to economic conditions and these health care programs having significant uptake, results suggest that states considering expansion of health care benefits to certain immigrant groups are unlikely to experience large increases in immigrants from other states,” Hainmueller and colleagues write.

In the U.S., one in four children under age 18 were either born outside the U.S. or have parents who are immigrants, researchers note.

Federal welfare reform in 1996 for the most part barred legal immigrants who were permanent residents from getting public health benefits through Medicaid without five years of residency.

A total of 18 states funded programs to cover immigrant children without five years of residency, and 16 states had prenatal care options for pregnant women who had not yet been legal residents for five years, researchers note.

After a series of federal policy changes in 2002 and 2009, 31 states expanded public health benefits to children who were legal permanent residents and 32 states offered coverage to pregnant women – even when these people hadn’t been legal residents for five years.

In the year before certain states expanded coverage for immigrant children, the migration rate was 3.9%, the study found. In the year after coverage for these kids was added, the migration rate to these states was 3.7%.

By comparison, in the year before this children’s coverage expansion, the migration rate to expansion states was 4% for lawful permanent residents without kids, compared to 5.9% in the year after new benefits were added for kids.

Over the year before certain states expanded coverage for pregnant women, meanwhile, migration rates to these states was 2.7%, compared with 4.6% the year afterward. Migration rates for lawful immigrants without kids was 3.5% in the year before the pregnancy coverage expansion and 3.9% in the year afterwards.

The study wasn’t a controlled experiment designed to prove whether or how health policy changes might have directly impacted migration patterns for immigrants within the U.S.

“Immigrants do not uproot their lives and cross state borders to access health care, even at critical life moments, such as pregnancy and childhood development, and even if health care benefits across state lines are more comprehensive,” Jonathan Miller of the Office of the Massachusetts Attorney General in Boston and Elora Mukherjee of the Immigrants’ Rights Clinic at Columbia Law School in New York City write in an editorial accompanying the study.

“Making it easier for immigrant communities to connect to and seek care from physicians will not radically shift migration patterns,” they write. “Instead, allowing access to the basic human right of health care shows a common commitment to human decency for all who are in the United States.”

SOURCE: JAMA Pediatrics, online November 18, 2019.