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  “Approximately 40 percent of immigrants in New York City and Los Angeles think that welfare recipients are not eligible for naturalization.”

  Yunju Nam

  Assistant Professor of Social Work

By BRIAN PETERS

Published: November 28, 2011

With health care, the national deficit and immigration all serving as current hot-button political issues, one UB faculty member has found a viable way to both save money and provide health care for elderly immigrants.

Simply make elderly immigrants eligible for Medicaid.

Yunju Nam, assistant professor in the School of Social Work, recently completed a study that found it is more expensive for the country to restrict immigrants’ access to Medicaid than it would be to allow them the benefits.

Nam’s research looked into how the Personal Responsibility and Work Opportunity Reconciliation Act of 1996—commonly known as “welfare reform”—affected health care coverage among a nationally representative sample of adults 65 years of age and older.

Because of welfare reform, noncitizens are no longer eligible for federally funded Medicaid if they immigrated to the United States after 1996 and have not lived in the country for at least five years. For example, under welfare reform, a 75-year-old woman who emigrated from Poland to the U.S. four years ago and is unable to afford health care on her own would be ineligible to receive Medicaid.

According to Nam, these toughened federal-eligibility requirements created by welfare reform resulted in a drop in the number of elderly immigrants covered by Medicaid, indicating it had become harder for noncitizens to gain access to health care. This caused an increase in emergency room Medicaid expenditures for older immigrant adults, as many of them were not able to afford preventative health care on their own.

In addition, the number of naturalized citizens covered by Medicaid increased after welfare reform, showing that those immigrants who still were eligible had gained citizenship specifically to receive health care coverage.

“Because better coverage for citizens would’ve been an incentive for immigrants to naturalize, cost savings that may have been realized from decreased Medicaid coverage among older noncitizens was likely offset by increased coverage for older naturalized citizens,” says Nam.

Nam’s research is expected to be published by the end of the year in the Journal of Aging and Health.

Unfortunately, many elderly noncitizens, even those eligible for naturalized citizenship, voluntarily withdraw from public-benefit programs, such as Medicaid, out of fear of potential disadvantages, Nam says.

“They are afraid that they would not be able to sponsor their family members’ immigration to the U.S. or that they might be deported if they received public benefits,” he adds. “Approximately 40 percent of immigrants in New York City and Los Angeles think that welfare recipients are not eligible for naturalization.”

Nam believes the federal government should reach out to low-income elderly immigrants and educate them about the realities of receiving public assistance to help them overcome their fears. “Let them know that participation in Medicaid will not affect their eligibility for naturalization or their ability to sponsor the immigration of family members to the U.S.,” Nam says.

Previous studies have shown that a lack of health coverage limits an individual’s access to both preventative and needed medical care, resulting in increased emergency-room services and higher long-term costs to society. Since Medicaid is the only way for many of these elderly immigrants to keep themselves healthy and out of emergency rooms, Nam drew the conclusion that making access to Medicaid easier would cost society less than denying them health coverage.

“Restricting older immigrants’ Medicaid coverage likely raises long-term health care costs, even if it were to succeed in excluding immigrants from Medicaid coverage in the short term,” Nam says. “Given this study’s findings and other empirical evidence on the negative consequences of limited access to medical care, policymakers should reconsider the current policy of restricting Medicaid eligibility of noncitizens.”