Excluded in the Expansion: The persisting gaps in health care coverage for immigrant Oklahomans

Medicaid expansion in Oklahoma has allowed more than 300,000 residents to enroll for health care, but almost 82,000 Oklahomans who are immigrants remain uninsured. Since the mid-1990s, many immigrants are either partially or entirely ineligible for federal public benefits programs, including Medicaid. As a result, noncitizen immigrants are significantly more likely than citizens to be uninsured, leaving them at risk of serious illness and with limited options for preventative care. Relying on emergency health services to care for the uninsured — regardless of immigration status — is an enormous burden on both taxpayers and Oklahoma’s medical providers. Lack of regular health care access also jeopardizes the significant impacts our immigrant community provides both to our state’s economy and the essential services that keep our communities running. However, Oklahoma has the power to build on federal guidelines and expand state-funded Medicaid to more people, ensuring that all Oklahomans have access to health insurance and can live healthy and prosperous lives.

Immigrants are frequently barred from Medicaid

The complicated rules around immigrants’ eligibility for federal benefit programs stem from a 1996 federal law named the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). This law created two categories of immigrants: qualified and not qualified. These categories determine whether immigrants qualify for federal programs, although the name is misleading because even qualified immigrants can be barred from accessing these benefits for the first five years after gaining qualified status. According to OK Policy analysis1, only about one in three noncitizens in Oklahoma are qualified individuals, meaning the majority of immigrants cannot access programs like Medicaid.

For a more detailed breakdown of immigrant eligibility for federal programs, click here.


Around the nation, these strict eligibility categories have contributed to immigrants’ overall lower health insurance rates. The usually more expensive private or employer-based health insurances are not a viable option for noncitizen immigrants, who earn lower incomes than U.S. citizens. Additionally, low-income people and people of color disproportionately rely on community health centers (CHCs), which have a unique mission of ensuring access for underserved, under-insured, and uninsured patients.. The pandemic hit these centers hard, especially during the earliest days when almost 2,000 locations were temporarily shuttered due to health concerns and outbreaks. In the ensuing years, community health centers nationwide have faced operational disruptions, including employee recruitment and retention, that threaten their capacity to serve communities in need. 

Oklahoma has several options to insure our vulnerable populations

Oklahoma can expand health coverage to more people by starting with children. Our state has already taken important steps to protect some of the most vulnerable in Oklahoma by offering prenatal care to all pregnant persons, regardless of their immigration status. As such, Oklahoma should use state Medicaid funds to expand SoonerCare qualifications to include all age- and income-eligible undocumented children and remove the five-year waiting period for qualified immigrant children currently ineligible for Medicaid. Currently, six states have already expanded their state Medicaid programs to include their younger residents, resulting in uninsured rates dropping as much as 34 percent.

The state can also improve the health of Oklahoma families by creating programs for older immigrant adults who are otherwise ineligible for Medicaid due to their immigration status. For instance, Illinois created a program that provides medical coverage to all seniors, despite their immigration status. By the end of the program’s first year, more than 9,000 documented and undocumented seniors had enrolled for the program. Studies show that older adults often forgo needed health care services because of high costs, making it even more imperative that Oklahoma protect our aging population, especially since the older foreign-born population is expected to grow rapidly in the coming years.

Oklahoma has the right to expand state-funded Medicaid to more of its residents

States have the power to decide how to use their Medicaid funds, meaning Oklahoma has the ability to remove the confusing restrictions around Medicaid at the state level and expand access to state-funded Medicaid to more of its residents. State Medicaid programs are funded by a combination of state and federal dollars, so using state-funded Medicaid to remove the five-year waiting period for eligible immigrants and expanding state Medicaid access to undocumented immigrants does not run afoul of federal rules. Enacting these expansions will require that the state increase funding to Medicaid, but the alternative option of inaction is just as costly. 

Without access to health care, many uninsured immigrants have no choice but to put off health visits until it is unavoidable, resulting in the state and hospitals having to pay for emergency health care services. Emergency Medicaid covers emergency labor and delivery and acute symptoms that could cause a body part or organ to not function properly or in a way that would directly affect life or health. It is available to all individuals regardless of immigration status and income level, but it is expensive. In 2020, Oklahoma taxpayers and area hospitals provided more than $663 million in uncompensated care costs. Expanding Medicaid to all immigrants, regardless of immigration status, remains a financially sound move that will save the state money, while ensuring the health of our population. Immigrants contribute billions to the U.S. economy and all Oklahoma residents — regardless of immigration status — are paying taxes and financially contributing to government operations. Therefore, they should be able to enroll in the programs that their tax dollars support.

A healthier Oklahoma starts here

In 2019 before the state expanded Medicaid coverage, Oklahoma had the nation’s second highest uninsured rate. After implementing expanded Medicaid coverage, Oklahoma’s uninsured rate declined significantly, dropping more than five points from 14.6 percent to less than 10 percent. Expanding state-funded Medicaid health care to more immigrants, including undocumented immigrants, is a logical next step and investment in ourselves and our future. Barring someone from medical coverage because of their immigration status is not only counterproductive to public health, but it also willfully endangers the well-being of our friends and neighbors. Oklahomans have proven that we are willing to expand Medicaid to ensure that more of our fellow Oklahomans are protected. It’s time to do the same for immigrant Oklahomans, regardless of their immigration status.

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1Sources: Migration Policy Institute and U.S. Department of Homeland Security 


Gabriela joined OK Policy as an Immigration Policy Analyst in August 2021. Raised in Oklahoma City, she graduated from the University of Oklahoma with a Bachelor of Arts in International Studies with minors in German, Arabic, and International Security Studies. During college Gabriela had internships at the Council on American-Islamic Relations Oklahoma, the Office of former Congresswoman Kendra Horn, and she took part in events to help educate first-generation Latinx students on how to attend college. Gabriela looks forward to using her skills at OK Policy to work towards a more equitable future for all Oklahomans.

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