The State of Older Undocumented Immigrants and Their Health

Accessing high-quality healthcare can be difficult for immigrants living in the United States, however, for older undocumented immigrants this difficulty is compounded by a combination of legal, cultural, language and systemic barriers that have widened the existing disparities of healthcare access for this population.

As the number of older undocumented immigrants in the United States continues to grow, new challenges are emerging, and the expansion of healthcare coverage across the country has not included undocumented immigrants. Access to federal programs like Medicare and Medicaid, and broad immigration reform, will be necessary steps to help close the gaps in our current system.

In a recently published study, we examined trends in immigrant health and healthcare after the Great Recession and the nationwide implementation of the Affordable Care Act. While our data showed that most immigrants are actually healthier on average than U.S.-born citizens, that was not the case for the millions of undocumented immigrants living in the country.

Across the board undocumented immigrants have disproportionately higher health risks. Our study found that twice as many undocumented immigrants ages 65 and older reported being in “fair or poor” health than did U.S.-born citizens, and only 29.3% said they were in “very good” or “excellent” health, compared to 54.2% of citizens.

Higher Rates of Injury and Infection, Mental Health Stigma

Many undocumented immigrants are also forced to continue working in their old age as they are ineligible for Medicare, Social Security and retirement benefits, and for most, working conditions can be less than ideal. Risks like higher rates of occupational injuries are reported in jobs more likely to employ immigrants. Injury rates among immigrants are higher than the national average, and many workplace exposures and injuries go unreported because of fear of immigration enforcement against those who are undocumented.

Early epidemiological research shows that undocumented immigrants working in front-line and low-wage jobs have been at higher risk for infection throughout the COVID-19 pandemic. Also, overcrowded housing, poorly treated chronic conditions and social determinants of health are contributing factors to disproportionately higher mortality among undocumented Latino immigrants, especially older adults.

In addition, undocumented immigrants can experience disparities in mental health care use. The stigma of mental health issues among many immigrant communities is the backdrop to a daily fear of detention and deportation; it isolates immigrants who may need critical mental health care resources for the health and well-being of themselves and their families.

‘Across the board undocumented immigrants have disproportionately higher health risks.’

Risks in mental and physical health are exacerbated by a lack of proper access to health insurance from private providers or from federal programs. Our current healthcare system is largely unprepared to deal with this uninsured population that legally can’t acquire health insurance from federally mandated programs such as Medicare or the ACA health insurance exchanges.

Although federal legislation like the Affordable Care Act (ACA) has contributed to increased eligibility and health insurance coverage among legally authorized immigrants, it has for the most part excluded undocumented immigrants. In 2019, approximately 46% of undocumented immigrants were uninsured, compared to 9% of U.S. citizens. This poses a great risk for this population as their health needs are not being met effectively.

For the thousands of older undocumented immigrants living in the United States this means having poor access to quality care, and suboptimal health insurance coverage. All of which culminates in broad deteriorating health standards for a population that has limited options for reliable healthcare.

Additionally—for many older immigrants—returning to their homeland is not a viable option for healthcare. Research has found that undocumented Mexican immigrants are unlikely to use healthcare in Mexico until their legal status is resolved, as returning to the U.S. would prove more difficult. And older undocumented immigrants are often ineligible to receive health benefits in their countries of origin because they spent their productive lives working in the U.S. This creates great challenges for accessing and financing healthcare in their countries of origin.

So, How Can We Fix It?

With declining federal support for immigration reform, the burden of covering this population has shifted to state and local safety-net providers. Some states have begun taking direct measures that would provide undocumented immigrants with access to healthcare, but many of those programs can be severely limited.

In 2021, California created the first ever expansion of Medi-Cal, the state's Medicaid program, to undocumented Californian’s ages 50 and older. The bold initiative expanded the program to include approximately 235,000 undocumented immigrants in the state, with plans of expanding to all undocumented immigrants in California by 2024. This expansion is seen by many as a necessary step for a state that is home to more than a quarter of all undocumented immigrants.

‘Some states have begun taking direct measures that would provide undocumented immigrants with access to healthcare.’

Similarly, the MassHealth Limited program in Massachusetts is for individuals ages 65 and older who cannot access the state’s Medicaid program due to immigration status. The program covers expenses like emergency services, certain outpatient services provided by community clinics, pharmacy services and ambulance transportation.

Although California and Massachusetts can serve as models for how to appropriately expand state Medicaid programs to undocumented immigrants—much still needs to be done.

Limited state and local level programs that only partially address health inequities are unable to meet the full healthcare needs of older undocumented immigrants. In addition, Medicaid is not nearly as robust as a program like Medicare, which is more comprehensive in terms of coverage.

Expanding Medicare coverage for all older adults at the federal level could solve many of the difficulties that immigrants face in finding healthcare coverage. Similarly, immigration reforms to naturalize undocumented immigrants could have positive spillover effect providing eligibility to Medicare and Medicaid to most immigrants. Both routes have the same outcome and would ease the difficulties of finding healthcare coverage as an undocumented immigrant.

Approximately 10% of the undocumented population is now older than age 55. This population, however, is rapidly aging. We need to take steps to reduce healthcare disparities by providing undocumented older adults with quality healthcare as they age.

Arturo Vargas Bustamante, PhD, MPP, is director of Faculty Research at the UCLA Latino Policy and Politics Institute (LPPI), and professor of Health Policy & Management at the UCLA Fielding School of Public Health. He may be contacted at Jose Garcia Portillo is a policy fellow at the UCLA Latino Policy and Politics Institute (LPPI), and a graduate student at the UCLA Luskin School of Public Affairs.