Citizenship documentation for Medicaid eligibility effects on Oregon children

The Deficit Reduction Act of 2005 required states to verify U.S. citizenship for all Medicaid applicants, leading to declines in enrollment and increased administrative burdens. This study examined which children were denied Medicaid for lack of citizenship documentation, whether these denials led to insurance gaps, and how they affected access to care. Using data from the 2007 Oregon Health Plan Disenrollment Study (n=394; weighted n=104,375), we found that denied children were more likely to come from low‑income households, have chronic conditions, and have reapplied for Medicaid. Over one‑third experienced a six‑month insurance gap, and denied children had greater unmet health care needs than accepted applicants—an effect moderated by having insurance or a usual source of care. Findings indicate that citizenship documentation requirements disproportionately burden medically and socially vulnerable citizen children and contribute to gaps in coverage and care, highlighting the need to revise or streamline these policies.