Identifying the Undeserving Poor: The Effect of Racial, Ethnic, and Anti-Immigrant Sentiment on State Medicaid Eligibility

ABSTRACT In the United States, race and racism are woven into the very fabric of the welfare state. Racial antipathy has undermined public support for benefits perceived as favoring African Americans and has resulted in significant cuts in programs for the poor. Recently, some studies have found that public discussion on immigration has linked attitudes toward Hispanics and illegal immigrants with preferences toward programs once overwhelmingly influenced by racial attitudes. Building on this literature, the present study assesses the effect of racial and ethnic attitudes on state policy outcomes. Specifically, we examine Medicaid eligibility criteria for four categories of beneficiaries, ranked by level of perceived deservingness. We find that eligibility limits are most generous for children, followed by pregnant women and parents. Benefits for “other adults” (low-income non-parents aged 18–64) are subject to more stringent eligibility criteria or entirely unavailable. In contrast with the limits for other groups, the primary attitudinal predictors of Medicaid eligibility limits for the “other adults” category are antipathy toward Blacks, Hispanics, and illegal immigrants. These results confirm that perceptions of deservingness are a central component of U.S. social policy and demonstrate that material policy outcomes – not just policy preferences – are substantially shaped by attitudes toward Hispanics and immigrants as well as African Americans.