Illegal Aliens Draining Medicaid Despite Federal Restrictions
States Expand Medicaid Access for Undocumented Immigrants Through Various Exceptions and State-Funded Programs
Although undocumented immigrants are not eligible for regular Medicaid under federal law, many receive healthcare benefits through a range of exceptions and state-level initiatives.
Emergency Medicaid, a federal requirement, covers life-threatening conditions, labor and delivery, and certain chronic treatments like dialysis. Some states also extend prenatal care to undocumented pregnant women. In mixed-status households, U.S. citizen children may qualify for benefits, and in some states, undocumented minors are covered under children’s health programs. Family planning and limited emergency mental health services may also be available in certain cases.
Additional exceptions apply to individuals who fall under special legal classifications. This includes victims of trafficking, domestic violence, or those who hold “qualified non-citizen” status without being full citizens.
In recent years, several states have chosen to expand healthcare coverage to undocumented immigrants using state-only funds, since federal Medicaid matching funds cannot be used for this population. For example:
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California’s Medi-Cal program now provides full-scope benefits — including preventive care, prescriptions, and specialty services — to all income-eligible undocumented immigrants, regardless of age. This program costs the state approximately $2.6 billion annually.
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New York offers its Essential Plan to undocumented residents with incomes up to 200% of the federal poverty level, spending about $500 million per year.
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Washington State, Illinois, Oregon, and Colorado have also implemented their own state-funded programs with varying levels of coverage.
These expansions have contributed to significant increases in enrollment and spending. In New York, for instance, emergency Medicaid enrollment among undocumented immigrants reached approximately 480,000 as of March 2024 — a 1,200% increase since 2014. This group now represents about 7% of the state’s total Medicaid enrollment. While overall spending on this group tripled from $207 million to $639 million over the past decade, the average per-person cost has declined, as many enrollees do not use services regularly.
The increase in enrollment followed policy changes under the Affordable Care Act, which allowed immigrants ineligible for other insurance options to pre-register for emergency Medicaid. Enrollment rose further during the COVID-19 pandemic and again since 2022, as large numbers of new migrants arrived in the state. About 74% of these enrollees live in New York City, with the remainder primarily on Long Island and in the Hudson Valley.
In addition to emergency Medicaid, nearly 500,000 other non-citizens in New York are enrolled in the Essential Plan.
The Empire Center, a policy research organization, obtained these figures through a Freedom of Information Law (FOIL) request. The group noted some inconsistencies in the data provided by the New York State Department of Health, raising concerns about the accuracy and transparency of reporting.
At the federal level, the House Budget Committee recently cited analysis by the Congressional Budget Office (CBO) estimating that over $16.2 billion in Medicaid-funded emergency services have been provided to undocumented immigrants during the first three years of the Biden administration — a 124% increase from the same period under the Trump administration. The CBO also found that federal Emergency Medicaid spending reached $3.8 billion in FY 2023, about 0.4% of total Medicaid expenditures.
Committee Republicans argue that this growth reflects a combination of increasing undocumented immigration and expanded state-level benefits. They expressed concern that rising healthcare costs for undocumented immigrants could strain Medicaid, a program originally designed to assist low-income U.S. citizens and legal residents.
The report referenced the 1996 Personal Responsibility and Work Opportunity Reconciliation Act, which generally bars undocumented immigrants from receiving federal public benefits but still mandates coverage for emergency medical care.
In total, federal and state governments are estimated to spend between $7 and $9 billion annually on healthcare for undocumented immigrants. If more states adopt similar policies and if federal matching funds are reduced, analysts warn that state budgets could face up to $92 billion in additional costs over the next decade.
House Republicans have pledged to investigate the fiscal impact of undocumented immigration on federal health programs and are advocating for policy reforms aimed at preserving Medicaid for eligible U.S. citizens and legal residents.
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