HMN 2025: How Medicaid for undocumented immigrants is under 1% of spending

Authors affiliated with Emory University, the Lown Institute, the University of Colorado Anschutz Medical Campus, and Harvard T. H. Chan School of Public Health report that emergency Medicaid represented only a small share of state Medicaid spending in 2022, with higher spending concentrated in states with larger undocumented populations.

Federal law excludes undocumented immigrants from comprehensive Medicaid, Medicare, and ACA Marketplace coverage. Emergency Medicaid operates as a limited benefit for immigrants that covers stabilization for serious conditions and commonly includes labor and delivery, with some states also covering dialysis and cancer treatment.

The 2025 federal budget reconciliation law contains significant cuts to Medicaid that extend far beyond emergency Medicaid for immigrants. While the law does affect federal payments for emergency Medicaid, its provisions also target millions of U.S. citizens and lawfully present immigrants. Still, the argument in favor of the cuts tends to focus solely on emergency Medicaid for undocumented immigrants.

In the Research Letter, “Emergency Medicaid Spending for Undocumented Immigrants in the US,” published in JAMA, researchers conducted a cross-sectional analysis to examine emergency Medicaid spending relative to total Medicaid expenditures and to identify state factors associated with variation.

Analysis relied on 38 states and Washington, DC, that reported emergency Medicaid expenditures for fiscal year 2022.

Results showed emergency Medicaid accounted for a mean of 0.4% of total Medicaid expenditures and a mean of $9.63 per resident across reporting states.

Authors conclude that emergency Medicaid constitutes less than 1% of overall Medicaid spending even in states with large undocumented populations. Cuts to the emergency Medicaid are expected to yield minimal overall savings.

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