Emergency Medicaid for undocumented immigrants accounts for less than 1% of state spending: Study

Emergency Medicaid for undocumented immigrants made up only 0.4% of total Medicaid spending in 2022, a new study finds.

Researchers from Emory University; University of Colorado Anschutz Medical Campus, Aurora; and Harvard T.H. Chan School of Public Health looked at financial management report data for fiscal year 2022 from the Medicaid Budget and Expenditure System.

Of the 38 states that had data and Washington, D.C., the team found that emergency Medicaid spending for undocumented immigrants amounted to about $9.63 for every resident in those states, according to the research letter published Thursday morning in JAMA.

Supporters of the 2025 Budget Reconciliation law say the cuts to Medicaid will only affect care for groups whom they believe should not be receiving it to begin with, such as undocumented immigrants.

However, undocumented immigrants are unable to receive comprehensive Medicaid, Medicare and Marketplaces options under the Affordable Care Act under federal law, the researchers note.

Emergency Medicaid is a limited form of Medicaid that pays for emergency medical care for people who meet all the usual Medicaid requirements except U.S. citizenship or legal immigration status.

Emergency Medicaid primarily covers immediate, short-term medical treatment such as labor and delivery, but some states also include care such as dialysis and cancer treatments.

Even in states with the largest undocumented populations, costs remained under 1% of Medicaid budgets, though these states spent roughly 15 times more per person than those with smaller undocumented populations. 

The authors noted that cutting emergency Medicaid, as proposed in the 2025 Budget Reconciliation law, would save little and would harm states with large populations of undocumented immigrants.

Additionally, the cuts will disproportionately harm safety-net hospitals and clinicians caring for immigrant communities, the authors say.

The authors added that the study has limitations including that 11 states did not report emergency Medicaid spending and that the analysis did not account for other public spending on undocumented immigrants.