Authors from Emory University, the Lown Institute, the University of Colorado Anschutz Medical Campus, and Harvard T. H. Chan School of Public Health reported that emergency Medicaid comprised a very small portion of total state Medicaid expenditures in 2022, with higher costs found in states having larger populations of undocumented immigrants.
Federal regulations exclude undocumented immigrants from full Medicaid, Medicare, and ACA Marketplace benefits. Emergency Medicaid provides a limited package aimed at stabilizing serious health conditions, often covering labor and delivery; some states extend coverage to dialysis and cancer care.
The 2025 federal budget reconciliation legislation introduces extensive Medicaid cuts beyond emergency Medicaid for undocumented immigrants. While the law reduces federal contributions to emergency Medicaid, it also diminishes support for millions of U.S. citizens and legally resident immigrants. Nevertheless, the public debate around the proposed reductions frequently centers only on emergency Medicaid for the undocumented.
In the Research Letter titled “Emergency Medicaid Spending for Undocumented Immigrants in the US,” published in JAMA, investigators performed a cross‑sectional analysis to evaluate emergency Medicaid spending relative to total Medicaid and to determine state characteristics linked to variation.
The analysis included 38 states and Washington, D.C., that reported emergency Medicaid expenditures for fiscal year 2022.
The findings indicated that emergency Medicaid represented an average of 0.4% of total Medicaid expenses and averaged $9.63 per resident among reporting states.
Authors concluded that emergency Medicaid accounts for less than 1% of overall Medicaid spending even in states with sizeable undocumented populations, and that forthcoming cuts to emergency Medicaid would generate only modest savings for the total Medicaid budget.
Written for you by Justin Jackson, edited by Sadie Harley, and fact‑checked by Robert Egan, this piece reflects rigorous human journalism. Your support helps keep independent science reporting alive: consider a donation—especially monthly—for an ad‑free experience.