Less than 1% of Total Medicaid Spending Goes to Emergency Care for Noncitizen Immigrants

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A new Congressional Budget Office (CBO) report shows a total of $27 billion in federal and state spending on Emergency Medicaid for noncitizen immigrants between fiscal years (FY) 2017 and 2023. This report could fuel further false claims from former President Trump and Vice Presidential candidate Vance that immigrants are accessing public benefits and draining federal resources, leading to continued misinformation among the public.

Twenty seven billion dollars certainly sounds like a lot of money, but this spending represents less than 1% of overall spending in Medicaid over the entire time period, and, in some years, is less than half of a percent. Spending on Emergency Medicaid was $3.8 billion in FY 2023 and was .4% of total Medicaid spending that year.

Undocumented immigrants are not eligible for federally-funded Medicaid coverage. Emergency Medicaid spending reimburses hospitals for emergency care they are obligated to provide to individuals who meet other Medicaid eligibility requirements (such as income) but who do not have an eligible immigration status. These include lawfully present immigrants who are subject to a five-year waiting period for Medicaid and undocumented immigrants. Emergency services include those requiring immediate attention to prevent death, serious harm or disability, although states have some discretion to determine reimbursable services. Much of Emergency Medicaid spending goes toward labor and delivery costs. Without Emergency Medicaid, the costs of care would be shifted to hospitals that are required to treat individuals in emergency situations or fully to states.  

Although undocumented immigrants remain ineligible for federal health insurance programs like Medicaid, survey data show that much of the public incorrectly believes they are eligible or is uncertain. Overall, research shows that immigrants use less health care and have lower health care costs than their U.S.-born counterparts, reflecting that they are younger and healthier and that they face greater barriers to care, including language access challenges, confusion, and immigration-related fears that were amplified under the Trump Administration. Moreover, while less than half of the public believes undocumented immigrants make substantial tax contributions, data show that they pay billions in federal, state, and local tax payments, with research showing that they help subsidize health care for U.S.-born people and stabilize Medicare and Social Security.