Undocumented Emergency Medicaid Comprises Under 1% of State Spending, Study Finds

(UNITED STATES) Emergency Medicaid for undocumented immigrants made up a very small slice of total Medicaid spending last year, according to new research reviewed by policy analysts and immigrant health advocates. The program, which pays for immediate, short-term care like labor and delivery, accounted for just 0.4% of total Medicaid spending in both 2022 and 2023.

In fiscal year 2023, states and the federal government spent $3.8 billion on Emergency Medicaid for noncitizen immigrants, including undocumented immigrants, while overall Medicaid spending ran in the hundreds of billions nationwide.

Total spending and multi‑year view

Across seven fiscal years, from 2017 through 2023, combined federal and state Emergency Medicaid costs for noncitizen immigrants totaled $27 billion, with the share staying under 1% of total Medicaid spending each year.

That pattern held even in states with the largest undocumented populations, where pressures on safety‑net hospitals and public budgets are often sharpest. According to analysis by VisaVerge.com, the data adds context to recurring debates over how much undocumented immigrants drive health costs and what cuts would actually save.

Spending patterns and what Emergency Medicaid covers

Researchers found that states with larger undocumented populations spent about 15 times more per capita than states with smaller undocumented populations. Even so, Emergency Medicaid remained below 1% of state Medicaid budgets.

In 2022, Emergency Medicaid costs for undocumented immigrants came to about $9.63 per resident across the 38 states and Washington, D.C., that reported data. The figure helps put the program’s scale in perspective for taxpayers and lawmakers who often hear claims that these costs are driving overall Medicaid spending.

Emergency Medicaid has a narrow purpose. Key features:

• Pays only for urgent, short‑term treatment for people who meet income and other Medicaid rules but lack an eligible immigration status.
• The most common claims are for labor and delivery.
• In some states, the program also covers dialysis and certain cancer treatments when the situation meets the legal definition of an emergency.
• It does not cover routine doctor visits, long‑term care, or preventive services.

Federal law excludes undocumented immigrants from comprehensive Medicaid, Medicare, and Affordable Care Act Marketplace coverage. That leaves Emergency Medicaid as the sole federal health program accessible to undocumented immigrants, and only when a medical situation is acute. States cannot use Emergency Medicaid to create broader coverage without clear legal authority.

The Centers for Medicare & Medicaid Services explains the policy baseline and state options in its guidance on coverage of emergency services for non‑citizens, which sets the guardrails for what states can claim under federal law. Readers can review that official overview at Medicaid.gov: Medicaid and CHIP Coverage of Emergency Services for Non‑Citizens.

Policy fights, potential savings, and real‑world impact

Budget writers in some states and in Congress have pointed to Emergency Medicaid as a place to trim spending. Recent proposals tied to the 2025 Budget Reconciliation process included ideas to restrict or cut the program.

However, studies indicate such changes would likely bring minimal cost savings while shifting pressure onto states with larger undocumented communities and the safety‑net hospitals that care for them. Those hospitals already operate on thin margins and tend to serve neighborhoods where many patients are uninsured or face language and transportation hurdles.

• Reducing Emergency Medicaid would not stop medical emergencies; it would shift costs to:
  • hospital charity care,
  • counties,
  • private payers.

The research also flags limits in the data:

• Not all states reported Emergency Medicaid spending.
• Analyses focus on this program alone and do not tally other public costs or offsets linked to undocumented immigrants (e.g., local health programs, emergency response, downstream effects when patients delay care).

Still, the 0.4% figure in both 2022 and 2023, and the steady under‑1% share year after year, serve as a consistent signal across multiple datasets.

Taxes, contributions, and fiscal context

Tax records and independent estimates add another piece to the picture. Undocumented immigrants pay billions in federal, state, and local taxes each year through payroll withholding, sales taxes, and property taxes (paid directly or through rent). Those taxes help fund broad programs, including Medicare and Social Security, which rely on worker contributions.

Some economists note that undocumented workers often pay in without receiving benefits later in life, which can stabilize trust funds in the short term.

Patient experience and practical implications

For families, the rules around Emergency Medicaid can be confusing and scary in the middle of a crisis. Important points:

• A mother in active labor, a worker with a traumatic injury, or a patient whose dialysis cannot wait will qualify only for the emergency period.
• Once the emergency ends, coverage ends. Hospitals then work with patients on payment plans or charity programs.
• Repeat emergency use does not morph into full coverage; the program’s narrow design is why total Emergency Medicaid costs remain a small fraction of overall Medicaid spending.

Practical steps for mixed‑status families:

1. Keep identity and income documents ready in case an emergency occurs.
2. Bring any medical records you have to the hospital.
3. Ask the hospital’s financial counselor about Emergency Medicaid screening after urgent treatment begins.

This screening does not create broader enrollment; it only determines if the emergency visit fits the rules for payment.

Geographic differences and implications for policymakers

The uneven distribution of costs across states matters:

• States with higher shares of undocumented residents—and those with large agricultural, construction, hospitality, or caregiving sectors—are more likely to see higher per‑capita Emergency Medicaid spending.
• Even in those states, Emergency Medicaid remains below 1% of state Medicaid budgets because Medicaid is such a large program overall.

Policymakers weighing cuts should factor in how hospitals in border states and major metro areas would absorb unpaid care if the program shrinks.

Hospitals and clinicians argue Emergency Medicaid can prevent worse outcomes and higher costs by allowing timely treatment during a crisis. Examples:

• Labor and delivery coverage reduces severe complications for mothers and newborns, avoiding longer hospital stays and higher costs.
• Covering dialysis and certain cancer treatments in emergencies can avert rapid declines that would trigger more expensive care within days.

Fiscal takeaways and benchmarks

From a fiscal angle, the headline figures remain consistent:

• $3.8 billion in FY 2023
• 0.4% of total Medicaid spending (2022 and 2023)
• $27 billion across FY 2017–2023
• $9.63 per resident in 2022 across reporting states and D.C.

VisaVerge.com reports that the share has not crept upward even as state budgets have faced post‑pandemic shifts and enrollment churn.

As state legislatures enter budget season and Congress debates federal spending caps, Emergency Medicaid will likely surface again in hearings and floor debates. Supporters of cuts may frame the program as a magnet for migration, though the research summarized here focuses on spending shares rather than migration drivers. Health systems and local officials may counter that cutting a program that equals less than 1% of Medicaid spending risks higher uncompensated care, ER crowding, and worse maternal health, with little fiscal upside.

Bottom line

Emergency Medicaid serves as a narrow, last‑resort safety line for urgent care among undocumented immigrants, and it represents a very small fraction of overall Medicaid spending. Any changes to this program will be felt most by states with large undocumented populations and by the safety‑net hospitals that already carry a heavy load.