Although illegal aliens do not qualify for regular Medicaid, millions receive benefits through a range of exceptions. Emergency Medicaid is available for life-threatening conditions, dialysis, and labor and delivery. Several states also extend prenatal care to illegal alien pregnant women, while mixed-status households sometimes access benefits through citizen children. In some states, illegal alien minors are covered under children’s programs, and family planning or mental health emergency services may also be available.
Additional exceptions exist for victims of trafficking or domestic violence, as well as “qualified non-citizens” who hold certain legal statuses short of full citizenship. Apparently, if an illegal alien is beaten by their spouse, they receive taxpayer money.
A growing number of states have gone further by expanding Medicaid coverage using state funds. California’s Medi-Cal program now covers all income-eligible illegal alien immigrants regardless of age, offering full benefits including routine care, prescriptions, and specialty services.
New York provides Essential Plan coverage for illegal alien immigrants with incomes up to 200 percent of the federal poverty level. Washington State includes illegal alien immigrants under its Apple Health program, while Illinois, Oregon, and Colorado have implemented their own versions of expanded coverage.
California’s program alone costs approximately $2.6 billion annually in state funds. New York spends roughly $500 million per year. These programs require states to use their own tax revenue since federal Medicaid matching funds cannot be used for illegal alien immigrants.
The practical result is that while illegal alien immigrants cannot enroll in federally-funded standard Medicaid, many do receive various forms of Medicaid-funded healthcare through these multiple pathways and exceptions, with some states providing near-comprehensive coverage at significant state expense.
New York’s emergency Medicaid enrollment for illegal alien immigrants has risen dramatically, reaching 480,000 as of March 2024, a 1,200% increase since 2014. This group now makes up about 7% of total Medicaid enrollment. Spending tripled over the past decade, from $207 million to $639 million, though average cost per person dropped as many enrollees don’t actually use services.
The surge began in 2014 after the Affordable Care Act allowed immigrants ineligible for other insurance to pre-register for emergency Medicaid. Growth accelerated during COVID-19 (up 33% in one year) and again since 2022 as thousands of new migrants arrived in New York. Most recipients live in New York City (74%), with smaller concentrations on Long Island and in the Hudson Valley.
In comparison, the only larger growth in Medicaid was among able-bodied, childless adults ages 19–64. Overall, New York Medicaid enrollment grew by 1.6 million over the decade. Beyond emergency Medicaid, nearly 500,000 other non-citizens are covered through the state’s Essential Plan.
The Empire Center obtained the figures through a Freedom of Information Law request but noted inconsistencies and implausible numbers in the Health Department’s responses, raising questions about the accuracy and transparency of state reporting.
The House Budget Committee, citing new analysis from the nonpartisan Congressional Budget Office (CBO), reported that the Biden-Harris Administration’s open border policies have cost federal and state taxpayers more than $16.2 billion in Medicaid-funded emergency services for illegal aliens during the first three years of their administration.
This represents a 124 percent increase compared to the same period under President Trump. The CBO analysis was prepared at the request of House Budget Committee Chairman Jodey Arrington (R-TX).
Committee Republicans emphasized that Medicaid, a program created to serve vulnerable Americans, is being drained by illegal immigration. They pointed out that this comes on top of $9 billion in Obamacare benefits extended to illegal immigrants through executive action. The report also referenced the 1996 Personal Responsibility and Work Opportunity Reconciliation Act, which barred most federal benefits for “non-qualified aliens” but still requires Medicaid to cover emergency medical treatment.
According to Congressional Budget Office analysis, federal spending on Emergency Medicaid reached $3.8 billion in FY 2023, about 0.4 percent of total Medicaid spending. Under the Biden-Harris Administration, costs have soared to more than $16.2 billion over three years. For comparison, federal spending in 2016 was $974 million, just 0.2 percent of Medicaid expenditures. The sharp increase reflects both the growth of the illegal alien population and the expansion of state-funded programs.
Several states now provide broad coverage using state money. California spends approximately $2.6 billion annually on comprehensive coverage for undocumented immigrants, while New York spends about $500 million per year. Fourteen states plus the District of Columbia offer similar programs, which could shift an estimated $92 billion in costs over the next decade if federal matching rates are reduced. Altogether, combined federal and state spending on health care for illegal immigrants is estimated at $7–9 billion annually.
The House Budget Committee warned that these ballooning costs highlight how the administration’s border failures have fueled mass illegal migration, worsened the fiscal crisis, and threatened both national and economic security. Republicans pledged to continue investigating the impact of illegal migration on federal health care programs and to push reforms to safeguard Medicaid for American citizens.
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