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Authors affiliated with Emory University, the Lown Institute, the University of Colorado Anschutz Medical Campus, and the Harvard TH Chan School of Public Health report that emergency Medicaid accounted for only a small share of state Medicaid spending in 2022, with higher spending concentrated in states with larger undocumented populations.
Federal law excludes undocumented immigrants from comprehensive Medicaid, Medicare, and ACA Marketplace coverage. Emergency Medicaid operates as a limited benefit for immigrants that covers stabilization for serious illnesses and typically includes labor and delivery, with some states also covering dialysis and cancer treatment.
The 2025 Federal Budget Reconciliation Act contains significant cuts to Medicaid that extend well beyond emergency Medicaid for immigrants. Although the law affects federal payments for emergency Medicaid assistance, its provisions also target millions of U.S. citizens and lawfully present immigrants. Yet the argument for cuts tends to focus only on emergency Medicaid for undocumented immigrants.
In the research letter titled “Emergency Medicaid Spending for Undocumented Immigrants in the United States,” published in JAMAResearchers conducted a cross-sectional analysis to examine Medicaid emergency spending relative to total Medicaid spending and to identify state factors associated with variation.
The analysis relied on 38 states and Washington, D.C., that reported emergency Medicaid spending for the 2022 fiscal year.
The results showed that emergency Medicaid accounted for an average of 0.4 percent of total Medicaid spending and an average of $9.63 per resident across reporting states.
The authors conclude that emergency Medicaid represents less than 1 percent of overall Medicaid spending, even in states with large undocumented populations. The Medicaid emergency program reductions are expected to generate minimal overall savings.
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More information:
Patricia Mae G. Santos et al, Emergency Medicaid Spending for Undocumented Immigrants in the United States, JAMA (2025). DOI: 10.1001/jama.2025.18709
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