Emergency Medicaid Spending for Undocumented Immigrants Less than 1%, Expenditure Analysis Shows

Emergency Medicaid spending accounted for just 0.4% of total Medicaid expenditures in 2022, with an average cost of $9.63 per resident, according to an expenditure analysis of 38 states published today in JAMA Network. Although states with higher undocumented immigrant populations paid more than 15 times per capita, the overall expenditure rate rose to 0.9%.

These results suggest that cuts to emergency Medicaid funds will hurt states with large undocumented populations and yield minimal cost savings overall, the authors, including corresponding author Patricia Mae G. Santos, M.D., MS, assistant professor in the department of radiation oncology at the Emory School of Medicine, said in the letter.

Current federal law prohibits undocumented immigrants from receiving Medicaid, Medicare and Marketplace options under the Affordable Care Act (ACA). However, undocumented individuals can receive care through emergency Medicaid, a limited form of Medicaid intended only for serious medical conditions, such as labor and delivery. However, some states' emergency plans also cover dialysis and cancer treatments.

This analysis is in part a response to the Budget Reconciliation Law of 2025, also known as the “One Big Beautiful Bill Act,” which was signed into law on July 4, 2025. The legislation includes more than a trillion dollars in cuts to Medicaid, Medicare and the Affordable Care Act. As a result, 7.8 million people may lose their healthcare coverage by 2034.

“The Budget Reconciliation Law substantially reduces federal emergency Medicaid funding, cutting the federal match rate from 90% for ACA expansion populations to each state’s usual rate, ranging from 50% to 76% in 2025,” Santos and her team continued. “Safety net hospitals and health care clinicians caring for immigrants could be hit much harder by the cuts.”

Study limitations include the fact that 11 states did not report their emergency Medicaid expenditures. The analysis also relied on aggregate data, so there is no way to organize data by diagnosis or healthcare utilization. Last, the study did not account for the economic contributions of undocumented immigrants or public spending on them outside of emergency Medicaid, which the authors say warrants further study.

Proponents of the cut have argued that the cuts will not impact people who are in the country legally—only undocumented immigrants.

Ashley Hayek, president of American First Works, a conservative non-profit organization, is one of the supporters. Her endorsement is one of the many listed on the official White House page.

“While the Left pushes tax increases, open borders, and extreme spending, this bill does the opposite: it makes the Trump tax cuts permanent, protects Social Security and Medicaid for our seniors and most vulnerable, and stops taxpayer-funded benefits for illegal immigrants,” her comment reads.

No Democrats voted in favor of the bill, and they were joined by only two Republicans, Reps. Brian Fitzpatrick of Pennsylvania and Thomas Massie of Kentucky.

U.S. Rep. Ilhan Omar said in a press release that the One Big Beautiful Bill Act is "the most harmful, immoral budget we have seen in modern American history.”