Illegal Aliens Draining Medicaid Despite Federal Restrictions

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 fi