Do Illegal Immigrants Get Medicaid? 7 Key Facts About Coverage, Costs, and Policy Updates

Confusion about who qualifies for public insurance programs is widespread. A recent Kaiser Family Foundation (KFF) brief found that about half of U.S. adults were either unsure or incorrectly believed that most immigrants are eligible for Medicaid as soon as they arrive.

In reality, eligibility is limited to citizens and certain lawfully present immigrants.

Families often have mixed immigration status – for example, one in four children in the U.S. (about 19 million) has at least one immigrant parent, and roughly nine million of those children are U.S. citizens with a non‑citizen parent. Although most immigrant families include a full‑time worker, their incomes are typically lower than those of U.S.-born families.

Medicaid and the Children’s Health Insurance Program (CHIP) play a crucial role in keeping uninsured rates low for eligible children and lawfully present adults, yet immigrants under 65 are less likely than U.S.-born citizens to have Medicaid/CHIP coverage (19 % vs. 23 %), and eligible non‑citizen immigrants make up just 6 % of enrollees.

1. Eligibility Rules: Who Qualifies and Who Doesn’t

Undocumented immigrants are not eligible for Medicaid, CHIP, or Medicare. They also cannot purchase coverage through the Affordable Care Act (ACA) marketplaces.

The only federal mechanism that reimburses hospitals for their care is Emergency Medicaid, which pays for emergency services (such as trauma care or labour and delivery) provided to otherwise Medicaid‑eligible individuals who lack an eligible immigration status.

Lawfully present immigrants may qualify, but their eligibility is limited by two key criteria:

1. Immigration status: Applicants must have a “qualified” immigration status. Federal law lists categories of non‑citizen immigrants who meet this definition. They include lawful permanent residents, asylees and refugees, certain Cuban or Haitian entrants, survivors of domestic violence or trafficking, members of federally recognised tribes or American Indians born in Canada, and citizens of the Marshall Islands, Micronesia, or Palau living in the U.S. (Other categories exist but are beyond the scope of this summary.)
2. Five‑year wait: With some exceptions, most lawful permanent residents (green‑card holders) must wait five years after obtaining qualified status before enrolling in Medicaid or CHIP. During this period, they may purchase marketplace coverage and receive subsidies.

A handful of groups are lawfully present yet still ineligible – for example, people with Temporary Protected Status (TPS) or Deferred Action for Childhood Arrivals (DACA) status cannot enrol in Medicaid or CHIP. States verify citizenship and immigration status with the Social Security Administration and Department of Homeland Security before approving coverage.

Selected Immigration Statuses and Medicaid/CHIP Eligibility

These rules mean that many mixed‑status families rely on Emergency Medicaid or state‑funded programs for urgent care while they wait to become eligible for comprehensive coverage.

Confusion about the rules contributes to misperceptions – for example, more than half of U.S. adults incorrectly believe most immigrants can immediately enrol in Medicaid.

2. Coverage and Uninsurance: Immigrants Remain Under‑Insured

Despite having lower household incomes, immigrants under 65 have lower rates of Medicaid coverage than U.S.-born citizens (19 % vs. 23 %).

Data from the 2023 KFF/LA Times Survey show that only 6 % of Medicaid and CHIP enrollees are eligible non‑citizen immigrants. Many immigrants instead rely on employer coverage, marketplace plans,ce plans, or remain uninsured.

The same survey found that about 28 % of both immigrant adults and U.S.-born adults reported receiving assistance with food, housing, or health care in the past year, dispelling myths that immigrants disproportionately rely on public benefits.

The KFF/New York Times 2025 Survey paints a stark picture of uninsurance:

• Overall uninsured rates: 15 % of immigrant adults (18+) and 19 % of immigrants aged 18‑64 reported being uninsured in 2025, compared with 6 % and 8 % of U.S.-born adults in those age groups.
• By immigration status: Around 46 % of likely undocumented adults and 21 % of lawfully present immigrants said they lacked coverage, compared with only 7 % of naturalised citizens.
• Disparities: Uninsured rates are higher among Hispanic immigrants (27 %), those with lower incomes (23 %), those with limited English proficiency (23 %), and parents of minors (22 %).

The survey also reveals that state policies matter: immigrants living in states with more expansive coverage – those that adopted the ACA Medicaid expansion, waived the five‑year wait for children/pregnant people, or offer state‑funded coverage – are half as likely to be uninsured (11 % vs. 22 %) compared with immigrants in states with less expansive policies.

Selected Coverage Statistics for Immigrant Adults (2023–2025)

These figures underline that immigration status and state policy choices drive health coverage gaps. Even among immigrants who are eligible for Medicaid, language barriers, administrative complexity, and fear of jeopardising family members’ status deter enrollment.

3. Fear, Barriers, and Mental‑Health Consequences

Many immigrant families encounter significant barriers when attempting to enrol in assistance programs. In 2023, 8 % of immigrants said they avoided applying for food, housing, or health care assistance because they did not want to draw attention to their own or a family member’s immigration status.

These fears have intensified under the Trump administration’s enforcement policies. The KFF/New York Times survey reports that four in ten immigrant adults and 77 % of likely undocumented immigrants experienced negative health impacts, such as stress, anxiety, sleep problems or worsening chronic conditions, due to immigration‑related worries.

Nearly half of lawfully present immigrants (47 %) and 29 % of naturalised citizens reported similar effects. Parents noted that 18 % of their children suffered sleep or eating problems, declines in school performance, or behaviour issues because of these anxieties.

Immigrants’ own words illustrate the human toll: one respondent said that under the Trump administration, they felt “insecure and full of discrimination,” noting that racial slurs and fear made them feel unwelcome.

Others described depression, insomnia, and constant worry about separation. These narratives remind us that health policy debates are not just about numbers – they affect real people who already contribute to American communities.

Fear also undermines public health goals. Researchers warn that proposed changes to the public‑charge rule may further deter eligible families from using Medicaid or CHIP.

A November 2025 analysis from Georgetown University’s Centre for Children and Families notes that the Department of Homeland Security’s 2025 proposed rule would rescind the Biden administration’s 2022 public‑charge policy without offering a replacement, creating confusion and “decreased participation in public benefit programs”.

The same analysis estimates that such changes could cause approximately 422,000 children and pregnant women to disenroll from Medicaid/CHIP, leading to worse health outcomes.

4. Emergency Medicaid: Tiny Share of Spending, Major Lifeline

Although opponents of immigrant coverage sometimes highlight Emergency Medicaid as a cost driver, the program represents less than 1 % of total Medicaid spending.

Between fiscal years 2017 and 2023, Emergency Medicaid spending was consistently below one percent; in FY 2023, it totalled $3.8 billion, accounting for 0.4 % of the $860 billion spent on Medicaid that year.

Emergency Medicaid reimburses hospitals for stabilising care required under the Emergency Medical Treatment and Labour Act (EMTALA) – including labour and delivery – for patients who meet income requirements but lack an eligible immigration status.

Without this reimbursement, hospitals and states would shoulder the full cost of emergency care, and providers could face financial strain.

Because Emergency Medicaid spending is so small, proposals to cut it would yield minimal federal savings while shifting costs to hospitals and states.

At the same time, such cuts would not reduce the need for care; people experiencing emergencies still show up at hospitals, and EMTALA requires treatment regardless of status. Experts, therefore, argue that reductions to Emergency Medicaid would harm patients and providers without meaningfully improving the federal budget.

5. State Coverage Expansions: Waiving Waiting Periods and Filling Gaps

Federal law allows states to waive the five‑year waiting period for children and pregnant people. As of January 2025, 37 states and the District of Columbia have adopted this option for children, and 31 states plus D.C. have done so for pregnant individuals. Twenty‑three states and D.C. also provide prenatal care from conception through delivery under a CHIP option.

In addition, 14 states and D.C. use state‑only funds to provide comprehensive coverage to income‑eligible children regardless of immigration status, and seven states and D.C. offer some state‑funded coverage to adults.

Expansions matter. According to a KFF analysis, immigrant adults living in more‑expansive states – those that implemented the ACA Medicaid expansion, waived the five‑year wait, and/or offer state‑funded coverage – are half as likely to be uninsured as those in states with less expansive policies (11 % vs. 22 %).

They are also less likely to delay or forgo care due to cost. Research shows that coverage expansions improve health outcomes:

• Children: California’s 2016 expansion, providing coverage to low‑income children regardless of status, led to a 34 % decline in uninsured rates. Other studies found that children in states that cover all children are less likely to be uninsured or skip preventive care.
• Pregnant people: Expanding Medicaid to all pregnant people, regardless of status, is associated with higher prenatal care use and improved birth outcomes, such as longer gestation and higher birth weight. In contrast, restrictive policies correlate with reduced postpartum care.
• Costs: Providing insurance to immigrant adults through Medicaid expansion costs less than half per person compared with covering U.S.-born adults, suggesting that expansions can be efficient investments.

However, state budgets are under strain. California, Illinois, and Minnesota have recently paused or plan to scale back state‑funded adult coverage due to cost pressures. The new 2025 tax and budget law (discussed below) restricts federal funding for immigrants and may force states to choose between raising taxes or cutting coverage.

Selected State Coverage Options as Of 2025

6. New Federal Policies: HR 1, the Marketplace Rule, and Coverage Losses

In 2025, Congress enacted a sweeping tax and budget law known as H.R. 1. Coupled with a new federal rule, it will dramatically reduce access to health coverage for lawfully present immigrants. Key provisions include:

• Marketplace restrictions: Lawfully present immigrants have been eligible for ACA Marketplace premium tax credits (PTCs), including those with incomes below the poverty line who are barred from Medicaid due to the five‑year wait. H.R. 1 and a June 2025 rule eliminate PTC eligibility for most categories of lawful immigrants in stages: DACA recipients became ineligible on August 25, 2025; low‑income lawful immigrants without Medicaid eligibility lose PTCs on January 1, 2026; and most other lawfully present immigrants – including refugees, asylees, survivors of domestic violence or trafficking and many others – lose PTC eligibility on January 1, 2027. Only green‑card holders, certain Cuban/Haitian entrants, and Compact of Free Association migrants will remain eligible.
• Medicaid definition of “eligible alien”: Starting October 1, 2026, H.R. 1 restricts Medicaid eligibility to lawful permanent residents, certain Cuban and Haitian immigrants, COFA migrants lawfully residing in the U.S., and lawfully residing children or pregnant adults in states that waive the five‑year wait. This change ends Medicaid eligibility for asylees, refugees, and survivors of domestic violence or trafficking.
• Emergency Medicaid funding cuts: H.R. 1 reduces the federal matching payment for Emergency Medicaid for individuals who would otherwise qualify for expanded Medicaid from 90 % to as low as 50 %, shifting costs to states.

The impact will be severe. Georgetown University’s Center on Health Insurance Reforms estimates that about 1.2 million lawfully present immigrants will lose Marketplace coverage and become uninsured due to these changes.

Premiums will soar for those losing subsidies – for example, a lawful immigrant with an income just below the poverty line could see premiums jump from $0 to roughly $5,958 per year.

The Commonwealth Fund notes that by shrinking the pool of insured immigrants, risk pools will shrink, and premiums for everyone are likely to rise. These federal changes also restrict states’ ability to use matching funds to cover immigrants, forcing many to cut back state‑funded programs.

7. Immigrants’ Contributions: Less Use, More Support

Amid debates over benefits, it is essential to recognise that immigrants use less health care and public assistance but contribute significantly to financing and staffing the U.S. health system.

Lower Health Care Use and Costs

Research consistently shows that immigrants consume less care. On average, per‑capita health expenditures for immigrants were about two‑thirds those of U.S.-born citizens ($4,875 vs. $7,277) according to KFF’s analysis of 2021 data.

Medicaid spending per enrollee was similar for immigrants ($854) and U.S.-born people ($830). These differences reflect immigrants’ younger age profile and persistent barriers to accessing care.

A 2026 Cato Institute analysis using Census Bureau data found that immigrants consumed 24 % less welfare and entitlement benefits per capita than native‑born Americans in 2023.

Non‑citizen immigrants consumed 53 % less welfare than native‑born Americans and represented 7.5 % of the population but only 3.2 % of welfare spending. Naturalised citizens consumed slightly more welfare due to their older age, but overall, the immigrant population is a net contributor.

Social Security and Tax Contributions

Immigrants are crucial to the solvency of Social Security. The Center on Budget and Policy Priorities notes that they are more likely to be of working age and have higher labour force participation than U.S.-born individuals.

Without immigrants and their U.S.-born children, the prime working‑age population would have shrunk by more than eight million between 2000 and 2023. Social Security actuaries estimate that higher immigration reduces the long‑term trust‑fund deficit; net immigration of 400,000 more people per year would lower the deficit by about 11 %.

Immigrants without legal status paid an estimated $25.7 billion in Social Security taxes in 2022, and a 2013 SSA report found that their contributions produced a net $12 billion surplus in 2010.

Workforce Contributions

Immigrants and their U.S.-born children play an outsized role in essential industries. They fill labour shortages in construction, agriculture,e and other sectors and make up 19 % of the health‑care workforce, including 23 % of physicians and surgeons and 28 % of direct-care workers.

As the U.S. population ages, these workers are vital to meet growing demand for health services. Their taxes also help subsidise care for U.S.-born citizens.

Selected Metrics Illustrating Immigrants’ Contributions

These data show that immigrants pay into the systems they rely on and often receive less in return. Their economic contributions support Social Security and Medicare and help subsidise care for U.S.-born people.

Conclusion

Medicaid and CHIP provide a lifeline for eligible immigrant families, yet misunderstandings and policy barriers leave many uninsured. Undocumented immigrants are barred from federally funded coverage, and lawfully present immigrants often face lengthy waiting periods and complex eligibility rules.

Despite lower incomes, immigrants under 65 are less likely to have Medicaid or CHIP than their U.S.-born counterparts, and many – particularly those who are undocumented or have limited English proficiency – remain uninsured. Fear of deportation and changing public‑charge rules exacerbate these gaps.

States have shown that targeted expansions can make a difference. By waiving the five‑year wait and creating state‑funded programs, dozens of states have reduced uninsurance and improved maternal and child health outcomes.

Yet new federal policies threaten to undo these gains. H.R. 1 and related federal rules will cause more than a million lawfully present immigrants to lose affordable coverage, cut the federal match for Emergency Medicaid, and narrow Medicaid eligibility. These changes will raise premiums for everyone and strain state budgets.