Fact check: What is the estimated cost of healthcare for undocumented immigrants.

1. What advocates and studies repeatedly claim about scale — “It’s smaller than you think”

Multiple studies and policy reports assert that the aggregate fiscal footprint of undocumented immigrants’ healthcare is small compared with total U.S. spending. A Kaiser Family Foundation summary reports that average annual per-capita expenditures for undocumented immigrants are about $4,875 versus $7,277 for U.S.-born citizens, implying lower utilization and spend per person ^[1]. Independent academic work published in JAMA and follow-up cross-sectional analyses calculate that emergency Medicaid for noncitizens represented about 0.4% of Medicaid’s total expenditures in 2022 and under 1% across the 2017–2023 window, reinforcing that emergency-only eligibility produces limited federal outlays relative to the full program budget ^{[4] [5] [2]}. These repeated measurements support a robust quantitative conclusion that the budgetary share is small and concentrated in emergency care like labor and delivery. ^{[1] [4] [5] [2]}

2. The per-resident framing that policymakers use — “Penny-per-resident math”

Analyses emphasize per-resident metrics to illustrate scale: the JAMA-related studies report an average emergency Medicaid cost of about $9.63 per resident when spread across state populations in 2022, a figure used to argue that cuts to emergency Medicaid would yield minimal statewide savings but could produce concentrated harms in states with larger undocumented populations ^{[3] [5]}. This per-capita framing serves a political function: it reframes an abstract multi-billion-dollar total into a tangible, low-dollar impact per taxpayer or resident, supporting arguments against large-scale program cuts on fiscal-efficiency grounds. The same data also show variation by state, meaning that while national averages are small, the local budgetary and human impacts are uneven and more substantial in states with higher undocumented populations ^{[3] [6]}. ^{[3] [5] [6]}

3. Emergency Medicaid composition — “Labor and delivery dominate the line items”

Both policy summaries and academic studies identify labor and delivery as a major component of emergency Medicaid spending for noncitizens, with other lifesaving services such as dialysis and cancer care also included in some states’ emergency benefit packages. The KFF review and JAMA analyses consistently note that a substantial share of federal emergency spending goes to childbirth-related care, and that absent Emergency Medicaid these costs would largely shift to hospitals or state budgets ^{[2] [5]}. This composition matters for policy debates because it highlights the ethical and practical consequences of cuts: reducing emergency coverage would not eliminate these costs but would redistribute them to other payers, potentially increasing uncompensated care and shifting costs to local institutions. ^{[2] [5]}

4. New state-level scrutiny — “California’s study signals more localized budgeting questions”

Recent state initiatives reflect the next phase of analysis: the California Department of Insurance launched a study to quantify the fiscal impacts of expanding Medi-Cal and Covered California coverage for undocumented residents, indicating a growing interest in state-specific cost-benefit assessments rather than relying solely on national averages ^[7]. This move suggests policymakers acknowledge national findings of low aggregate shares but still want precise estimates of the fiscal tradeoffs, administrative effects, and health outcomes at the state level. State studies will likely document both direct budgetary changes and indirect economic, health, and administrative effects, creating evidence that could either reinforce the national conclusions about modest fiscal impact or reveal important local variations that matter for state budgets and health systems. ^[7]

5. What these numbers don’t capture — “Equity, access, and cost-shifting create the missing context”

The dataset and studies focus on measured spending but leave out crucial contextual elements: uncompensated care costs shifted to hospitals, long-term public-health effects, and non-emergency care forgone because of coverage gaps. While emergency Medicaid spending is under 1% of Medicaid totals, the reported figures do not fully capture indirect fiscal impacts such as reduced preventive care leading to costlier future interventions, local hospital financial strains, or broader community health outcomes. Different stakeholders deploy the same small-share data to either argue for maintaining emergency-only rules (fiscal restraint) or expanding coverage (equity and prevention), highlighting that policy choices hinge on values and long-term modeling beyond the headline percentages even as the core fiscal metrics remain consistently small across sources. ^{[1] [2] [3] [6]}