Did Congress pass federal laws in 2023 expanding Medicaid eligibility for noncitizens?

1. What proponents claimed — a strong-sounding claim that didn’t pass

A widely circulated claim said Congress passed laws in 2023 to expand Medicaid for noncitizens. That claim rests on conflating three different threads of activity: the Consolidated Appropriations Act, 2023 (CAA), introduced bills like the HEAL for Immigrant Families Act, and administrative rulemaking by HHS and CMS. The CAA included many Medicaid- and CHIP-related changes—territorial financing, continuous coverage unwind rules, and child- and postpartum coverage adjustments—but it did not include a provision categorically expanding Medicaid eligibility for noncitizens. Congressional Research Service analyses and summaries of the CAA show no statutory change granting broad new Medicaid eligibility to noncitizens in the 2023 enacted legislation ^{[1] [4]}.

2. Introduced bills: bold proposals that never became law

Advocacy and some reporting pointed to the HEAL for Immigrant Families Act of 2023 as evidence of Congressional action. That bill proposed amending the Social Security Act and the ACA to make lawfully present noncitizens broadly eligible for federally funded programs, and to give states an option to cover individuals without lawful presence. However, the HEAL measure was only introduced and referred to committee; it did not clear either chamber or reach the president’s desk in 2023. Because introduction is not enactment, the bill is a statement of congressional intent by sponsors, not a change in federal law ^[2]. The distinction between “introduced” and “enacted” is central here: proposals matter politically but do not alter eligibility until they become law.

3. Administrative rulemaking added nuance but did not change statute

In April 2023, HHS/CMS published a proposed rule to clarify the definition of “lawfully present,” including treating DACA recipients similarly to other deferred-action beneficiaries for some program eligibility determinations. The proposed rule promised to affect Marketplace premium tax credits and could influence Medicaid/CHIP eligibility determinations if finalized. But this was regulatory rulemaking, not congressional legislation, and the rule was open for comment and subject to change; its publication does not equal a statutory expansion by Congress. Regulatory changes can widen or narrow program access, but they operate within existing law and are distinct from acts of Congress ^{[3] [5]}.

4. State initiatives and the post-pandemic Medicaid unwinding added confusion

Throughout 2023 and into 2024, states acted independently to expand coverage to some noncitizen populations, and the unwinding of continuous Medicaid coverage requirements led to large churn and renewed attention to eligibility rules. Several academic and policy studies documented state-level efforts to cover undocumented or lawfully present immigrants, noting that the majority of noncitizens remain ineligible for federal Medicaid due to immigration-status bars. These state-level expansions and the broader unwinding produced headlines that were sometimes misread as federal action, increasing public confusion about what Congress had enacted versus what states or agencies were doing ^{[6] [4]}.

5. Bottom line: the claim is not supported by enacted federal law; watch proposals and rules

The factual bottom line is that Congress did not pass a federal law in 2023 that expanded Medicaid eligibility for noncitizens. The CAA amended many Medicaid rules but did not change eligibility for noncitizens; major expansion proposals were introduced but not enacted; and HHS/CMS proposed regulatory clarifications that could affect eligibility determinations if finalized. Observers should track three distinct paths—statutory enactment (Congress), regulatory rulemaking (agencies), and state policy choices—to understand future changes, and treat introduced bills and proposed rules as potential but not binding changes to federal eligibility ^{[1] [2] [3] [5]}.