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Fact check: What are the average costs per patient for emergency care provided to undocumented immigrants in US hospitals in 2024?
Executive Summary
Emergency Medicaid spending specifically for noncitizen and undocumented immigrants was limited in scale relative to total Medicaid outlays, with federal estimates showing $3.8 billion in FY2023 and multi‑year totals of $27 billion from 2017–2023; these figures imply per‑patient averages far lower than some hospital charge reports and wide variation across states and facilities [1]. State and hospital reports produce much higher apparent per‑patient charges in specific contexts — for example a Texas trauma center reported a mean hospital charge of $162,152 per undocumented patient over a multi‑year sample — reflecting differences between billed charges, actual costs, and payer reimbursements [2]. This analysis reconciles those competing claims and highlights where data gaps and methodology choices drive divergent averages.
1. Why aggregate federal totals paint a small-picture cost story
Federal accounting through Emergency Medicaid shows emergency care for noncitizen immigrants is a small share of Medicaid spending, measured as 0.4% in FY2023 and under 1% across recent years, with $3.8 billion for FY2023 and $27 billion over 2017–2023 [1]. Those figures are aggregate program expenditures, not per‑patient averages, and they reflect reimbursements made to hospitals under Emergency Medicaid rules rather than hospitals’ charged amounts or full economic costs of care. The federal totals combine many states with varying undocumented populations and differing Emergency Medicaid policies, so national per‑patient averages computed from these totals will smooth over concentration of costs in border and high‑volume states [1]. The CBO framing makes clear that Emergency Medicaid is narrowly targeted to emergency services and does not represent comprehensive coverage for undocumented immigrants [1].
2. Why hospital charge studies report dramatically higher per‑patient figures
Published facility‑level studies and state reports show far higher per‑patient hospital charges, often because they report billed charges or costs for specific clinical groups rather than averaged program reimbursements. A Texas trauma center study cited an average hospital charge of $162,152 per undocumented patient over a four‑year sample, totaling $4.5 million for 128 patients — a dataset that captures high‑acuity trauma cases and billed charges, not net payments or average ED visits [2]. State press releases and media‑compiled tallies from Florida and Texas report totals for undocumented patient visits (e.g., Florida’s nearly $660 million total in 2024 and Texas’s $121.8 million in November 2024), which can produce per‑visit averages depending on inclusion criteria and whether inpatient, trauma, or outpatient ED visits are counted [3] [4]. The differences show billed charges versus reimbursed amounts and case‑mix severity drive divergence.
3. Variation in visit types and preventability skews per‑patient averages
Recent research emphasizes that case mix matters: a 2025 study found the most common ED discharge diagnoses among undocumented patients were infections, injuries, gastrointestinal and OB/GYN diseases, with 61% of visits classified as preventable or primary‑care treatable by an algorithm, indicating many visits are lower acuity and would have lower per‑patient costs than severe trauma cases [5]. High averages reported in trauma center studies reflect a subset of patients with intensive surgical and inpatient needs, whereas population‑level Emergency Medicaid spending averages include many low‑cost emergency stabilizations. State reporting inconsistencies and differing diagnostic mixes therefore yield divergent implied per‑patient cost figures [5] [2].
4. Data quality, definitional differences, and potential political uses of figures
State and media reports vary in methodology and completeness; the Texas and Florida figures noted inconsistent hospital data collection and divergent inclusion rules, and independent experts raised doubts about some state presentations, signaling methodological caution when converting totals into per‑patient averages [4] [6]. Fact‑checking commentary on related policy debates found that claims about expanded eligibility under recent federal reconciliation laws were often distorted or false, underscoring that cost figures are frequently used in political arguments and may be selectively framed [7]. Researchers must distinguish billed charges, hospital costs, net reimbursements, and Emergency Medicaid payments to avoid conflating different financial concepts.
5. Bottom line: no single, reliable national “average cost per undocumented patient” for 2024
Available analyses show no consistent, single national per‑patient cost for emergency care in 2024 within the provided data. Federal Emergency Medicaid totals allow back‑of‑envelope per‑patient estimates only if one assumes a denominator of visits that the reports do not uniformly provide [1]. Facility‑level and state reports demonstrate extreme heterogeneity — from high trauma‑center charges (e.g., $162,152) to aggregated state totals that, when divided by visit counts, yield much lower per‑visit numbers [2] [3] [4]. Policymakers and analysts should rely on transparent, standardized definitions (charges vs. costs vs. payments), consistent denominators (visits vs. unique patients), and case‑mix adjustment before reporting a national per‑patient average.