What are the projected health and economic benefits of covering undocumented residents?
Executive summary
Expanding health coverage to undocumented residents in states that have done so has produced measurable health gains and reduced uninsured rates, while state pilots show program costs in the low hundreds of millions and targeted enrollments in the tens of thousands (e.g., Illinois’ HBIA covered ~32,000 adults and cost the state roughly $487 million in FY24) [1]. National analyses show undocumented people remain largely excluded from federal programs, but states using state or federal CHIP HSI mechanisms or fully state-funded programs report improved access and potential economic stability benefits for communities [2] [3].
1. States stepping in: patchwork coverage and immediate health gains
A growing number of states have created programs to cover people barred from federal programs; these state efforts are the primary source of documented health gains for undocumented residents. California’s Medi‑Cal expansion to include residents regardless of immigration status produced improved health outcomes—especially for non‑citizen children—while state analyses note remaining gaps for undocumented adults [4]. Illinois’ state program HBIA enrolled about 32,083 adults (42–64) and HBIS covered 8,931 seniors, showing that state-funded coverage can reach substantial, measurable populations [1]. KFF and the Center for Budget and Policy Priorities document several other state initiatives and note these programs reduce uninsured counts and improve access to preventive and maternity care [2] [3].
2. Costs and scale: limited fiscal footprints in the examples available
Available state program data suggest enrollment numbers and fiscal costs are significant but not unconstrained. Illinois reported combined HBIA/HBIS spending of $682 million in FY24 and HBIA administration costs of $487 million in FY24, with 32,083 adults enrolled as of February 2025—figures that let policymakers estimate per‑enrollee program costs and budget impacts [1]. Colorado’s OmniSalud capped subsidies at 12,000 people; states have paused or limited enrollment when funds ran short, indicating predictable budget ceilings and tradeoffs in program design [5] [2]. CBPP and KFF document that states use a mix of fully state‑funded approaches, CHIP HSI waivers, and federal match strategies to expand coverage within fiscal constraints [3] [2].
3. Health outcomes and preventive value: evidence points to better care, particularly for children and maternal health
Analyses from California and national briefs show expansions increase access to preventive services and maternal care and reduce uninsured rates among covered groups. California data highlight improved health status among non‑citizen children after Medi‑Cal expansion, and much of Emergency Medicaid spending historically went toward labor and delivery—suggesting expanded regular coverage could shift care from costly emergency settings to outpatient and preventive care [4] [6]. KFF highlights that emergency Medicaid is a limited, costly backstop (and represented under 1% of total Medicaid spending in FY2023), reinforcing that comprehensive coverage for noncitizens would change utilization patterns [6].
4. Economic and social spillovers: work, taxes, and community stability
Multiple sources frame coverage as tied to economic stability. The National Immigration Forum and American Immigration Council emphasize undocumented workers’ tax contributions and the argument that coverage prevents medical debt and poverty, strengthening community economies [7] [8]. State briefs from CBPP describe coverage as a tool to prevent poverty, support workforce participation, and reduce uncompensated care costs for hospitals—fiscal effects that accrue both to local providers and to broader state budgets [3]. KFF notes fear of seeking benefits persists and that policy changes can alter economic behavior tied to health access [6].
5. Federal policy limits: most undocumented people remain ineligible for federal programs
Federal law and recent 2025 changes keep most undocumented immigrants excluded from Medicaid, Medicare, and ACA premium assistance; long‑standing PRWORA restrictions and the 2025 tax and budget law further narrowed eligibility for many noncitizens, meaning state actions operate within a federal exclusionary backdrop [9] [10]. KFF and Commonwealth Fund explain that undocumented immigrants are not eligible for federally funded Medicaid, Medicare, or ACA marketplace tax credits—so any coverage gains for undocumented residents to date have mostly come from state choices or local initiatives [10] [11].
6. Competing viewpoints and limits of evidence
Advocates emphasize health and economic benefits and cite state program outcomes; fiscal hawks point to program costs and capped enrollments, and several states have paused or planned rollbacks due to funding pressures [2] [1] [5]. Available sources document improved outcomes for children and targeted adults in states that expanded coverage but do not offer a single, nation‑wide cost–benefit estimate for universal coverage of undocumented residents—national modeling and long‑term budget effects are not found in the current reporting (not found in current reporting).
7. What to watch next: program design, funding, and federal policy
Future impacts will hinge on program scale, whether states secure sustainable funding or federal options change, and how policymakers weigh per‑enrollee costs against reductions in uncompensated emergency care and broader economic stability. Watch state enrollment caps, pauses (e.g., Colorado, Illinois), and whether more states pursue CHIP HSI or fully state‑funded routes [5] [1] [3]. Available sources do not mention a comprehensive national projection combining health and economic metrics for full coverage of undocumented residents (not found in current reporting).