Do federal funds or Medicaid waivers contribute to non-emergency care for undocumented immigrants in New York?

1. Federal Medicaid rules: non-enrollment for most undocumented immigrants

Federal Medicaid eligibility does not permit most undocumented immigrants to enroll in standard, federally funded Medicaid, CHIP, or Medicare plans; federal reimbursement covers Emergency Medicaid for urgent conditions but not routine, non-emergency care for undocumented adults under 65 ^{[1] [4]}. KFF and other explainers state plainly that undocumented immigrants are not eligible to enroll in federally funded Medicaid and that Emergency Medicaid reimburses hospitals only for emergency care they must provide ^[1].

2. Emergency Medicaid: federally reimbursed but limited to emergencies

Hospitals treating undocumented New Yorkers who meet income and other non-immigration criteria can seek federal Emergency Medicaid reimbursement for emergency medical conditions; that program does not extend to ongoing non-emergency primary or long‑term care for most undocumented adults ^{[1] [4]}. New York guidance and federal summaries make the distinction between Emergency Medicaid and “full” Medicaid explicit ^{[5] [7]}.

3. New York’s policy change: state-funded full Medicaid for ages 65+

Beginning January 1, 2024, New York opened mainstream Medicaid to undocumented immigrants age 65 and older who meet the financial eligibility rules — a change converting many from Emergency Medicaid-only access to full Medicaid coverage, including long-term care benefits; state and advocacy documents estimate roughly 25,000 people could be affected ^{[2] [3] [6]}. City and state fact sheets and the Empire Justice/NY Immigration Coalition materials document the expansion and enrollment pathways ^{[2] [8] [6]}.

4. Funding mechanics: where federal dollars do — and do not — flow

Available sources show Emergency Medicaid is federally reimbursed for emergency care for undocumented people who meet other eligibility criteria, but New York’s expansion for 65+ undocumented immigrants is implemented through mainstream Medicaid programs under state policy changes; the sources indicate New York uses state/local mechanisms to enroll these older undocumented residents into full Medicaid rather than relying on new federal permission to enroll undocumented people generally ^{[3] [5] [4]}. PolitiFact and other fact checks emphasize that federal funds are not used to enroll undocumented immigrants broadly into Medicaid in New York, though Emergency Medicaid remains a federally reimbursed exception ^[9].

5. Who still gets only emergency care — and who gets routine care

Undocumented adults under 65 who are not pregnant generally remain limited to Emergency Medicaid for treatment of emergency medical conditions; pregnant people are separately eligible for Medicaid regardless of immigration status in many New York programs, and those 65+ who qualify financially can now receive full Medicaid including non-emergency and long‑term care ^{[10] [4] [3]}.

6. Competing narratives and political stakes

National and partisan critics have argued states should not use funds to expand non-emergency coverage to undocumented people; fact-checkers and state documents counter that federal law still bars general federal Medicaid coverage for undocumented immigrants and that New York’s expansion is a state-level policy choice for a defined group ^{[9] [3]}. Sources show advocacy groups frame the move as a “landmark expansion,” while conservative think-tank pieces criticized broader state spending growth — both perspectives appear in the collected reporting ^{[8] [9]}.

7. Limitations and what reporting does not say

Available sources document the 65+ expansion and the federal Emergency Medicaid rule, but they do not provide a full dollar accounting here of exactly how much state versus federal spending increases due to the 65+ expansion, nor do they enumerate every administrative mechanism New York uses to blend state and federal claims; precise fiscal breakdowns and later policy changes after 2025 are not found in the current reporting set (not found in current reporting; ^[3]; p1_s4).

Bottom line: federal Medicaid rules still prevent general enrollment of undocumented immigrants in federally financed Medicaid; Emergency Medicaid (federally reimbursed) covers emergencies, while New York’s state policy now provides full, non-emergency Medicaid coverage to undocumented residents aged 65+ through state-managed programs ^{[1] [2] [3]}.