How much did federal vs. state governments spend on emergency medical care for undocumented immigrants in 2024?
Executive summary
Available reporting does not provide a single, definitive dollar split for 2024 emergency medical spending on undocumented immigrants; Congressional Budget Office (CBO) and academic summaries note Emergency Medicaid spending has been counted over multi‑year periods (for example, CBO calculations cited as $27 billion over seven years in one 2024 letter), and sources emphasize that undocumented people are largely ineligible for most federal programs except emergency services reimbursed via Emergency Medicaid where applicable (not all sources give a 2024 federal vs. state breakout) [1] [2] [3].
1. Why a neat “2024 federal vs. state” number doesn’t exist in the sources
Federal and academic reporting discussed in the provided material treats Emergency Medicaid and related reimbursements across multi‑year windows or as part of broader Medicaid spending; the CBO is cited in a 2024 context as calculating roughly $27 billion in Emergency Medicaid spending over a seven‑year period (the specific yearly federal/state split for calendar year 2024 is not given in the materials you provided) [1]. Policy briefs and analyses repeatedly note limitations in federal data and survey under‑counts for undocumented populations, which further complicates single‑year accounting [4] [5].
2. What is Emergency Medicaid and who pays for it
By federal law, undocumented immigrants cannot be denied emergency medical care; Medicaid may reimburse providers for emergency services for people who meet Medicaid financial eligibility except for immigration status. Those Emergency Medicaid payments follow federal‑state cost‑sharing rules: the federal government pays a share and states pay the remainder, but eligibility rules restrict full‑scope federal benefits to lawfully present immigrants [3] [2]. Several policy analyses emphasize that undocumented immigrants are ineligible for most federal programs except emergency care and a limited set of state programs, so much uncompensated care is ultimately a mix of federal Emergency Medicaid reimbursements (where applicable), state‑only programs, and hospital uncompensated care [2] [3] [6].
3. Recent estimates and contested figures
Some actors have pointed to large dollar totals attributed to Medicaid spending on noncitizens: for example, a House committee press release claims CBO showed “Medicaid spending on illegal aliens” of $162+ billion under certain timeframes, language that the provided sources frame as politically charged and disputed [7]. The NILC and other fact‑checking or advocacy pieces caution that headlines claiming big federal savings or large one‑year federal costs often misinterpret CBO figures that are multi‑year or tied to program design changes, and that cutting federal funding typically would shift costs to states rather than magically “save” federal dollars spent on undocumented people [1] [8].
4. States are filling gaps and shifting the payer mix
A growing number of states have created state‑funded coverage or “Medicaid look‑alikes” for immigrants excluded from federal programs; these programs are primarily state‑paid and explicitly designed to cover people regardless of immigration status or to cover pregnancy/children with some federal match options in limited cases [9] [10] [6]. As of 2024–2025 reporting, several states had expanded state‑only programs (California, Colorado, Washington and others) — meaning a portion of emergency and other care costs for undocumented people may be borne entirely by states rather than the federal government [9] [6] [10].
5. Research on overall utilization and costs — lower per‑person spending, measurement limits
Congressional Research Service and KFF syntheses cite studies finding immigrants (authorized and unauthorized) often have lower per‑person health expenditures than U.S.‑born populations, and some studies found no significant differences in ER or Medicaid expenditures between immigrants and U.S.‑born people (though immigrants may use emergency rooms relatively more) [5] [4]. Several sources warn federal surveys likely undercount undocumented immigrants and may undercapture Emergency Medicaid spending, so measured totals may understate true costs [4] [5].
6. What the sources agree on and the remaining gaps
All provided sources agree: undocumented immigrants are largely ineligible for most federal coverage but are entitled to emergency care; states vary in how much they fund care for immigrants and some have created state‑funded programs [2] [3] [10]. What the materials do not provide is a clear, authoritative year‑by‑year federal vs. state dollar split for emergency medical care in calendar year 2024 — available sources do not mention a single 2024 federal/state breakdown figure or a definitive national tally for that year [1] [5].
7. How to get a more precise 2024 split (next steps for reporting)
To produce a defensible 2024 federal vs. state estimate you would need CBO or CMS single‑year Emergency Medicaid tables (and any state reports) plus state‑by‑state data on state‑only immigrant coverage and hospital uncompensated care reimbursements; the policy sources here reference multi‑year CBO calculations and state program summaries but do not supply the granular national 2024 dollar split [1] [6] [9]. For immediate use, cite CBO/CMS raw tables (if available) or state Medicaid expenditure reports and clarify the methodological limits noted in the analyses above [1] [8].
Bottom line: the provided reporting explains how Emergency Medicaid works, points to multi‑year CBO estimates and state efforts to cover immigrants, and warns that single‑year federal vs. state breakdowns for 2024 are not present in these sources — obtaining a precise 2024 split requires additional federal and state expenditure data beyond the materials supplied [1] [3] [6].