Fact check: How do states like California and New York provide healthcare to undocumented residents?

1. How West and East Coast Leaders Patch the System Together — state programs and local partnerships

California and New York have implemented state-level and local initiatives that aim to expand health access for undocumented immigrants through targeted programs and partnerships with community organizations. A 2020 policy toolkit summarizes options used by states and localities, noting that some jurisdictions establish Medicaid-equivalent state plans, county programs, and clinic partnerships to supply primary care and preventive services to undocumented people ^[1]. These measures often prioritize groups such as pregnant women, children and people with severe disabilities, reflecting political choices to allocate limited public resources where health interventions are seen as most urgent or cost-effective ^[4].

2. Real-world proof: ActionHealthNYC reduced emergency visits and expanded primary care

Controlled experiments in New York City show measurable benefits when friction in access is reduced. The ActionHealthNYC experiment cut emergency department visits by roughly 21–23% overall and achieved steeper declines for high-risk subgroups (32–42% reductions reported in different analyses), while increasing self-reported access to primary care and preventive screens ^{[2] [3]}. These findings from 2022–2023 research indicate that administrative simplification and sponsored clinic networks can redirect care toward lower-cost, preventive settings — a concrete pathway for city- or state-level strategies to improve outcomes without federal insurance expansion ^{[2] [3]}.

3. Emergency Medicaid: A safety net, not full coverage — uneven across states

Emergency Medicaid remains a default backstop for undocumented immigrants in many states, covering life-threatening conditions and childbirth but rarely offering comprehensive chronic disease management or cancer care. A 2025 survey of states found that 37 states offer Emergency Medicaid in some form, but the scope and implementation vary widely, producing geographic disparities in access and service breadth ^[5]. Clinicians and health systems report that relying on Emergency Medicaid creates care fragmentation and delayed treatments, especially for complex conditions such as cancer where continuous coverage is critical ^{[5] [6]}.

4. Who gets included — selective eligibility and persisting uninsured gaps

State expansions often leave out key adult populations despite targeted gains for children, pregnant people and disabled individuals. Research through 2023 shows that while six states provided benefits regardless of migration status to certain segments, Medicaid expansion policies did not substantially increase coverage for non-lawful permanent residents — a category largely composed of unauthorized immigrants — creating persistent disparities in uninsured rates ^{[4] [7]}. The ACA-era changes improved coverage for many lawful residents, but unauthorized immigrants saw only modest gains, widening some inequities in access to continuous care ^[7].

5. Cancer care and chronic conditions expose policy limits

Analyses published in 2025 emphasize systemic limitations when treating complex illnesses for undocumented patients, noting that Emergency Medicaid and piecemeal Medicaid-equivalent programs seldom ensure full diagnostic, treatment, and survivorship services for cancer patients. The Lancet Oncology review highlights practical and ethical challenges, urging policy innovation to bridge gaps in oncology and other chronic disease care where episodic emergency coverage is inadequate ^[6]. States that aim to improve health equity must therefore balance immediate safety-net care against the need for longitudinal management and preventive services.

6. Policy toolkits show wide options but reveal trade-offs

A 2020 toolkit lays out policy levers — state-funded insurance analogues, county programs, clinic networks, and reduced administrative friction — and clarifies trade-offs among cost, political feasibility, and coverage breadth ^[1]. Implementing Medicaid-equivalent programs requires state funding choices and administrative systems; local initiatives can act faster but have limited reach. Evidence from NYC’s experiment suggests that investments in administrative simplification and sponsored clinic access generate downstream reductions in acute care use, offering a policy route that is both practical and cost-conscious ^{[1] [2] [3]}.

7. Conflicting evidence and research gaps that policymakers should note

Existing studies uniformly show benefits from targeted access expansion, yet findings diverge on the magnitude and transferability across states. ActionHealthNYC provides strong urban evidence of reduced emergency use, while national analyses show persistent uninsured pockets and varying state implementations up to 2025 ^{[2] [3] [5] [4]}. Important gaps remain: long-term outcomes for chronic disease, cost-effectiveness across different program models, and political sustainability of state-funded expansions. Policymakers need comparative data from diverse geographies to know which mixes of programs scale.

8. Bottom line — practical takeaways for readers and policymakers

California and New York demonstrate that state and local action can materially improve access for undocumented residents via targeted coverage, sponsored clinics and streamlined enrollment, producing measurable reductions in emergency use and increases in primary care ^{[1] [2] [3]}. Yet federal restrictions, reliance on Emergency Medicaid, and variable state policies mean coverage remains incomplete, especially for chronic and complex care. Any durable improvement will require deliberate choices about funding, eligibility scope and integration between safety-net clinics and broader systems to close the remaining gaps ^{[5] [6] [4]}.