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Fact check: How does the cost of providing Medicaid to illegal immigrants compare to other government healthcare expenditures in 2024?
Executive Summary
The available analyses show the cost of Medicaid or emergency Medicaid for undocumented immigrants is small relative to total Medicaid spending but appears politically amplified: emergency Medicaid for noncitizens is reported as under 1% of Medicaid and roughly $27 billion from FY2017–2023, while some partisan accounts claim more than $16.2 billion since the Biden administration took office — a difference driven by definitions, timeframes, and what spending is counted [1] [2]. Reconciling these figures requires attention to whether sources count only emergency care, include state-funded programs, measure multi-year aggregates, or conflate unauthorized migrants with all noncitizens [3] [4] [5].
1. Why the headline numbers look so different — definitions and political framing that change the story
Reported totals diverge because analysts are not measuring the same thing; “Medicaid spending on illegal aliens” can mean Emergency Medicaid, state-funded immigrant coverage, or broader categories that include past expenditures, and some counts span different start dates. The House Budget Committee citing CBO-style figures asserts over $16.2 billion since a particular administration began, which reflects a specific aggregation and political frame [2]. Independent research in peer-reviewed venues and CBO summaries focus tightly on Emergency Medicaid and noncitizen emergency care, finding under 1% of total Medicaid and about $27 billion across FY2017–2023, which presents a much smaller fiscal footprint when compared to overall program costs [1] [3]. These differences are technical and material when readers try to compare them to broader government health expenditures.
2. The small-slice finding — emergency care’s share of Medicaid is minimal
Carefully scoped analyses show Emergency Medicaid for undocumented immigrants represents a very small share of state and federal Medicaid spending. A JAMA analysis calculated Emergency Medicaid costs at less than 1% of state Medicaid spending in 2022 — about $9.63 per resident — signaling that emergency services for undocumented people are a relatively minor budget item compared with total Medicaid outlays [3]. The CBO-style aggregate that yields $27 billion from 2017–2023 corroborates this small-share finding when placed against annual Medicaid totals in the hundreds of billions [1]. Framing that small absolute and proportional share as a large fiscal burden requires additional assumptions or different scope than emergency-only accounting.
3. The counterclaim: higher totals and the political narrative
Other actors, notably House budget officials, promote higher cumulative dollar figures and link them to broader policy critiques, asserting a 124% increase in what they label as Medicaid spending on unauthorized immigrants compared with a prior administration and totaling over $16.2 billion in the cited period [2]. That presentation combines specific selections of expenditures and a political timeframe to make a comparative point about administrative policy. Observers should note the potential for motivated selection: choosing a subset of years, emphasizing percentage changes from small bases, and aggregating state and federal flows can produce headlines that outsize the fiscal reality displayed by emergency-only metrics [2] [5].
4. State variation and tools that show the picture is not uniform
Costs vary widely by state and program design; state-funded immigrant coverage can be substantial in some locales while negligible in others, and the RAND ACCESS estimator demonstrates that coverage expansion for immigrants produces widely divergent cost estimates depending on eligibility rules and uptake [4]. The California Health Care Foundation’s wider look at national spending stresses that household affordability pressures and rising overall health costs overshadow the comparatively small line item of emergency care for undocumented immigrants in many states [6]. This heterogeneity means national aggregates can mask significant local fiscal choices and trade-offs that policymakers face.
5. Putting the figures next to overall government healthcare spending — perspective matters
Total Medicaid spending exceeds $800 billion annually, with various analyses noting broad program challenges such as improper payment rates; against that backdrop, under-1%-of-Medicaid figures for emergency care to undocumented immigrants are fiscally modest, while multi-year aggregations in the tens of billions remain small relative to cumulative Medicaid and Medicare outlays [5] [1]. MedPAC and other program-level sources emphasize that Medicare, Medicaid, and other federal health programs dominate public health spending and policy debates, so isolated immigrant-related line items should be assessed as part of the larger fiscal picture, not as sole drivers of budgetary strain [7] [8].
6. Conclusion — what’s solid, what’s uncertain, and what questions remain
Solid: Emergency Medicaid for undocumented immigrants is a minor share of total Medicaid spending per multiple analyses, and state-by-state variation matters [3] [1] [4]. Uncertain: higher multi-year totals and percentage-change claims depend on choices about definitions, timeframes, and whether non-emergency or state-funded programs are included, all of which can be used to amplify political messages [2] [5]. Remaining questions include precise annualized comparisons to other program lines, transparency on state-level inclusions, and reconciliation of partisan aggregates with peer-reviewed and CBO-style accounting; answering these requires disaggregated federal and state data and consistent definitional standards across studies [2] [1] [4].