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Fact check: What are the estimated costs of providing state-funded healthcare to undocumented immigrants?
Executive Summary
State-level estimates for providing state-funded healthcare to undocumented immigrants vary widely and hinge on program scope: some states fund children or limited adult benefits, while others restrict coverage to emergency care; aggregate national cost estimates are scarce and highly sensitive to scope and utilization assumptions. Recent analyses through 2025 document that 14 states plus D.C. cover income-eligible children regardless of status and seven states plus D.C. cover some adults, but studies emphasize variation in costs by state programs and note the absence of a single, reliable national price tag [1] [2].
1. Why costs are slippery: varied state programs and hidden assumptions
Cost estimates diverge because states design different benefit packages—from emergency-only Medicaid to fully state-funded comprehensive coverage for children or select adults—and those design choices change per-enrollee cost calculations. Academic reviews in 2025 underline this fragmentation and the difficulty of scaling local experience into national estimates: policy scope (children vs. adults), eligibility thresholds, provider payment rates, and whether preventive care is included all materially alter per-person and aggregate costs. Researchers therefore avoid single national figures, instead documenting program-by-program differences and calling for state-level costing [1] [2].
2. What recent U.S. studies actually report about coverage and fiscal exposure
Two 2025 overviews—one state-policy survey and one JAMA Internal Medicine landscape review—report that 14 states plus D.C. provide full coverage to income-eligible children regardless of immigration status and seven states plus D.C. provide some adult coverage, and both stress that fiscal exposure depends on enrollment and benefit generosity. Neither report provides a definitive national expenditure figure; instead, they map policy variation and note that emergency Medicaid remains a costly safety net where comprehensive state programs are absent, amplifying short-term acute spending [1] [2].
3. Per-person spending comparisons: immigrants versus U.S.-born figures
Earlier comparative estimates have shown lower average healthcare spending per unauthorized immigrant than per U.S.-born person, reflecting demographic differences and access limits; a commonly cited 2022 study estimated annual per-person expenditures around $1,629 for unauthorized immigrants, $3,795 for authorized immigrants, and $6,088 for U.S.-born individuals. These per-capita figures inform some fiscal projections but understate added administrative and transition costs when expanding coverage, and they do not capture state-to-state price variation, thus limiting direct extrapolation to statewide program budgets [3].
4. International evidence: costs can fall with broader coverage
Comparative research in 2025 from France offers another data point showing that comprehensive access can reduce hospital costs and intensive care needs, suggesting preventive and routine care may lower costly emergency admissions. This international evidence indicates that program design matters: providing comprehensive primary and preventive services can shift spending away from high-cost acute care. However, differences in healthcare systems, price levels, and immigrant populations caution against direct transfer of French per-capita savings to U.S. state budgets without careful adjustment [4].
5. What advocates and skeptics focus on—and what they leave out
Proponents of state-funded coverage emphasize long-term savings and public-health gains from preventive care and reduced emergency spending, citing studies that link broader access to lower hospital costs. Critics underscore short-term fiscal pressures and argue that expansion increases near-term state budgets, noting that enrollment growth, pent-up demand, and higher provider prices could raise costs beyond per-capita averages. Both sides often omit the administrative costs of program setup, cross-state migration effects, and potential federal policy changes that would shift financial burdens—factors that materially alter cost trajectories but are rarely included in headline estimates [2] [1] [3].
6. Bottom line for policymakers seeking estimates today
There is no single, authoritative national cost estimate for fully state-funded healthcare for undocumented immigrants; accurate budgeting requires state-specific modeling that accounts for eligibility rules, benefit scope, utilization patterns, and likely behavioral responses. Recent 2025 surveys and reviews provide the map—which states currently extend which benefits—and point practitioners to construct micro-level estimates rather than rely on extrapolated national numbers. Policymakers must budget for transition and administrative expenses and consider evidence that comprehensive primary care can reduce costly emergency utilization over time [1] [2] [4] [3].