Keep Factually independent
Whether you agree or disagree with our analysis, these conversations matter for democracy. We don't take money from political groups - even a $5 donation helps us keep it that way.
Which U.S. states offer state-funded Medicaid or Medicaid-like programs to undocumented adults and what are the eligibility criteria and annual cost per enrollee?
Executive Summary
Several states and Washington, D.C., now operate fully state-funded health programs that cover some undocumented adults, but this remains limited: as of early 2024 six states (California, Colorado, Illinois, New York, Oregon, Washington) plus D.C. had expanded state-funded adult coverage, while a broader set—12 states and D.C.—cover children regardless of immigration status [1]. Eligibility rules, benefit scope, and per-enrollee costs vary sharply by state: New York’s emergency-Medicaid surge shows annual spending of $639 million and an average cost per enrollee of about $1,300 in fiscal 2023–24, while other states report different mixes of prenatal-only, emergency-only, or full-benefit state programs and lack comparable per-enrollee metrics [2] [3] [4].
1. Who’s actually offering care — the short list that matters
States that have moved from limited emergency or prenatal coverage to explicitly funding Medicaid-like packages for some undocumented adults include California, Colorado, Illinois, New York, Oregon, and Washington, plus the District of Columbia; these expansions are recent policy choices made at the state level rather than changes to federal Medicaid eligibility [1]. Other jurisdictions provide narrower services such as pregnancy and postpartum coverage, emergency-only Medicaid, or local/clinic safety-net programs; tables compiled by immigrant-rights and policy groups enumerate prenatal and limited-care policies separately from full adult coverage, underscoring that “coverage” is not uniform across states and can mean anything from emergency-only to near-full Medicaid benefits [3] [4].
2. Who qualifies — narrow windows and income tests define the field
Eligibility is typically framed around income limits, state residency, and—critically—age or pregnancy status; where adults are covered, states set income thresholds similar to Medicaid’s state rules and often phase enrollment by age, pregnancy, or other categories. For children and pregnant people, 12 states plus D.C. removed immigration status as a barrier and apply income-based tests to determine eligibility; for adults, state programs that cover undocumented people usually require proof of state residency and meeting the same income ceilings used for Medicaid or state-funded alternatives, but documentation standards and enrollment processes differ across states [1] [3] [4].
3. What benefits do enrollees actually get — full Medicaid or fragments?
Benefit packages range from full Medicaid-equivalent benefits to emergency-only care. Some state-funded adult programs mirror Medicaid benefits closely, offering primary, specialty, and inpatient care; other state policies limit coverage to pregnancy-related care, postpartum services, or emergency hospital services. New York’s data highlight the emergency-only pathway: emergency-Medicaid enrollment ballooned and spending rose, but the program’s scope remains emergency services rather than comprehensive continuous coverage, illustrating how headline “coverage” numbers can mask limited benefit designs [2] [4].
4. How much does this cost — per-enrollee figures are sparse but revealing
Per-enrollee cost data are fragmentary. New York provides the clearest contemporary figure: fiscal 2023–24 emergency-Medicaid spending rose to roughly $639 million with about 480,000 enrollees, producing an average cost per enrollee of about $1,300 as enrollment climbed faster than immediate expenditures [2]. National analysts and KFF modelers warn that expanding state-funded programs could trigger federal policy pushes—proposals to reduce federal Medicaid matching funds for states that cover undocumented immigrants could reallocate hundreds of billions in federal support over a decade and change state budget calculus; KFF’s modeling estimates a potential $92 billion shift over ten years if federal penalties were applied to the 14 states and D.C. that provide such coverage [5].
5. Big-picture tradeoffs, politics, and data gaps you should know
States that expanded coverage cite improved access and lower uncompensated-care costs; opponents warn of fiscal risks and potential federal repercussions. Policy research organizations document successful state-level programs and highlight that data gaps—especially standardized, state-by-state per-enrollee cost metrics and uniform benefit descriptions—hamper apples-to-apples comparisons, leaving policymakers to weigh health-system impacts, budget exposure, and potential federal policy responses. The most reliable, recent public numbers come from state reports and independent analyses dated 2024–2025; decisions about expansion remain highly state-specific and contingent on budget forecasts and federal policy signals [4] [5] [2].