Fact check: Are there any state-specific healthcare programs for undocumented immigrants in the US?

1. Why the nation looks split: emergency-only care versus broader state programs

Research published in 2025 documented a clear national divide: 37 states and Washington, D.C. restrict undocumented immigrants primarily to Emergency Medicaid, whereas 12 states plus D.C. have adopted state-sponsored Medicaid-equivalent programs that extend routine and chronic-care coverage beyond emergencies ^[1]. This split reflects differing fiscal priorities and political choices at the state level, with emergency coverage remaining a federal floor that ensures acute care access but leaves preventive and chronic care gaps for millions. Policymakers in expansion states prioritize continuity of care and public health benefits; other states focus on limiting new ongoing expenditures.

2. Connecticut as a laboratory: detailed modeling of expansion impacts

Multiple studies have used Connecticut as a case study to model outcomes of removing immigration status restrictions from Medicaid and CHIP (HUSKY). RAND analyses in 2022 and 2025 found lifting status requirements would reduce uninsurance among undocumented and recent legally present immigrants by roughly 32–37%, but would also raise state costs substantially under varying scenarios ^{[3] [4]}. The 2025 RAND work emphasized that including programs like HUSKY C (coverage that includes long-term care) would not meaningfully change child and young adult coverage rates but would substantially increase long-term fiscal obligations, illustrating how benefit design drives cost dynamics.

3. How many states cover children and adults regardless of status — and who?

As of mid-2025, 14 states plus D.C. provide full state-funded health coverage to income-eligible children regardless of immigration status, while seven states plus D.C. extend fully state-funded coverage to some income-eligible adults regardless of status ^[2]. These targeted expansions reflect strategic choices to prioritize vulnerable populations, particularly children, and to promote preventive care. The KFF/LA Times survey corroborates that immigrants in more expansive states are less likely to be uninsured (11% vs. 22%), demonstrating the measurable effect of state-level policy variation on insurance rates ^[5].

4. What constitutes “coverage” — emergency care, chronic disease, and dialysis exceptions

Studies from 2025 highlight that state programs differ not only in eligibility but in the scope of services covered. Many states that limit coverage to Emergency Medicaid nevertheless carve out longer-term care for specific chronic conditions such as dialysis and cancer treatment, creating a patchwork of access that can leave patients without routine management for diabetes, hypertension, or mental health ^[1]. This ad hoc approach reduces immediate mortality risk for certain conditions but fails to provide comprehensive, cost-effective management that can lower long-term costs and improve public health outcomes.

5. Numbers matter — how many undocumented people are affected and the projected fiscal impact

Modeling for Connecticut estimated potential state costs that vary widely by scenario: estimates ranged from tens to hundreds of millions of dollars, with figures like $39 to $252 million in one RAND scenario and $83 to $121 million in another, depending on which age groups and HUSKY tiers are included ^{[4] [3]}. These divergent estimates underscore how assumptions about utilization, program scope, and inclusion of long-term care swing fiscal impacts, informing the political debate in states weighing expansions.

6. Policy trade-offs and the political agenda behind choices

State decisions reflect competing agendas: proponents argue expanded coverage reduces uncompensated care, improves population health, and can lower total system costs over time, while opponents emphasize near-term budget constraints and concerns about public perceptions of benefits for noncitizens. The data show trade-offs clearly—states that expanded access report lower uninsured rates among immigrants, but estimates project increased state expenditures depending on benefit richness and population covered ^{[5] [4]}. These differing priorities explain why some states pursue limited emergency-only models and others fund broader programs.

7. Evidence gaps, timing, and what the recent literature misses

Recent studies up through 2025 provide national overviews and state-level modeling but leave gaps in real-world, longitudinal outcome data post-expansion. Most published work relies on modeling or cross-sectional comparisons rather than long-term empirical follow-up, limiting certainty about downstream cost savings from preventive care or shifts in health outcomes. Additionally, the studies often focus on single-state models like Connecticut, which may not generalize to larger or demographically different states, and they vary in publication dates and methods, producing a range of fiscal estimates ^{[3] [4] [1]}.

8. Bottom line for policymakers and the public: options and consequences

Policymakers face clear choices: maintain Emergency Medicaid as a federal baseline or invest state funds to create Medicaid-equivalent programs that reduce uninsured rates and expand chronic-care access. Evidence through 2025 shows expansion reduces uninsurance and improves access, particularly for children, but these benefits come with measurable state costs that depend on program design. States advancing coverage should plan for benefit design choices, fiscal estimates, and evaluation mechanisms to measure health and economic outcomes over time ^{[1] [2] [4]}.