Which U.S. states provide public health insurance to undocumented adults and what are the eligibility rules?
Executive summary
A growing but fragmented patchwork of state programs now fills federal gaps to provide public or publicly funded health insurance to some undocumented adults; however, which states cover adults, who is eligible, and what benefits are offered vary sharply — from full Medicaid-like plans to narrowly targeted seniors or pregnancy-only coverage — and reporting sources disagree on counts and program details [1] [2] [3].
1. The headline numbers — how many states and which ones claim coverage for undocumented people
National trackers count roughly a dozen to 14 states (plus Washington, D.C.) that offer some public or state-funded health coverage to immigrants with “unsatisfactory” or undocumented status, but most of those expansions focus on children and pregnant people while only a subset extends to non‑elderly adults; different organizations use different cutoffs so lists differ — for example, Newsweek reported 14 states including California, New York, Illinois, Washington, New Jersey, Oregon, Massachusetts, Minnesota, Colorado, Connecticut, Utah, Rhode Island, Maine and Vermont (plus D.C.) as offering some coverage to undocumented migrants [4], while the California Health Care Foundation and KFF note that 14 states and D.C. offer state-funded coverage to people with unsatisfactory status but only eight states and D.C. cover adults in full-scope programs [1] [2].
2. Which states actually cover adults — the messy middle ground
At the center of the reporting are a smaller group of states that have created Medicaid-like, fully state-funded programs for adults regardless of immigration status: California, New York, Oregon, Washington, Illinois, Colorado and a handful of others are repeatedly cited — KFF lists California, Connecticut, Illinois, Maine, Massachusetts, New Jersey, New York, Oregon, Rhode Island, Utah, Vermont and Washington as states that have provided state-funded coverage for some immigrants [2], while other analyses emphasize that six states plus D.C. expanded fully state-funded coverage to some income‑eligible adults [2] [3]. The takeaway is that a core cluster of states — led by California and several Northeastern and West Coast states — furnish adult coverage, but the exact roster depends on program design, recent legislative changes, caps and enrollment freezes [2] [1].
3. Eligibility rules — age, income, pregnancy, and program type define access
State programs differ on the defining variables: many are income‑tested and modeled on Medicaid (state‑funded “Medicaid-like” benefits), some target age bands (Illinois’ Health Benefits for Immigrant Adults historically covered ages 42–64), others prioritize seniors or people over 65, and several exempt pregnant people or expand prenatal care regardless of status; for example, California moved in 2024 to make low‑income immigrants eligible regardless of status but attached later administrative pauses, planned premium requirements and benefit changes for certain age groups [5], while Illinois’ program covered specific age ranges and faces budgetary threats [6]. Several programs impose enrollment caps, co‑payments, or limit services to emergency care unless paid by state funds, and even where full‑scope coverage exists, income thresholds and residency requirements apply [7] [8].
4. Funding and legal contours — state dollars vs. federal limits
Because federal law excludes undocumented immigrants from Medicaid and the ACA exchanges, these state programs are usually financed entirely with state dollars or are narrowly permitted federal options for lawfully present immigrants; critics argue state-funded coverage strains budgets and could incentivize migration, while proponents argue it improves public health and reduces uncompensated emergency care costs [9] [4] [7]. Some states have sought federal waivers or creative marketplace access (Maryland pursued exchange access with federal approval), but federal policy remains the gating factor that keeps the landscape uneven [9].
5. Current vulnerabilities and policy churn — freezes, caps, and political pushback
Programs are fragile: California announced pauses and benefit changes to Medi‑Cal for undocumented adults as budget pressure rose (pauses starting January 2026, dental and premium changes in 2026–2027) [5]; Illinois’ HBIA has faced proposed elimination in budget plans [6]; Washington has at times closed enrollment when caps were met [8]. Analysts warn that despite state action the uninsured rate among undocumented adults remains high and that meaningful uniform access will require federal policy change [2] [3].