Fact check: Which states provide state-funded health insurance to undocumented immigrants?

1. What the claims actually say — a clear extraction of the core assertions that matter

The provided materials make three tightly related claims: first, a May 2025 report states that 14 states plus D.C. cover income-eligible children with state funds regardless of immigration status; second, the same source finds seven states plus D.C. extend fully state-funded coverage to some income-eligible adults; third, older sources identify a smaller set of adult expansions (six named states plus D.C.) and note substantial variation across states in programs such as Emergency Medicaid and CHIP ^{[1] [2] [4]}. The analyses also repeatedly assert that pregnant people and children have been the targets of most state expansions, with distinct tallies—22 states for pregnant people and 12 states plus D.C. for CHIP-based child coverage—reported in a 2024 overview ^[3]. These claims collectively map to two truths: states are the principal actors for nonfederal coverage of undocumented immigrants, and coverage availability varies by population (children, pregnant people, adults) and by program type.

2. The most recent headline numbers — who’s counted and why the lists differ

The May 2025 count is the most recent and authoritative snapshot in the packet: 14 states plus D.C. for children and seven states plus D.C. for some adults ^[1]. Earlier counts—such as a 2022 academic review that lists six states for adults (California, Colorado, Illinois, New York, Oregon, Washington) plus D.C.—reflect earlier policy states of play and do not include more recent rollouts ^[2]. Differences arise because states have enacted new laws or broadened eligibility since 2022; some expansions phase in by age or income, and some are limited to particular adult groups (for example, adults 50+ or pregnant adults). Consequently, comparing a 2022 list to a 2025 synthesis can undercount recent state actions, which explains apparent discrepancies between the documents provided ^{[1] [2]}.

3. Where coverage is concentrated — children and pregnant people vs. adults

Policy documents and reporting emphasize that state-funded coverage has concentrated first on children and pregnant people, because federal rules permit or simplify state-funded alternatives for these groups and because political coalitions have prioritized them. A 2024 overview reports that 22 states have extended coverage to pregnant people regardless of immigration status, and 12 states plus D.C. cover children through CHIP regardless of status, reflecting staggered policy choices across states ^[3]. The May 2025 synthesis confirms broader child coverage (14 states plus D.C. for fully state-funded programs) while noting fewer fully state-funded adult expansions, underscoring that adult coverage has trailed and remains the most politically and administratively contested category ^{[1] [3]}.

4. Patching gaps: Emergency Medicaid and remaining coverage holes

Multiple analyses document that Emergency Medicaid remains a critical but limited safety net and that state-to-state variation is substantial. A national landscape review finds significant heterogeneity in how Emergency Medicaid and state programs fill gaps for undocumented immigrants, with some states relying heavily on EM for acute care while others build broader state-funded programs for preventive and chronic care ^[4]. The policy and implementation literature also highlights that even where state-funded adult programs exist, income thresholds, age cutoffs, and phased implementation mean many adults remain ineligible, creating persistent coverage gaps that Emergency Medicaid does not address because it covers only acute or emergency services ^{[5] [4]}.

5. Policy playbook and local innovation — how states and counties have acted

Policy toolkits and implementation reports document a range of levers states and localities use: full state-funded Medicaid-like programs for specific populations, CHIP expansions for children, targeted pregnancy coverage, county-funded clinics, and partnerships with community organizations and consular networks to increase access ^{[6] [5]}. These sources show a strategic pattern: states that politically prioritize immigrant-inclusive health policy pair statutory expansions with administrative guidance and local safety-net investments, while others rely on narrower or local-level interventions. The toolkit literature stresses that program design choices—eligibility definitions, outreach, and payment mechanisms—determine how effective expansions are in practice ^[6].

6. Bottom line and where reporting still needs to improve

The available evidence establishes that state action to cover undocumented immigrants has expanded notably through 2025, particularly for children and pregnant people, with a smaller but growing set of adult programs ^{[1] [3]}. However, discrepancies between older lists and the May 2025 synthesis reflect rapid policy change and differences in counting rules (who is “income-eligible,” which adults are included, whether programs are fully state-funded). Coverage remains fragmented: Emergency Medicaid covers emergencies only, many adults remain excluded due to age or income cutoffs, and implementation details matter for access. Future reporting should publish state-by-state, program-level inventories with implementation dates and eligibility specifics to keep pace with these fast-moving policy shifts ^{[1] [4]}.