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Do undocumented immigrants receiving health care in the emergency department cost taxpayers money?
Executive Summary
Undocumented immigrants do use emergency departments and that care generates costs absorbed by hospitals, states, and federal programs, but available federal analyses show those costs are small relative to overall Medicaid spending. Multiple recent studies and government reports put Emergency Medicaid and uncompensated emergency care for noncitizen patients at well under 1% of total Medicaid spending nationally, while state-level tallies show larger raw-dollar impacts in particular jurisdictions [1] [2] [3]. Policymakers proposing cuts to Emergency Medicaid should recognize that savings would be modest while consequences for hospitals and patients could be significant, and that some state reporting emphasizes raw costs without situating them against broader uncompensated-care burdens or immigrant tax contributions [2] [4] [3].
1. Why the Numbers Look Small Nationwide but Big in Some States — The National Context That Changes the Headline
National estimates from federal analyses and peer-reviewed studies show Emergency Medicaid spending for noncitizen emergency care is a minor share of Medicaid. The Congressional Budget Office–referenced and health-policy summaries report that $27 billion was spent on Emergency Medicaid for noncitizen immigrants from FY2017–FY2023, amounting to less than 1% of total Medicaid outlays; a JAMA analysis using 2022 data calculated roughly $9.63 per resident and also found emergency-Medicaid costs under 1% of Medicaid budgets across 38 states and D.C. [1] [2]. These national proportions matter because they signal that, in aggregate, cutting Emergency Medicaid would yield limited federal savings even though headlines from individual states can appear large in raw dollars.
2. State Reports and Hospital Burdens: When Local Dollars and Political Narratives Diverge
State-level releases and testimony highlight concentrated costs that can be substantial for state systems and safety-net hospitals. Florida reported nearly $660 million in costs attributed to undocumented patients’ hospital and emergency care in 2024, with federally mandated Emergency Medicaid payments of $76.6 million reimbursing part of that burden; Texas testimony cited millions spent and state hospital associations report billions in uninsured care, much of which is for U.S. citizens lacking coverage [3] [4]. Those state tallies are real dollars for local budgets and hospitals, and politicians use them to make policy arguments. At the same time, focusing solely on undocumented-patient costs risks obscuring that uncompensated care is dominated by uninsured citizens and systemic gaps, not just immigration status [4].
3. What Emergency Medicaid Covers, and Why Eligibility Rules Matter for Budgets
Federal law and Medicaid rules determine who gets reimbursed: undocumented immigrants are generally ineligible for full federally funded Medicaid, but the Emergency Medical Treatment and Labor Act plus Medicaid’s emergency provisions require hospitals to provide and, in some cases, receive federal reimbursement for stabilizing emergency care, including labor and delivery. That creates the Emergency Medicaid category whose reimbursements reduce but do not eliminate uncompensated hospital costs; CBO and policy analyses emphasize that Emergency Medicaid acts as a narrow, reimbursing safety valve rather than a broad entitlement [1]. Because the service is concentrated and legally mandatory, hospitals and states face constrained options: either treat and seek limited reimbursement or deny care in contravention of federal law.
4. Usage Patterns, Preventable Visits, and the Potential for Policy Alternatives to Reduce Costs
Research on visit types shows many ED visits by undocumented patients are for conditions that primary care could prevent or treat, implying that expanding non-emergency access would reduce ED utilization and local costs. A July 2025 study found 61% of 319 undocumented-patient ED visits were preventable or primary-care treatable, with infections, injuries, GI and OB/GYN conditions common on discharge [5]. Policy alternatives — community clinics, expanded state coverage for certain services, and targeted preventive programs — could lower ED pressures and uncompensated costs. Analysts warn, however, that scaling those alternatives requires upfront investment and political will and would not immediately eliminate existing emergency-care obligations [6].
5. What Cutting Emergency Medicaid Would Actually Save — Small Budgets, Large Consequences
Analysts and studies converge on the point that proposed cuts to Emergency Medicaid would yield modest budgetary savings but outsized operational strain on hospitals and harm to vulnerable patients. The JAMA analysis concluded that emergency-Medicaid cuts would save little at the national level while disproportionately harming states and safety-net providers with larger undocumented populations [2]. State reports arguing for policy change often emphasize headline costs, yet the fiscal math shows limited federal savings and significant local dislocation, and any evaluation must weigh narrow budget reductions against hospital financial stability, legal care obligations, and public-health consequences [1] [3].