How much does the US spend on health care for undocumented immigrants and how much is paid by taxpayers

Executive summary — concise verdict on the numbers and the politics

The available data show the direct federal and state bill for health care provided to undocumented immigrants is measurable but small compared with total U.S. health spending, concentrated largely in Emergency Medicaid and state-level programs; estimates cited in recent reports range from hundreds of millions in single states to roughly $27 billion in Emergency Medicaid over 2017–2023. Taxpayers fund most emergency care through Medicaid reimbursements and state programs, while undocumented immigrants also contribute substantial tax revenue that offsets some public costs. These figures are large enough to matter politically in some states but small as a share of overall federal and state health spending, and interpretations vary depending on whether analysts count only federally reimbursed Emergency Medicaid, state-funded expansions, or private out-of-pocket and uncompensated care ^{[1] [2] [3] [4]}.

1. Big-picture claims: how much is spent and where the headline numbers come from

Several recent, concrete numbers anchor public debate: a Congressional Budget Office tally reports about $27 billion in Emergency Medicaid for noncitizen immigrants from 2017–2023, identifying this as less than 1% of total Medicaid spending and noting that much of it goes to labor and delivery ^[1]. State-level documents show sharper, short-term impacts: California’s 2025 projection of over $8.4 billion in taxpayer-funded Medicaid benefits for undocumented immigrants reflects a policy change expanding state coverage and draws strong local attention ^[3]. Texas’ November 2024 accounting shows $121.8 million in hospital costs for people not lawfully present, a useful example of how costs concentrate in particular states and systems ^[5]. Emergency care and maternity care dominate measurable, taxpayer-funded line items, per federal and state reports ^{[1] [2]}.

2. Small share, big rhetoric: reconciling per-capita and budget-share studies

National analyses put undocumented-immigrant health spending in perspective: a recent JAMA study of 38 states estimated Emergency Medicaid for undocumented immigrants at under 1% of state Medicaid spending and about $9.63 per resident for fiscal year 2022, concluding that cuts would save little while harming safety-net providers ^[2]. That contrasts with state-specific headline totals that feed political narratives about fiscal strain. The key factual point is that nationwide the measurable, taxpayer-reimbursed portion is a small fraction of Medicaid and total health spending, but concentrated in certain states and services, which produces large local impacts and strong political messaging ^{[2] [1]}.

3. Who pays: taxpayers, states, or the patients themselves?

Federal taxpayers pay most federally reimbursable Emergency Medicaid costs, while states pick up nonfederal shares and any state-funded expansions. California’s $8.4 billion projection explicitly involves state-funded coverage and federal “drawdowns,” leading critics to argue that federal funds are indirectly supporting the expansion; proponents note the state is choosing to cover people excluded from federal programs ^[3]. Texas reporting lists hospital costs for nonlawfully present individuals but does not fully break down payer sources, because some care is covered by federal emergency reimbursements, some by state programs, some by uncompensated-care pools, and some by patient payments ^[5]. Consequently, the taxpayer share varies by program and state policy choices, not a single nationwide percentage ^{[3] [5]}.

4. Offsets often omitted: tax contributions and utilization patterns

Multiple analyses document significant tax contributions by undocumented immigrants—roughly $96–100 billion in federal, state, and local taxes in 2022—meaning they pay into the systems that fund public services ^{[6] [4] [7]}. Research on utilization finds immigrants, including undocumented people, often use less healthcare per capita than U.S.-born residents; one study reported annual per-capita spending of $4,875 for immigrants vs. $7,277 for U.S.-born people, and noted immigrants’ payroll and sales tax contributions that subsidize programs they largely cannot access ^[8]. These facts complicate simple “who pays” narratives: undocumented people both generate taxpayer revenue and incur certain public-service costs, and they generally are not net beneficiaries of federal programs like Medicare or full Medicaid. ^{[4] [8]}.

5. Why the numbers are disputed and what’s missing from the debate

Debate escalates because advocates and critics selectively cite state totals or federal aggregates without consistent definitions. Some actors emphasize headline state expenditures (California’s $8.4 billion) to argue for fiscal strain, while other analysts emphasize emergency-only federal reimbursements to argue the burden is minor ^{[3] [1]}. Key missing elements across public claims include consistent accounting of uncompensated care absorbed by hospitals, private-pay and out-of-pocket spending by undocumented patients, and long-term costs associated with preventive vs. emergency care. The October 2025 commentary noted attempts to correct misinformation about eligibility changes, underscoring how policy shifts and reporting practices affect future totals ^[9]. A fully comparable national estimate requires harmonized definitions of “health care for undocumented immigrants” and linkage of payer sources across federal, state, local, and private spending streams ^{[9] [5]}.

Overall, the factual record shows measurable taxpayer-funded spending concentrated in Emergency Medicaid and state programs, a substantial but not dominant fiscal footprint nationally, and meaningful tax contributions and lower per-capita utilization by immigrants that offset some public costs; interpretation depends on which programs, states, and time frames are counted ^{[1] [3] [4]}.