What state‑funded programs expanded coverage for undocumented immigrants in 2024 and what were their costs?
Executive summary
In 2024 several states moved beyond federally funded eligibility rules and either extended Medicaid‑like coverage to undocumented residents or created state‑funded marketplace subsidies for them; the most prominent expansions were California’s full‑scope Medi‑Cal extension to adults 26–49, Colorado’s state subsidy program covering up to 11,000 people, and Washington’s new 1332‑waiver marketplace pathway with a capped enrollment (California is the only one among these for which a multi‑billion dollar state cost figure is cited in available reporting). [1] [2] [3] [4]
1. California: full‑scope Medi‑Cal for nearly all low‑income adults and the headline $8.4 billion figure
California completed a multiyear phase‑in of state‑funded Medi‑Cal to cover low‑income adults regardless of immigration status, extending coverage to those ages 26–49 beginning in 2024 and thereby making full‑scope Medi‑Cal available to most low‑income undocumented adults in the state (building on earlier expansions for younger and older cohorts) [1] [3]. The U.S. House Budget Committee and California Department of Finance figures cited in reporting put California’s fiscal bill for this population at roughly $8.4 billion for the year referenced, a number that Republican congressional analysts have used to argue the expansion exceeded initial estimates and strained Medi‑Cal budgets [4]. That $8.4 billion figure is a state cost projection highlighted by the House Budget Committee; independent budgetary breakouts and long‑term actuarial estimates are not fully detailed in the sources provided here. [4]
2. Colorado: state subsidies for private plans — up to 11,000 people in 2024
Colorado implemented a state‑funded subsidy program to make private coverage affordable for undocumented residents with incomes up to a set threshold, expanding financial assistance capacity from about 10,000 enrollments in 2023 to funding assistance for up to 11,000 people in 2024, providing no‑premium plans and substantial cost‑sharing help to eligible undocumented Coloradans [2]. The Commonwealth Fund and Urban Institute note Colorado’s model uses state funds to subsidize marketplace plans for undocumented residents, but the reporting available here does not include a single consolidated dollar cost for the program in 2024; instead it reports enrollment caps and program design [2] [5]. States typically publish budget documents with per‑enrollee costs; those detailed line items are not provided in the sources supplied.
3. Washington: 1332 waiver, marketplace enrollment, enrollment caps and funding limits
Washington secured a Section 1332 waiver to allow undocumented individuals to enroll directly through the state ACA marketplace and to provide state subsidies, launching a program in 2024 that was capped (reported cap of 13,000 people) and designed to offer premium assistance though federal law barred federal marketplace subsidies for undocumented people [2] [3]. KFF and Commonwealth Fund reporting indicate the program’s subsidies were available in 2024 but funding constraints led to a pause in subsidies for 2025, and the sources do not supply a total program dollar cost for 2024 beyond describing caps and the waiver mechanism [3] [2].
4. New York, Minnesota and other incremental state actions (intentions vs. implemented costs)
Reporting indicates New York intended to expand similar marketplace approaches (via the Essential Plan) and Minnesota planned further MinnesotaCare expansions in 2025, and separate reporting claims New York created a $2.1 billion program affecting hundreds of thousands of people—however the $2.1 billion claim appears in an AEI‑linked summary and is presented as a contested political figure rather than a neutral state budget document in the materials provided here [2] [6]. Commonwealth Fund and other briefs note plans and intentions but do not uniformly provide reconciled, audited cost totals for those state initiatives in 2024, so the precise statewide dollar expenditures for New York and Minnesota in calendar 2024 cannot be confirmed from the supplied sources. [2] [6]
5. What the sources agree on and where the evidence is thin
Analysts and nonpartisan briefs (Urban Institute, Commonwealth Fund, Migration Policy Institute) consistently describe a patchwork of state‑funded options—full Medi‑Cal expansions in California and Oregon, state Medicaid‑like programs in a dozen jurisdictions for some noncitizen groups, and marketplace subsidy models in Colorado and Washington—while budget politics have driven headline cost claims from congressional committees and advocacy groups [7] [5] [2]. Where the record is weakest in the material provided is consolidated, audited dollar totals for most state programs in 2024: outside California’s widely cited $8.4 billion figure (reported by the House Budget Committee and state finance summaries cited by them), the sources emphasize enrollment caps, program design, and waiver mechanics rather than uniform statewide cost totals for 2024. [4] [2]