Emergency Medicaid spending—the subject of intense political debate during the federal government shutdown—is actually a tiny fraction of the entire Medicaid budget, accounting for less than 1% of total expenses, according to new research published in the Journal of the American Medical Association on Thursday. But here's where it gets controversial: despite its minimal financial impact, the program has become a focal point in broader discussions about immigration and health care funding.
The study reviewed data from Washington, D.C., plus 38 states that provided detailed reports on their emergency Medicaid costs during the 2022 fiscal year. Researchers discovered that emergency Medicaid accounted for just 0.4% of all Medicaid spending nationwide, averaging roughly $10 per person. The program primarily covers critical, life-sustaining services such as childbirth labor and delivery; in some states, treatments like dialysis and cancer care are also included.
This relatively small slice of spending has nonetheless caught the eye of Republican lawmakers pushing for Medicaid cuts totaling trillions of dollars. Their argument? These cuts would primarily reduce care for immigrants without legal status, as well as people who are “lawfully present” but don’t yet have enforceable legal status—such as recipients of the Deferred Action for Childhood Arrivals (DACA) program, those with Temporary Protected Status, and refugees or asylum seekers still navigating the legal process.
It’s important to clarify that federal law does not allow unauthorized immigrants to access any federally funded health coverage, including Medicaid, the Affordable Care Act marketplace plans, or the Children’s Health Insurance Program (CHIP). The only exception is emergency Medicaid, which covers urgent medical care intended to stabilize serious conditions, specifically for individuals who would otherwise qualify for Medicaid if their immigration status weren’t a barrier.
The study also highlighted that states with higher populations of undocumented immigrants spent more on emergency Medicaid—about 0.9% of their total Medicaid budget—compared to just 0.1% in states with fewer undocumented residents. Still, even in these high-immigrant states, emergency Medicaid remains less than 1% of total Medicaid spending, indicating a relatively modest financial load on state budgets. Interestingly, these states spend roughly 15 times more per person on emergency Medicaid, raising the question: do proposed cuts unfairly target certain communities?
The researchers conclude that cutting emergency Medicaid would likely yield only minor cost savings overall but could have disproportionate negative effects on states with large undocumented populations. This suggests a need to carefully weigh fiscal objectives against potential humanitarian impacts.
Meanwhile, Democrats have introduced a bill opposing the Republican Medicaid reductions. Notably, this legislation doesn’t challenge the existing rules that bar undocumented immigrants from federal health care support. Instead, the core dispute revolves around the coverage of immigrants whom the government classifies as “lawfully present,” yet who haven’t been granted legally enforceable status recognized by courts.
Currently, about 1.4 million people in the U.S. fall under this “lawfully present” category—they are known to the government, and many are in the process of obtaining official legal status or green cards. This nuance in legal classification underpins much of the ongoing policy debate.
And this is the part most people miss: the nuances of immigration status and how they affect health care access are complex, yet they heavily influence budgetary and legislative decisions that impact millions. Are the proposed Medicaid cuts about fiscal responsibility, or do they serve as a political tool that could inadvertently harm vulnerable populations? What do you think—does emergency Medicaid deserve more attention, or is it being unfairly politicized? Share your thoughts and join the conversation.
Nicole Acevedo is a national reporter for NBC News and NBC Latino. Sahil Kapur, Hallie Jackson, Kyle Stewart, and Gabe Gutierrez also contributed to this report.
