“Not a single federal dollar goes to providing health insurance for undocumented immigrants. NOT. ONE. PENNY.” These were the words of Senate Minority Leader Chuck Schumer (D-NY) in a recent X post, after Republicans accused Democrats of shutting down the government in order to keep funding Medicaid for illegal immigrants.
House Minority Leader Hakeem Jeffries (D-NY) echoed this same talking point, insisting, “Federal law prohibits the use of Medicare, Medicaid, the Children’s Health Insurance Program and the Affordable Care Act to provide health insurance in any way, shape or form, to undocumented immigrants. Period, full stop. And Democrats aren’t trying to change that.”
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But the truth is much more complicated. Federal money does indeed make it possible for states to extend Medicaid to millions of illegal immigrants. Democrats have shut down the government, in part, to keep things that way.
One of the methods states use to funnel federal dollars to healthcare for illegal immigrants is through “emergency” Medicaid. This is the part of the program intended to reimburse hospitals for providing emergency care to uninsured patients. In recent years, the amount of federal money used to provide such care to illegal immigrants has soared.
In 2020, emergency Medicaid spending on illegal immigrants was just $2.06 billion, according to the Foundation for Government Accountability. By 2024, that figure had ballooned to $6.15 billion — quite a bit more than one penny.
California is by far the chief offender, responsible for 74% of emergency Medicaid spending on illegal immigrants. The Golden State has even used emergency Medicaid funds to pay for managed care plans for undocumented immigrants — at a cost to federal taxpayers of nearly $373 million between October 2018 and June 2019.
At the beginning of 2024, all illegal immigrants in California became eligible for Medi-Cal, the state’s Medicaid program, thanks to legislation signed by Gov. Gavin Newsom (D-CA). The state claims it only uses its own funds to cover the cost of coverage for undocumented immigrants. But it can only do so because of the massive amounts of federal Medicaid funding it uses to pay for benefits for the legal Medicaid population.
In May 2025, there were 14.4 million Medi-Cal enrollees; of that number, 1.6 million were illegal immigrants.
There are numerous other ways in which states provide Medicaid benefits to illegal immigrants. Many are deemed to be “lawfully residing” in the United States, despite their undocumented status — and thus qualify for the program. Others have been granted qualified alien status by states, which also opens the door to federal Medicaid funding.
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The Republicans’ July budget reconciliation package took steps toward cracking down on such abuses of the program by restricting which undocumented immigrants can qualify for the program through “lawfully residing” status. It also requires more regular eligibility checks for Medicaid enrollees and enforces new penalties for states with high rates of improper Medicaid payments.
It’s hard to know what is worse — that Democrats oppose such commonsense reforms, or that they are willing to mislead the public so brazenly.
Sally C. Pipes is president, CEO, and Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy—and How to Keep It (Encounter 2025). Follow her on X @sallypipes.