Democrats have not given up their push to expand publicly funded health coverage to illegal immigrants in this country.
In California, the state Senate is considering legislation that would allow all undocumented residents ages 19 and older to enroll in Medi-Cal, the state’s Medicaid program. This year, California froze new enrollment for most undocumented adults and announced new premiums for this group set to take effect in 2027. The state already spends some $12 billion annually on healthcare for illegal immigrants.
Oregon’s latest budget similarly expanded public health coverage for immigrants — including undocumented residents. It now devotes more funding to that effort than to the state police.
These policies stretch Medicaid well beyond the intent of federal law. They’re also fiscally irresponsible.
Federal law limits federal Medicaid spending to citizens and those with “qualified alien status.” Illegal immigrants aren’t eligible. So it’s worth asking how, as of 2024, federal Medicaid spending on illegal immigrants had reached $6.15 billion, according to the Foundation for Government Accountability.
The answer is that states have gotten very good at using loopholes to circumvent federal law. Chief among them is something called “emergency Medicaid” — a component of the program intended to provide urgent medical care to otherwise ineligible immigrants.
Emergency Medicaid, as its name suggests, is supposed to be used only in extreme circumstances. But that isn’t how states have done things lately — and particularly not under former President Joe Biden.
During Biden’s tenure, federal emergency Medicaid spending on illegal immigrants tripled.
By 2024, California alone received $4.5 billion in emergency funding for Medi-Cal. This is hardly surprising, given that an estimated 1.7 million illegal immigrants were insured under the program as of October 2025 — accounting for 11% of total enrollment.
SUSIE WILES DIAGNOSED WITH ‘EARLY STAGE’ BREAST CANCER: TRUMP
Until recently, states were rewarded for employing this legal workaround, because the federal matching rates for emergency Medicaid patients were actually higher than for traditional enrollees. Thankfully, the One Big Beautiful Bill Act addressed this discrepancy in the law while also imposing stricter eligibility requirements for the program.
Medicaid, which covers roughly 76 million people, was originally designed as a safety-net program for the nation’s poorest citizens. Expanding it indefinitely, especially through legal gray areas and fiscal workarounds, risks undermining its fiscal future.
Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care 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.