Fact Over Fiction: Medicaid, Immigration, and Health Care Access

In 2025, approximately 52 million immigrants lived in the United States, forming 16% of the population. Health insurance coverage is closely tied to immigration status – including Medicaid. Many groups of immigrants are categorically excluded from federally-funded health insurance programs. Undocumented immigrants, in particular, have long been prohibited from obtaining Medicaid. However, in the last year, inaccurate claims around Medicaid eligibility for immigrants have been used to justify policy changes proposed under the One Big Beautiful Bill Act (OBBBA). For example, one false claim was that undocumented immigrants were responsible for increased Medicaid spending. It is crucial to ground any discussions of policy proposals and their potential impacts in evidence.

Let’s first correct inaccurate rhetoric with evidence:

• Undocumented immigrants are not eligible for Medicaid coverage.
• Some lawfully present immigrants (i.e., green card holders, asylees, refugees) may have a “qualified” immigration status for Medicaid, but must wait five years before they are eligible for coverage.
• States have some discretion in eligibility policies for particular populations. In January 2025, 29 states and Washington, D.C. had expanded Medicaid coverage (and/or waived the five-year waiting period) for lawfully residing immigrant children and pregnant people.
• Emergency Medicaid covers limited emergency care if the individual would otherwise be Medicaid-eligible if not for their immigration status (e.g., a person is undocumented or legally present but still within the 5-year waiting period for Medicaid eligibility). This represents less than 1% of overall Medicaid spending, even in states with large undocumented immigrant populations.
• Compared to U.S.-born citizens, immigrants are more likely to be uninsured, use fewer health care services, and have lower per-capita health care expenditures.

Despite these facts, inaccurate claims have quickly fueled anti-immigrant actions. Violence from Immigration and Customs Enforcement (ICE) raids and arrests and harmful policy changes have increased substantially under the second Trump administration. Policies included in OBBBA claimed to exclude undocumented people from social safety net programs like Medicaid. Instead, the policies are likely to be felt by legally present, low-income families. These events drive immigrants underground and away from vital health care.

Cruel rhetoric and funding cuts targeting immigrant families harm all of our communities, making us sicker and starving states of resources to ensure a healthy, prosperous life for all.

Centers for Medicare and Medicaid Services announced in July 2025 that it would share Medicaid data with the Department of Homeland Security (DHS) and ICE. DHS noted that the goal of this agreement is to identify and locate undocumented immigrants. Historically, this kind of data sharing was prohibited. In addition, a November 2025 revision to the Public Charge rule once again tied future immigration status determinations to previous participation in safety net programs. Heightened fears among immigrant families will likely lead to “chilling effects,” or reduced participation in Medicaid and Supplemental Nutrition Assistance Program (SNAP), even among children from immigrant families legally eligible to receive benefits.

The OBBBA will dramatically reduce Medicaid spending over the next decade, destabilizing low-income families, irrespective of immigration status. Additional OBBA provisions stripped Medicaid eligibility from refugees and asylees—all legally present in the U.S. Further, work reporting requirements increase administrative burden for enrolling and re-certifying Medicaid coverage. Administrative burdens compound the preexisting immigrant-specific challenges to maintaining Medicaid coverage, such as cultural or linguistic barriers and a higher likelihood of employment that may not have documentation.

As the already-limited Medicaid coverage available to low-income immigrant families dwindles, state governments have an important role in mitigating harm. Yet OBBBA’s likely ripple effects will also reduce federal Medicaid funding to states, forcing them to make difficult decisions to balance their budgets. Several states have offered fully state-funded coverage to some immigrants irrespective of status, and others have enacted legislation to increase access to certain public benefits. These states recognize that when one group is targeted, all are affected. Cruel rhetoric and funding cuts targeting immigrant families harm all of our communities, making us sicker and starving states of resources to ensure a healthy, prosperous life for all.

This post is in partnership with the Medicaid Policy Lab at Boston University School of Public Health.