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Undocumented immigrantsin the U.S. continue to navigate a complex-and often unforgiving-healthcare system in 2025. They aren't eligible for Medicare, Medicaid, CHIP, or ACA coverage. But that's only the beginning of the story.
What many people don't realize is that despite being shut out of federally funded insurance, undocumented individuals do have access to emergency services. Hospitals are legally required to provide treatment in life-threatening situations, thanks to the Emergency Medical Treatment and Labor Act (EMTALA). For those who meet financial criteria, Emergency Medicaid may cover the cost, especially for events like labor and delivery.
States step iIn where Federal Policy stops short
Some states are taking things into their own hands. California, for example, expanded Medi-Cal to include undocumented adults of all ages. New York and Illinois provide similar programs for children and prenatal care, regardless of immigration status. These efforts aren't cheap, but they've remained a small fraction of total spending-less than 1% of Medicaid dollars.
Federal data backs that up. In 2016, emergency medical services for undocumented immigrants cost just 0.2% of Medicaid spending-and that number hasn't dramatically increased since. Yet the political heat around these numbers remains high.
Meanwhile, undocumented immigrants continue to contribute to the very system they can't access. According to the New American Economy, they paid over $31 billion in taxes in 2018 alone, including billions that went straight into Medicare and Medicaid trust funds. In fact, between 2000 and 2011, they generated a $35 billion surplus in Medicare.
Despite this, between 45% and 71%of undocumented individuals still don't have health coverage. Most turn to Federally Qualified Health Centers (FQHCs), pay out-of-pocket, or skip care altogether.
As 2025 progresses, the conversation is shifting. It's no longer just about who gets what-it's also about who pays, who benefits, and who's left out.