Pre-OBBBA<\/p>\n
Medicaid could pay for<\/a> services for legal immigrants, and, in some cases, the federal government could pay for<\/a> emergency care for unauthorized immigrants.<\/p>\n The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), signed by President Clinton, allowed certain \u201cqualified aliens\u201d to access welfare (including Medicaid) while excluding non-qualified aliens. Under PRWORA, lawful permanent residents were still required to wait five years before becoming eligible for Medicaid. However, those entering the United States illegally who claimed asylum or were released with grants of parole were eligible for Medicaid immediately. Under the Biden administration, millions of unauthorized aliens abused these designations to stay in the country longer and were thus able to enroll in Medicaid. As of 2023, previously eligible qualified aliens (noncitizens) comprised 6 percent of individuals under the age of 65 with Medicaid, or approximately 4.6 million people.<\/p>\n Regarding unauthorized immigrants, there have been some circumstances in which the federal government paid for their emergency care. Generally, federal law does not reimburse states for Medicaid services to unauthorized immigrants. If states wish to have Medicaid cover services for unauthorized immigrants, they must pay for<\/a> that coverage with state-only dollars. As Paragon has documented, states such as California circumvented this restriction using legalized money laundering techniques to obtain federal Medicaid dollars, which they then used on medical services for unauthorized immigrants.<\/p>\n States are also affected by the Emergency Medical Treatment and Labor Act, which requires that if an individual shows up to the hospital with an emergency medical condition, hospitals must either provide stabilization treatment or transfer the individual to another medical facility. This rule applies regardless of immigration status.<\/p>\n Whether or not Medicaid pays for these services, however, relates to another provision of law. Section 1903 of the Social Security Act generally prohibits federal reimbursement for services received by anyone who is not a lawful permanent resident. However, the law specifically makes an exception and allows payments for non-lawful permanent residents if the following two conditions are met:<\/p>\n The services \u201care necessary for the treatment of an emergency medical condition of the alien.\u201d This exception created a situation in which the federal government was required to pay for emergency services for unauthorized immigrants at a higher rate than for citizens if states chose to (a) expand Medicaid under the ACA and (b) expand its program with state-only dollars to include unauthorized immigrants. Non-expansion states receive the normal federal medical assistance percentage<\/a> (FMAP<\/a>, typically around 60 percent) for their emergency services.<\/p>\n Some states that expanded Medicaid under the ACA also expanded the program to provide comprehensive Medicaid benefits to unauthorized immigrants. As of April 2025, seven states (California, Colorado, Illinois, Minnesota, New York, Oregon, and Washington) and the District of Columbia had expanded fully state-funded coverage to some income-eligible adults regardless of immigration status. So if an unauthorized immigrant has access to an expansion state\u2019s Medicaid program as part of the expansion population, the federal government must reimburse his or her emergency room care at the 90 percent FMAP<\/a>. Thus, the law results in the federal government making Medicaid reimbursements to states for able-bodied unauthorized immigrants at a much higher FMAP<\/a> (90 percent) than U.S. citizens in the traditional, more vulnerable population in most of these states (50 percent FMAP). Thus, the federal government spent nearly nine times more for each dollar of state spending on the able-bodied unauthorized immigrants\u2019 emergency services than for state spending for traditional enrollees\u2019 emergency services.<\/p>\n What OBBBA Did and Did Not Do<\/p>\n Beginning October 1, 2026, Section 71109 of OBBBA prohibits the federal government from reimbursing states for Medicaid or the Children\u2019s Health Insurance Program<\/a> (CHIP<\/a>) for anyone other than:<\/p>\n citizens, States will be ineligible for federal Medicaid funds for services received by refugees, aliens granted parole for at least one year, aliens granted asylum, and \u201calien visitors, tourists, diplomats, and students who enter the United States temporarily with no intention of abandoning their residence in a foreign country.\u201d The statute still allows federal reimbursement for emergency services and, per states\u2019 election, children and pregnant women who lawfully reside in the United States.<\/p>\n To address emergency care, Section 71110 of OBBBA reduces the FMAP from 90 percent to the state\u2019s normal FMAP for emergency medical services provided through Medicaid for unauthorized immigrants\u2014effective October 1, 2026. This section does not eliminate Medicaid funding emergency services for unauthorized immigrants. It simply ensures the federal match for unauthorized immigrants does not exceed that for citizens.<\/p>\n","protected":false},"excerpt":{"rendered":"Pre-OBBBA Medicaid could pay for services for legal immigrants, and, in some cases, the federal government could pay…\n","protected":false},"author":2,"featured_media":164808,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[97,252,253],"class_list":["post-164807","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-health","tag-health-care","tag-healthcare"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/164807","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=164807"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/164807\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/164808"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=164807"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=164807"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=164807"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nThe alien meets the state\u2019s other eligibility requirements.<\/p>\n
\nlawful permanent residents,
\nCuban and Haitian entrants, and
\nindividuals lawfully residing in the United States through a Compact of Free Association.<\/p>\n