Amid a government shutdown, the White House and its allies in Congress are repeating one talking point perhaps more than any other.
“The Democrats continue to recklessly hold the American people hostage over their demands to give illegal aliens free health care,” said White House Press Secretary Karoline Leavitt as she opened a press briefing on Friday.
Democrats are demanding a rollback of Medicaid cuts passed this summer in the One Big Beautiful Bill Act, paired with an extension of pandemic-era Affordable Care Act subsidies that are set to expire, as a condition for ending the government shutdown.
Why We Wrote This
Republicans say Democrats want to give health care to unauthorized immigrants. The Democrats’ proposal doesn’t call for that, and the law prevents it in most cases. We look at the nuances of a top issue in the government shutdown.
Republicans say that means unauthorized immigrants would have access to federally funded health care. Democrats say their changes are intended to benefit citizens and legal residents.
Here’s a look at how immigration status affects health-care benefits, what the Democrats’ proposal would really do, and what it means for the shutdown.
Do unauthorized immigrants receive health care benefits?
In a memorandum released by the White House, the administration said Democrats were demanding reforms that would result in $200 billion in government spending for unauthorized immigrants and noncitizens. A KFF analysis of estimates from the Congressional Budget Office found that the Democrats’ changes related to immigrants with legal status would increase federal spending by $131 billion. It did not provide an estimate for measures related to unauthorized immigrants.
The claim hinges on the Republican bill that became law in July. When it was being drafted, the administration trumpeted that it would “kick illegal immigrants off Medicaid.”
Immigrants who are in the country illegally are not eligible to enroll in Medicaid or Medicare. They also cannot purchase health-care coverage through the Affordable Care Act.
There are a few instances in which the government does pay for unauthorized immigrants to receive medical treatment. Hospitals are legally required to provide people with emergency treatment, regardless of their ability to pay or their immigration status. Hospitals can be reimbursed for these expenses through a program called Emergency Medicaid. The money – which includes federal dollars – covers emergency treatment for unauthorized immigrants who would have been eligible for Medicaid if not for their immigration status.
“There’s a specific formula that is used, and the amount that the federal government pays varies across states, but both [federal and state] governments chip in to cover the cost of that emergency care,” says Laura Wherry, an associate professor of economics at New York University.
Who qualifies for this depends on each state’s standards for Medicaid eligibility, and for what qualifies as an emergency. Emergency Medicaid uses federal money to help match states’ payments to hospitals. That emergency money makes up less than 1% of Medicaid spending, which goes to people including immigrants with legal status as well as unauthorized immigrants.
During her press briefing on Friday, Ms. Leavitt said it is not the administration’s position that hospitals should refuse care to unauthorized immigrants, but she criticized former President Joe Biden for paroling immigrants into the country. Immigrants who have been granted parole are in the U.S. lawfully.
A few states, including California and Illinois, have chosen to allow unauthorized immigrants to enroll in Medicaid programs. This is paid for with state dollars – not federal money.
Republicans have criticized the possibility that higher reimbursement rates under Medicaid expansion, which Democrats want to restore, could mean some emergency care would be reimbursed at a higher rate for an unauthorized immigrant than for a U.S. citizen.
What about legal immigrants?
Noncitizen immigrants who are in the country legally have varying levels of access to health care depending on their status. Many other immigrants with legal status are set to lose their Medicaid access because of the tax and spending bill.
Under the bill, many immigrants, including refugees and people who have won asylum cases, will lose eligibility on Oct. 1, 2026. These are people who have been granted permission to stay in the United States for protection from persecution. It is possible for a person to obtain asylum even if they crossed the border illegally.
Other groups of immigrants were also previously eligible to enroll in Medicaid. These include parolees – people temporarily allowed into the United States by discretion of the president, historically often for urgent humanitarian reasons – and people protected from being sent back to their home countries where they may face danger. In addition, under the Biden administration, recipients of Deferred Action for Childhood Arrival – immigrants who were brought to the country as children – could enroll in Medicaid, though this was changed after a Trump administration rule stopped defining them as “legally present.”
The Republican bill stripped Medicaid eligibility for these groups, although it allows a few other types of noncitizens to keep their eligibility. The bill also limited, but did not end, federal payments to hospitals through the Emergency Medicaid program.
How is this connected with the shutdown?
Before the government shutdown, Republican lawmakers introduced a continuing resolution that would maintain current federal funding levels until Nov. 21. Democrats have demanded that the resolution include extensions of Affordable Care Act subsidies that are set to expire at year’s end and a reversal of Medicaid cuts in the tax and spending bill.
The Democrats’ budget proposal would restore Medicaid, the Children’s Health Insurance Program, and Affordable Care Act coverage eligibility for immigrants with legal status who were eligible for it before the Republicans’ bill, such as refugees or those paroled into the country. It would not make any unauthorized immigrants eligible for these programs. Republicans argue President Biden used a loose parole policy to allow far too many immigrants into the U.S.
Restoring Medicaid access to these groups is only a part of Democrats’ proposed changes. They also want to roll back provisions in the Republicans’ spending bill that reduced federal funding for rural hospitals and imposed work requirements for citizens to be eligible for Medicaid.
“Describing this as about undocumented immigrants is quite misleading,” says Benjamin Sommers, a health economist at the Harvard T.H. Chan School of Public Health.
The shutdown is now in its seventh day, and a stalemate continues with no scheduled meetings between Republican and Democratic congressional leaders.
