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Emergency Medicaid spending — a flashpoint in the ongoing government shutdown fight — accounts for less than 1% of the federal health insurance program’s total costs, according to a new study published Thursday in the Journal of the American Medical Association.
The research, which examined data from Washington, D.C., and 38 states, found that emergency Medicaid made up just 0.4% of all Medicaid expenditures in fiscal year 2022, costing an average of about $10 per person nationwide.
The study’s authors said emergency Medicaid primarily covers life-saving procedures such as labor and delivery, with some states also paying for dialysis and cancer treatment for individuals who would otherwise qualify for Medicaid if not for their immigration status.
“Although states with larger undocumented populations spent approximately 15 times more per capita, emergency Medicaid still constituted less than 1% of overall Medicaid spending,” the researchers wrote. “Cuts to emergency Medicaid will produce minimal overall cost savings and will disproportionately harm states with large undocumented populations.”
GOP push for Medicaid cuts
The findings come as congressional Republicans press for deep cuts to Medicaid — totaling about $1 trillion — as part of a broader fiscal package sought by President Donald Trump to reduce government spending.
GOP lawmakers argue that their plan targets benefits for immigrants without legal status and would not affect services for U.S. citizens. But Democrats and public health advocates say the cuts would endanger emergency medical access for refugees, asylum seekers, and other immigrants considered “lawfully present” under federal law.
U.S. law already prohibits unauthorized immigrants from receiving federally subsidized health coverage through Medicaid, the Affordable Care Act or the Children’s Health Insurance Program. Emergency Medicaid is the only exception, covering hospital care for individuals with serious conditions such as heart attacks, pregnancy complications or severe injuries.
Minimal fiscal impact, major humanitarian stakes
According to the study, emergency Medicaid spending averaged 0.9% of total Medicaid costs in states with the largest undocumented populations — compared with 0.1% in states with the smallest.
That variation, the authors said, underscores the limited financial footprint of emergency Medicaid even in border or high-immigration states such as Texas, California and Florida.
“The overall fiscal burden on Medicaid is minimal,” the study said, “but the human cost of eliminating coverage could be catastrophic.”
Democratic response
A Democratic counterproposal now moving through Congress would preserve current emergency Medicaid funding levels while rejecting the Republican-backed cuts. The measure does not seek to expand coverage to immigrants in the country illegally but instead aims to protect access for lawfully present immigrants, including participants in the Deferred Action for Childhood Arrivals (DACA) program, refugees, and those with Temporary Protected Status.
An estimated 1.4 million people fall into this “lawfully present” category, according to government data. Many are in the process of securing permanent residency or other legal status, meaning their identities and cases are known to U.S. immigration authorities.
As the government shutdown continues, the issue of emergency Medicaid spending — despite its minuscule share of the federal budget — has become a potent symbol in Washington’s broader ideological fight over immigration, welfare, and fiscal priorities.
