More U.S. states are starting to pull back on their extensive free health care programs for undocumented immigrants as federal funding dwindles and state budgets strain under pressure.
Recently, six states, including Washington, D.C., have either cut back or are planning to reduce state-funded health care benefits for immigrants due to financial limitations, as noted in a report. This information comes from the Kaiser Family Foundation.
These adjustments are part of the implications of the 2025 Budget Reconciliation Act enacted by Congress last year, informally known as President Trump’s “One Big Beautiful Bill Act,” which aims to significantly reduce federal funding available for immigrant health care services.
States like Illinois, Minnesota, California, Colorado, North Carolina, and Washington have decreased funding and altered health care programs for both legal and undocumented immigrants in recent years, according to KFF’s report this month.
For instance, California has tightened its eligibility criteria, leaving many immigrants who previously qualified without coverage. Additionally, insurance premiums have been introduced, then raised, while some ancillary services, like dental care, have seen cuts. Meanwhile, Colorado is reducing support for pregnant immigrants and their children, and North Carolina has revamped its immigrant insurance coverage to align with the latest directives from the Trump administration.
Federal law still holds that undocumented immigrants cannot access federally funded programs like Medicaid, CHIP, ACA Marketplaces, and Medicare.
“By 2024, it is estimated there will be 24 million noncitizen immigrants in the U.S., comprising both legal residents and undocumented individuals. Many of these noncitizens, particularly those without legal status, encounter significant barriers in obtaining health insurance and are more likely to be uninsured compared to citizens,” KFF further elaborated.
This doesn’t mean that all states are cutting off health care access for immigrants.
Some states, including Massachusetts, Utah, and New York, are working towards expanding free services for undocumented individuals, such as medical and legal assistance. Additionally, states like Washington, Oklahoma, Hawaii, Rhode Island, and New Mexico are implementing policies to enhance job access for immigrants.
On another note, a handful of states have enacted laws making illegal entry a state offense in addition to being a federal crime. Mississippi is the most recent state to adopt such a law this year, joining Texas, Louisiana, and Oklahoma.
The financial burden for states providing medical services to immigrants is significant. For instance, Florida and Texas have recently introduced regulations requiring hospitals to disclose expenses incurred while treating low-income immigrants unable to afford care. A report from Texas indicated that hospitals in the state spent over $1 billion treating undocumented immigrants. Meanwhile, Florida’s Sunshine State newspaper reported that taxpayers in the state faced $566 million in unpaid medical bills during its first year of reporting.
