Rolling Back the Big Beautiful Bill’s Health Care Provisions Would Not Provide Health Care to Undocumented Immigrants
Undocumented immigrants are not eligible for federally-funded health coverage. The GOP’s Big Beautiful Bill didn’t change that. Overturning the health care provisions in the law won’t either. In the midst of the ongoing government shutdown, Republican policymakers claim that H.R.1, or the “Big Beautiful Bill”, will restrict health coverage for undocumented immigrants, and that a proposal from Democrats to reverse the cuts would expand coverage for those undocumented immigrants. However, provisions related to limiting immigrant eligibility for Medicaid, the Children’s Health Insurance Program (CHIP), Medicare, and subsidized Affordable Care Act (ACA) Marketplace coverage only impact lawfully present immigrants, as undocumented immigrants already are ineligible for federally-funded coverage in these programs under longstanding federal policy.
Under current law, eligibility for Medicaid and CHIP is limited to lawfully present immigrants with a “qualified” immigration status and immigrants usually must wait five years after obtaining their “qualified” status to enroll (with some exceptions). “Qualified” immigration statuses include but are not limited to lawful permanent residents (LPRs or “green card” holders), refugees, asylees, Cuban and Haitian entrants, survivors of trafficking and abuse with a pending or approved visa, and people residing in the U.S. under the Compact of Free Association (COFA). Therefore, under current policy, a “green card” holder would have to wait five years after obtaining their “qualified” status to enroll in Medicaid or CHIP if they met other requirements such as income. Subsidized ACA Marketplace coverage is currently available to lawfully present immigrants with a “qualified” immigration status and also to other groups of lawfully present immigrants such as those with Temporary Protected Status (TPS), and people on valid nonimmigrant visas (for example some types of work visas). Eligibility for Medicare is also limited to lawfully present immigrants who meet age and work requirements.
Provisions in H.R.1 limit eligibility for Medicaid and CHIP, subsidized Marketplace coverage, and Medicare to an even smaller subset of lawfully present immigrants, namely, lawful permanent residents, Cuban or Haitian entrants, and citizens of Compact of Free Association (COFA) residing in the U.S. States can also maintain Medicaid and CHIP coverage for lawfully residing pregnant people or children covered through a state option. As such, H.R.1 strips health coverage from several groups of lawfully present immigrants such as refugees, asylees, and survivors of trafficking and abuse. It does not impact health coverage for undocumented immigrants, who, under longstanding policy, have been and continue to be ineligible for all forms of federally funded health coverage.
Some states provide health coverage to undocumented immigrants using only state funds. An earlier version of the Republican tax and spending bill sought to penalize those states by reducing federal Medicaid funding, but that provision did not make it into the final version of the legislation. Some states have also taken up the “From-Conception to End of Pregnancy” option, which provides coverage to low-income citizen children regardless of their parent’s immigration status, and this option also remains unaffected by H.R.1.
Under the Emergency Medical Treatment & Labor Act (EMTALA), a longstanding federal law, hospitals are required to stabilize anyone who shows up in an emergency. Medicaid programs are required to pay hospitals for emergency care provided to undocumented immigrants who would be otherwise eligible for Medicaid, except for their immigration status. Nothing in the Republican tax and spending law changes these requirements, but it does reduce how much the federal government shares in the expense for emergency care provided to undocumented immigrants in states that have expanded Medicaid under the ACA. So, while a repeal could increase the federal share of spending to hospitals, it would not change eligibility for care for the immigrants themselves.