Emergency Medicaid spending accounts for less than 1% of program’s expenses, study finds

Emergency Medicaid spending, an issue partly fueling the federal government’s ongoing shutdown, accounts for less than 1% of the federal health insurance program’s total expenses, according to a study published Thursday in the Journal of the American Medical Association.

The study analyzed data from Washington, D.C., and 38 states that reported their emergency Medicaid expenditures for fiscal year 2022.

The researchers found that, overall, emergency Medicaid constituted 0.4% of total Medicaid expenditures, at an average cost of about $10 per person. Services covered by emergency Medicaid are life-saving procedures, including childbirth labor and delivery, the authors wrote. Some states also cover dialysis and cancer treatments.

Republicans in Congress support a trillion-dollar cut to Medicaid, which they say will only limit care for immigrants who lack legal status and others “lawfully present” in the United States — including Deferred Action for Childhood Arrivals program beneficiaries, who came to the U.S. illegally as children; people who have Temporary Protected Status; and refugees and people seeking asylum who are still going through the legal process.

U.S. law already prohibits unauthorized immigrants from obtaining any federally subsidized health care coverage through Medicaid, the Affordable Care Act, the Children’s Health Insurance Program or otherwise.

A limited exception to this is emergency Medicaid, which covers care meant to stabilize individuals with serious medical conditions who would otherwise be eligible for Medicaid if not for their immigration status.

Overall, emergency Medicaid expenses constituted about a 0.9% of the state’s total Medicaid expenditures in states with a high undocumented population share, compared to 0.1% in states with the lowest share, according to the study.

“Although states with larger undocumented populations spent approximately 15 times more per capita, emergency Medicaid still constituted less than 1% of overall Medicaid spending even in states with large undocumented populations, posing a limited fiscal burden on Medicaid,” the study said. “These results suggest that cuts to emergency Medicaid will produce minimal overall cost savings and will disproportionately harm states with large undocumented populations.”

A Democratic bill pushing back on the Republican-proposed Medicaid cuts is not seeking to change existing law barring people who are in the U.S. illegally from getting federal health care coverage. Instead, the disagreement is mainly centered on immigrants whom the federal government has decreed as “lawfully present,” but who haven’t formally been given legal status that is enforceable in court.

An estimated 1.4 million people are considered to be lawfully present in the United States. The government knows who they are and many of them are going through the process of seeking official legal status or green cards.