Countries that provide health care to immigrants are limiting their actions

Budget constraints are forcing liberal states that spend their own money on health care for foreigners to cut that aid as they grapple with federal cuts to Medicaid and the expiration of federal subsidies that helped people buy Obamacare plans.

Under federal law, immigrants are not in the country illegally right for federally funded health insurance.

However, as of last month, six states – California, Colorado, Illinois, New York, Oregon and Washington – as well as the District of Columbia were issuing state dollars cover certain income-eligible foreign adults, regardless of their immigration status. A total of 14 states plus the District provide state-funded care for foreign children, whether they are here legally or not. Three states – Colorado, New Jersey and Vermont – cover pregnant women regardless of their immigration status.

Additionally, 40 states have used the Medicaid option and the Children’s Health Insurance Program, known as CHIP, to provide coverage for lawfully present children and/or pregnant women who are not citizens.

But the sweeping tax and spending bill signed by President Donald Trump last summer cuts federal spending on Medicaid, the federal state’s joint health insurance program for low-income people. It also imposes recent eligibility restrictions on lawfully present immigrants, including refugees and asylum seekers, who are enrolled in various government-subsidized health programs, including Medicaid, CHIP, Medicare and plans available in the insurance marketplaces created by the Affordable Care Act, better known as Obamacare.

Congress behind schedule last year failed to renew federal subsidies that helped people buy Obamacare plans.

With less federal money to provide health benefits, at least five states (California, Colorado, Illinois, Minnesota and Washington) and the District of Columbia have already reduced or announced plans to reduce state-funded immigrant health benefits. Other states may also have to withdraw due to continued budget pressures.

“The federal government has shifted much more of the financial burden of providing these services to the states. So states are looking at their health care budgets as a whole and trying to figure out where they can cut them,” said Medha Makhlouf, a law professor and founder of the Medical-Legal Partnership Clinic at Penn State Dickinson Law, which studies immigrants’ access to health care.

“Historically and currently, as we see, immigrants will be the first to be cut down for a variety of reasons. They do not have the same political power as citizens.”

Drishti Pillai, director of immigrant health policy at KFF, a health policy research group, warned that state cuts combined with changes at the federal level “will likely escalate the number of uninsured people and reduce access to care among immigrants and their children, most of whom are U.S. citizens.

“In the long term, these changes may lead to worse health outcomes that may be more complex and expensive to treat,” Pillai said.

But Cooper Smith, director of homeland security and immigration at the America First Policy Institute, a conservative think tank that has worked with the current Trump administration to develop policy, said policymakers should prioritize U.S. citizens as budgets tighten.

“Taxpayers pay into the system,” Smith said. “I think it’s reasonable to expect that those who put money into the system should be the primary beneficiaries of the public benefit.”

California traditionally provides some of the most generous benefits. But last June, Democratic Gov. Gavin Newsom signed a state budget that prohibits immigrants who are here illegally from re-enrolling in the state’s Medicaid program, known as Medi-Cal. Additionally, current participants ages 19 to 59 will have to pay a recent monthly premium of $30 starting in July 2027. The state will eliminate dental coverage for noncitizens this July.

Newsom budget plan for next year proposes limiting Medi-Cal coverage for certain immigrants living in the country legally, including approximately 200,000 asylum seekers, refugees and others with certain immigration status.

Democratic California State Senator María Elena Durazo pushing through legislation this session, which would reverse the enrollment freeze and restore access to full Medi-Cal coverage for adults living in the U.S. illegally.

“California immigrants are not going to disappear,” Durazo said. “We need them. They are farm workers, food workers, construction workers.

“Will we not provide a minimum of basic health care and think that somehow it won’t come back and torment us in emergency rooms, other counties and public hospitals?”

Hannah Orbach-Mandel, a policy analyst at the California nonprofit California Budget and Policy Center, said the state should find alternatives to the cuts, such as raising corporate taxes. She said limiting coverage puts immigrants “in a really vulnerable situation that could ultimately result in people dying.”

Colorado made a similar choice.

Using state money, Colorado Silver Reinforced The savings program allows immigrants here illegally to purchase Obamacare plans with zero premiums. However, budget constraints prompted the state to lower the program’s enrollment cap to 6,700 from 12,000.

Now the state is ready to scale back another program. Last year, the state launched Embrace all Coloradans providing state-funded health care to low-income children and pregnant women who would be eligible for CHIP or Medicaid but for their immigration status. But Bill Legislature sent last month to Democratic Gov. Jared Polis will cut some of the benefits available under the program and limit enrollment to support close a roughly $1 billion gap in the state budget resulting in part from rising Medicaid costs.

When law the creation of the program was passed in 2022, financial analysts estimated this fiscal year, it would cost $14.7 million and cover nearly 3,700 children and pregnant women. Instead, the program served almost 28,000 people at an estimated cost of approximately $104.5 million.

Colorado Republican Rick Taggart, a member of the Joint Budget Committee, called the program changes “a painful compromise.”

“You can’t separate the human side from the financial side in this area,” Taggart said in a telephone interview. “We’re talking about children and we’re talking about pregnant women who have very real needs… children in most cases had nothing to do with the decision to immigrate to the U.S. and Colorado.”

Other Colorado lawmakers, however, have said that providing services to children who are here illegally ends up depriving them of legal residents.

“When we come here with compassion and talk about children, let’s talk about all the children in our state,” state Rep. Brandi Bradley said during a House debate last month. “There are plenty of children whose parents have a lot of work to do to keep up with inflation and grocery prices in the state as we continue to expand programs like this.”

Under a 2001 court ruling, the New York Constitution prohibits the state from distinguishing between citizens and legal immigrants in providing Medicaid. Legal immigrants include people who have short-lived and humanitarian status or are allowed to stay here under the Deferred Action for Childhood Arrivals program, known as DACA, and who qualify for income under Medicaid.

But even New York had to make changes. The state says it is tightening income eligibility rules because of cuts in federal funding state basic planwhich provides zero-premium coverage for people who are here legally but do not qualify for Medicaid.

Starting in July, the program will no longer cover households making between 200% and 250% of the federal poverty level. The change will end coverage for approximately 450,000 New Yorkers.

“Our priority continues to be protecting coverage for as many New Yorkers as possible and ensuring people have information and assistance during this transition,” said Danielle De Souza, spokeswoman for the New York State Department of Health.

Stateline reporter Shalina Chatlani can be reached at: schatlani@stateline.org