Fed audit, emergency Medicaid undercut Dems on illegal immigrant health coverage

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A past federal audit, along with existing state government policies, raises questions regarding claims from Senate Democrats that illegal immigrants do not receive Medicaid amid the ongoing federal government shutdown debate.

"Fact: Undocumented immigrants are not even eligible to purchase the ACA coverage we're trying to protect. Republicans voted to hike costs and take health care away from American citizens. Including their own constituents. Read that again. Over and over," Sen. Tammy Duckworth, D-Ill., posted to X on Tuesday.

Although those in the country illegally may not be able to purchase coverage through the Affordable Care Act, California, for example, was subject to a 2024 federal audit from the Office of the Inspector General for "improperly" requesting that the federal government cover $52.7 million in capitation costs for those with "unsatisfactory immigration status." 

The OIG then recommended that the state refund the federal government.

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In addition, there were concerns about the costs of emergency healthcare for illegal immigrants, which was also referenced by the OIG in the audit on the Golden State.

"States are generally prohibited from claiming Federal reimbursement for Medicaid services, other than treatment of an emergency medical condition, provided to certain noncitizens with unsatisfactory immigration status (UIS)," the OIG's website stated regarding the audit. 

"However, California's Medicaid program extends coverage beyond limited Federal Medicaid benefits to these noncitizens and would generally need to pay for nonemergency services using State funds."

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The OIG said California was using "the proxy percentage that was developed in the early 2000s without assessing whether the percentage correctly accounted for the costs of providing nonemergency services to noncitizens with UIS under managed care."

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Several states offer Medicaid coverage to individuals regardless of their legal status and typically use state taxpayer dollars to cover the costs. Still, as evidenced by the federal audit, it leads to broader concerns about whether any federal taxpayer funds are used, including for emergency costs.

At the state level, the costs of healthcare for those in the country illegally became a critical part of budget talks earlier this year in Minnesota, Illinois and California, according to The Wall Street Journal in June.

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"Congressional Democrats and the Mainstream Media are saying that Chuck Schumer's $1.5 Trillion Dirty CR Counteroffer does not allow illegal aliens to get free healthcare. But IT DOES," Speaker Mike Johnson posted to X on Wednesday. 

"Here's how: The Democrat CR would repeal our Working Families Tax Cut policies that eliminated waste, fraud, and abuse from Medicaid-including all our protections against taxpayer-funded health care benefits going to illegals."