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With one stroke, Congress can deliver on three of President Trump’s biggest priorities: Discourage illegal immigration, reform a broken welfare program and save taxpayers billions.
It can all be done if Republicans roll back Medicaid for illegal aliens in their coming reconciliation bill.
As we show in our new report for the Foundation for Government Accountability, migrants have been allowed and even encouraged to abuse Medicaid — at enormous cost to Americans.
Medicaid was created for low-income citizens and lawful residents. But for more than a decade, and especially under Joe Biden, states have corrupted the program by letting it cover illegal immigrants, too.
This creates an obvious incentive to enter the US illegally, since foreigners know they can get health care on the taxpayers’ dime.
It also pushes vulnerable Americans, including the elderly and people with disabilities, to the back of the line for care. Often, they’re stuck behind able-bodied adults who shouldn’t be in this country at all.
Since 2020, according to information we’ve gleaned from 18 states, Medicaid expenditures on illegal aliens have grown by more than 75%.
The Biden administration spent $16 billion on emergency services for this population — services that must be covered under federal law. But federal and state taxpayers are spending billions more on non-emergency medical care.
For years, states have allowed illegal aliens to sign up for Medicaid, pending verification of their citizenship or lawful immigration status — a grace window grounded in an assumption of good faith.
But states weren’t prepared for the unprecedented influx of illegal migrants in the Biden years, which led to far more non-citizens than ever before applying for Medicaid.
In the states that responded to our data requests, the number of Medicaid recipients who couldn’t prove their citizenship or lawful immigration status rose by more than 400% between 2020 and 2023.
Making matters worse, Biden effectively required states to give these people unlimited Medicaid access.
Since June 2024, Washington has forced states to grant endless grace periods, creating an obvious incentive for illegal aliens to lie about their citizenship status.
The Biden administration also made it harder to verify applicants’ identities by “minimizing” recordkeeping rules.
The goal was clearly to get more illegal aliens on Medicaid, regardless of the cost to taxpayers or to Americans who rely on the health care program.
Trump has promised to put Americans first, and Congress must help him succeed.
That starts by ending the federal loophole allowing people who haven’t proved their citizenship or lawful immigration status to obtain Medicaid coverage.
Congress can simply mandate that until applicants can demonstrate they’re a citizen or lawful resident, they don’t get a cent of taxpayer-funded health care.
It isn’t hard to provide a birth certificate, Social Security card or other document proving citizenship when applying for Medicaid. Legitimate applicants who have misplaced their documents would still be protected; Medicaid retroactively covers 90 days of care.
Making documentation a condition of getting on the program will save taxpayers at least $5 billion over the next decade, we estimate.
Next, Congress should stop states from covering illegal immigrants in other ways.
Roughly a dozen states, including the typical suspects of California, Illinois and New York, have passed laws allowing some or all illegal aliens to get non-emergency Medicaid coverage.
Federal law doesn’t permit this, so the states claim that all the funding comes from state coffers — but Washington still picks up most of the tab for administrative costs.
If Congress prohibited any administrative Medicaid spending on illegal aliens, we estimate federal taxpayers would save another $7 billion over 10 years.
That might make those 12 states change their coverage policies. But if they insist on continuing to deprioritize vulnerable Americans, Congress could penalize those states further.
We recommend that lawmakers impose a penalty, docking those states’ federal Medicaid match by 5% for every quarter in which they continue to cover illegal aliens.
Over a decade, federal taxpayers could save more than $200 billion in this way — though the scofflaw states would likely cry uncle well before those savings occur.
Either way, taxpayers win: either through less state spending on illegal recipients, or less federal matching for wayward blue states.
Congress can’t ignore this crisis. The Biden administration and blue states corrupted Medicaid by letting illegal aliens compete with American citizens for care.
While low-income families suffer worse health outcomes, taxpayers pay a pretty penny to cover illegal immigrants while unwittingly encouraging even more to cross our borders.
Trump has rightly vowed to solve these problems. It’s up to Congress to help him put American Medicaid recipients first.
Hayden Dublois is data and analytics director at the Foundation for Government Accountability, where Addison Scherler is data investigator.