Republicans Mischaracterize Impact of House Bill on Immigrant Healthcare Coverage

Congressional Republicans and the Trump administration are inaccurately claiming that a recently passed House budget reconciliation bill would remove “millions of illegal aliens” from Medicaid, according to policy experts and a Congressional Budget Office (CBO) analysis.

The bill, narrowly passed on May 22 with only Republican support, does not directly remove immigrants from Medicaid because those without legal status are already ineligible for comprehensive Medicaid benefits under federal law. Instead, the legislation would penalize states that use their own funds to provide healthcare coverage to undocumented immigrants.

“A state funded program is by definition not Medicaid,” explained Leonardo Cuello, research professor at Georgetown University’s Center for Children and Families, in an email interview. “Medicaid is when a state is accepting federal Medicaid dollars in compliance with federal Medicaid coverage rules.”

The confusion stems from provisions in the bill that would reduce the Federal Medical Assistance Percentage (FMAP) from 90% to 80% for states that offer any form of state-funded health coverage to undocumented immigrants. This financial penalty would likely cause some states to discontinue their state-funded health programs for these populations.

According to preliminary CBO estimates, this provision would result in approximately 1.4 million people losing their state-funded health insurance by 2034. These individuals “include people without verified citizenship, nationality, or satisfactory immigration status,” the CBO noted.

Despite these facts, former President Donald Trump urged Republicans to support what he called “THE ONE, BIG BEAUTIFUL BILL” in a May 16 Truth Social post, claiming it would “kick millions of Illegal Aliens off of Medicaid.” White House Press Secretary Karoline Leavitt similarly stated that “1.4 million illegal aliens who are currently improperly receiving Medicaid benefits will be kicked off the program.”

House Speaker Mike Johnson advanced this narrative after the bill’s passage, suggesting that Democrats who opposed the legislation wanted “Medicaid for illegal immigrants.”

Currently, 14 states and the District of Columbia use state taxpayer money to cover children regardless of immigration status, according to health policy research group KFF. Seven of these states and D.C. also cover some adults regardless of immigration status.

While undocumented immigrants cannot receive regular Medicaid coverage, hospitals can request reimbursement for emergency medical assistance provided to those who would otherwise qualify for Medicaid if not for their immigration status. These reimbursements, known as Emergency Medicaid funding, account for less than 1% of all Medicaid spending, according to KFF analysis of CBO data.

The House bill contains broader Medicaid provisions that would reduce overall Medicaid and Children’s Health Insurance Program coverage by 10.3 million people by 2034, with a net 7.6 million becoming uninsured, according to CBO projections.

Republicans have also overstated the tax benefits in the legislation. While Trump claimed the bill “cuts Taxes for ALL Americans,” the nonpartisan Tax Policy Center estimates that about 80% of U.S. households—not 100%—would receive tax cuts under the proposal.

The reconciliation bill, having cleared the House, now awaits consideration in the Senate, where its fate remains uncertain. The debate highlights ongoing partisan divisions over immigration policy, healthcare access, and fiscal priorities.