They've Paid for It: Why Undocumented Immigrants Deserve Medicaid

Opinion: Undocumented Immigrants Deserve Access To Health Care

As a social work intern, I recently followed up on a kindergartener who missed nearly a week of school. The child had been sick all week, but her mother could not afford a doctor’s visit — and because the family is undocumented, she could not get Medicaid.

The result was avoidable suffering and a missed opportunity for timely care. This is not an isolated story: many undocumented families delay care or rely on emergency treatment because federal eligibility rules bar them from most public benefits.

Taxes Paid, Benefits Denied

Data from the Institute on Taxation and Economic Policy (ITEP) make the contradiction stark. In 2022, undocumented immigrants contributed an estimated $96.7 billion in federal, state and local taxes despite representing roughly 27 percent of the immigrant population. That total included about $59.4 billion in federal taxes and $37.3 billion in state and local taxes.

Crucially, more than one-third of those contributions are payroll taxes dedicated to social insurance programs the workers cannot access. ITEP estimates undocumented workers paid $25.7 billion in Social Security taxes, $6.4 billion in Medicare taxes and $1.8 billion in unemployment insurance taxes in 2022 — effectively financing systems that exclude them.

What The Law Allows Now

The 1996 welfare reform law restricts most federal public benefits to individuals with a Social Security number or other qualifying immigration status. As a result, undocumented people are generally ineligible for Medicaid, food assistance, welfare and most Affordable Care Act plans. Their health coverage is therefore typically limited to emergency Medicaid, which covers immediate, short-term care such as labor and delivery; a few states expand emergency coverage to include ongoing treatments like dialysis or some cancer care.

Importantly, in states with the largest undocumented populations, emergency Medicaid spending represents less than 1 percent of the overall state Medicaid budget — suggesting that broader coverage would have modest fiscal impact while producing large public-health gains.

A Practical Policy Path

Granting work authorization to undocumented workers would likely raise wages, increase tax compliance and boost tax receipts. ITEP models a scenario in which work authorization increases annual tax contributions by $40.2 billion, bringing total yearly contributions to $136.9 billion, with about $33.1 billion to the federal government and $7.1 billion to states and localities.

Congress could also amend the 1996 law to extend Medicaid eligibility to undocumented immigrants or create targeted programs that provide primary and preventive care. Ensuring access to regular health care would prevent costly emergency interventions, improve workforce health and productivity, and strengthen public safety nets that these workers already help fund.

Who benefits? Undocumented workers and their families will be healthier; employers will see a more productive workforce; and the broader economy will benefit from reduced emergency care costs and increased economic output.

Dustin Hopkins is a master’s student in social work at Fort Hays State University and an elementary school social work intern.

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