Immigrants in the U.S. illegally are generally ineligible for federally funded health care programs such as Medicare and Medicaid and subsidized private insurance through the Affordable Care Act marketplace.
Democrats’ funding proposal would restore access to Medicaid and the Affordable Care Act marketplace for legal immigrants who will lose access once certain provisions of the Republicans’ tax and spending law take effect.
By Maria Ramirez Uribe
Republicans repeatedly accused Democrats of forcing the closure because they want to give health care access to immigrants in the U.S. illegally.
"Democrats are threatening to shut down the entire government because they want to give hundreds of billions of dollars of healthcare benefits to illegal aliens," Vice President JD Vance said Sept. 28 on "Fox News Sunday."
President Donald Trump, House Speaker Mike Johnson and Republican members of Congress have repeated this line.
It’s wrong.
Democrats have refused to vote for Republicans’ resolution to extend the federal spending deadline, and their position does, in part, hinge on health care spending. Democrats want to extend pandemic-era Affordable Care Act subsidies that are set to expire at the end of the year and roll back Medicaid cuts in the tax and spending bill that Trump signed into law this summer.
Republicans falsely tie shutdown to Democrats wanting health care for immigrants illegally in the US
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Immigrants in the U.S. illegally are generally ineligible for federally funded health care programs such as Medicare and Medicaid and subsidized private insurance through the Affordable Care Act marketplace.
Democrats’ funding proposal would restore access to Medicaid and the Affordable Care Act marketplace for legal immigrants who will lose access once certain provisions of the Republicans’ tax and spending law take effect.
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As the U.S. headed for a government shutdown, Republicans repeatedly accused Democrats of forcing the closure because they want to give health care access to immigrants in the U.S. illegally.
"Democrats are threatening to shut down the entire government because they want to give hundreds of billions of dollars of healthcare benefits to illegal aliens," Vice President JD Vance said Sept. 28 on "Fox News Sunday."
President Donald Trump, House Speaker Mike Johnson and Republican members of Congress have repeated this line.
It’s wrong.
Democrats have refused to vote for Republicans’ resolution to extend the federal spending deadline, and their position does, in part, hinge on health care spending. Democrats want to extend pandemic-era Affordable Care Act subsidies that are set to expire at the end of the year and roll back Medicaid cuts in the tax and spending bill that Trump signed into law this summer.
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The Democrats' proposal wouldn’t give health care to immigrants illegally in the U.S. — they are already largely ineligible for federally funded health care. Instead, the proposal would restore access to certain health care programs for legal immigrants who will lose access under the Republican law.
The White House did not respond to PolitiFact’s request for comment for this fact-check. Vance addressed criticism of his talking point in another interview by saying it was included in the Democrats’ spending proposal; it’s not.
A White House X account followed up with screenshots of the Democratic proposal repealing a section of the Republican law labeled "alien Medicaid eligibility." It’s important to know that these changes would not give Medicaid access to immigrants illegally in the U.S.
Vance defended his statement again in an Oct. 1 White House press conference, saying former President Joe Biden "waived away illegal immigration status" that helped migrants access federal assistance. It’s important to note that many people granted lawful status through humanitarian parole or Temporary Protected Status programs don’t automatically qualify for Medicaid; TPS recipients aren’t eligible, and many people who entered the U.S. on humanitarian parole are required to wait five years before accessing it.
The Trump administration has ended humanitarian parole and Temporary Protected Status for many people, rendering them ineligible for Medicaid and the Affordable Care Act marketplace.
We did not find evidence that Democrats want to spend "hundreds of billions" in costs for insuring migrants with unlawful presence.
Immigrants in the U.S. illegally are ineligible for federally funded health care
The vast majority of federal health care dollars cannot be spent on health care for people in the U.S. illegally. They cannot enroll in Medicaid or Medicare, and they are ineligible to purchase health care coverage through the Affordable Care Act marketplace. A small Medicaid program reimburses hospitals for uninsured emergency care, which can include immigrants in the country illegally but is not exclusive to them.
Some states including California and Illinois expanded Medicaid coverage for people regardless of their immigration status, and the states pay for that. Federal law already banned states from using federal money for these programs. An earlier version of the Republican spending law would have penalized such states by withholding funding, but that provision didn’t last.
People in the country illegally might receive some federally funded health care in emergency cases; in those situations, hospitals must provide care even if a person is uninsured or in the country illegally. Emergency Medicaid covers hospital care for immigrants who would be eligible for Medicaid if not for their immigration status. The Republican tax and spending law reduced the amount hospitals can receive for emergency immigrant care.
Most of the Emergency Medicaid spending is used on childbirth. In all, it represented less than 1% of total Medicaid spending in fiscal year 2023, according to KFF, a health think tank.
Republican law limited health care access for immigrants with legal status
The Republican tax and spending law made several changes to health care eligibility for immigrants in the country with legal permission. An estimated 1.4 million legal immigrants are expected to lose their health insurance, according to KFF’s analysis of Congressional Budget Office projections.
Starting October 2026, the law will restrict eligibility for Medicaid and the Children's Health Insurance Program to lawfully permanent residents, people from the Marshall Islands, Micronesia or Palau who lawfully reside in the U.S. under an international agreement, and certain Cubans and Haitians.
Previously, a broad group described as "qualified noncitizens" were eligible for Medicaid and CHIP, including refugees and people granted asylum.
Some immigrants who are eligible for Medicaid and CHIP, such as lawful permanent residents, are required to wait five years before accessing the benefits.
The law also limited Affordable Care Act marketplace eligibility to the same group eligible for Medicaid and CHIP beginning Jan. 1, 2027. Previously, people who were described as "lawfully present" were eligible. That group included the "qualified noncitizens" eligible for Medicaid and people with short-term statuses, such as Temporary Protected Status or international students.
Beneficiaries of the Deferred Action for Childhood Arrivals program, known as DACA, for immigrants who entered the U.S. illegally as children were previously eligible for Affordable Care Act coverage and its subsidies. They are ineligible after an August Trump administration rule.
Democrats’ proposal would restore legal immigrants’ access to federally funded health care
The Democrats’ Sept. 17 budget proposal would, in part, permanently extend the Affordable Care Act subsidies and roll back billions in Republican cuts to Medicaid and other health programs.
The change would make Medicaid, CHIP and Affordable Care Act coverage available to all legal immigrants who were previously eligible for it, such as refugees and people granted asylum.
The Democratic proposal would not broaden eligibility to federally funded health care programs to immigrants who are in the U.S. illegally.
Vance said the Democratic policies would "give hundreds of billions of dollars of health care benefits to illegal aliens," and the White House did not offer its source for that figure. When Johnson was pressed to support a similar talking point, he referenced the Congressional Budget Office. An August KFF analysis of CBO estimates found that the Republican law’s provisions related to legal immigrants would reduce federal spending by $131 billion; this projection did not include an estimate for people without legal status.
Vance said, "Democrats are threatening to shut down the entire government because they want to give hundreds of billions of dollars of health care benefits to illegal aliens."
Immigrants in the U.S. illegally are largely ineligible for federally funded health care programs Medicare and Medicaid, and they cannot seek coverage in the Affordable Care Act marketplace or apply for subsidies.
The Democrats' budget proposal would not change that.
The Democrats want to restore access to certain health care programs to legal immigrants who will lose access under the Republican tax and spending law — among other measures aimed at making Medicaid and Affordable Care Act insurance plans easier to keep.
Their proposal would not grant federally supported health care benefits to people in the U.S. illegally, because they did not have access to them in the first place. The small amount of funding designated for Emergency Medicaid reimburses hospitals that provide emergency care to immigrants who would be eligible for Medicaid if not for their immigration status. Finally, we did not find evidence for Vance’s assertion that Democrats want "hundreds of billions" in health benefits for migrants in the country illegally.
