{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T09:06:30Z","timestamp":1792487190872,"version":"4.5.0"},"reference-count":54,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"Importance<\/jats:title>Undocumented immigrants represent a disproportionate share of uninsured individuals in the US, owing to federal restrictions that limit access to affordable health care coverage. Emergency Medicaid (EM) and other state-sponsored programs offer mechanisms for receiving necessary medical care, but their scope and provisions are poorly understood by patients, clinicians, and policymakers alike.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the national policy landscape of EM and other state programs designed to provide health care coverage for undocumented immigrants.<\/jats:p><\/jats:sec>Evidence Review<\/jats:title>Between January 2024 and June 2024, individual state policies on EM and programs providing health care coverage for undocumented immigrants were reviewed, including (1) Medicaid-equivalent programs, (2) State Plan Amendments (SPAs), and (3) Marketplace-based programs via Section 1332 waivers. Policy documentation for all 50 states and Washington, DC, was sourced from publicly available materials\u2014including state Medicaid agency websites, policy manuals, and clinician handbooks. Findings were verified via multiple independent manual reviews.<\/jats:p><\/jats:sec>Findings<\/jats:title>Thirty-seven states (74%) and Washington, DC, offer EM coverage for the duration of the emergency only. Eighteen states provide (36%) 3 to 6 months of retroactive coverage, whereas 13 states (26%) offer 2 to 12 months of prospective coverage. Twenty states (40%) and Washington, DC, provide coverage of routine dialysis for patients with end-stage kidney disease, whereas only 5 states (10%) offer coverage for cancer treatment. Twelve states (24%) and Washington, DC, offer state-sponsored Medicaid-equivalent plans, with 4 states (8%) and Washington, DC, offering coverage to all age groups. Twenty-two states (44%) and Washington, DC, provide prenatal coverage via the From-Conception-to-End-of-Pregnancy SPA option; and 6 states (12%) offer postpartum coverage. In 2 states (4%), residents can purchase commercial Marketplace plans, regardless of immigration status.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This nationwide analysis found significant variation in the health care coverage available to undocumented immigrants. Although some states have optimized flexibility in EM policy language to expand coverage for ongoing care of certain chronic conditions, substantial coverage gaps persist. Medicaid-equivalent plans and Marketplace-based strategies offer avenues for comprehensive coverage; however, these mechanisms are subject to state budgetary constraints and political challenges. Despite anticipated rollbacks of federal Medicaid funding, states must continue to identify sustainable and equitable coverage solutions for this essential part of the US population.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2025.0604","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T15:01:25Z","timestamp":1747062085000},"page":"866","source":"Crossref","is-referenced-by-count":13,"title":["Landscape of Emergency Medicaid and Health Care Coverage for Undocumented Immigrants in the US"],"prefix":"10.1001","volume":"185","author":[{"given":"Patricia Mae G.","family":"Santos","sequence":"first","affiliation":[{"name":"Division of Health Services, Outcomes, and Policy, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia"},{"name":"Department of Health Policy and Management, Emory Rollins School of Public Health, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman","family":"Narayan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur S.","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Persaud","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sierra","family":"Silverwood","sequence":"additional","affiliation":[{"name":"Michigan State University College of Human Medicine, East Lansing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kawther","family":"Al Ksir","sequence":"additional","affiliation":[{"name":"Division of Health Services, Outcomes, and Policy, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilia","family":"Cervantes","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D.","family":"Sommers","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumiko","family":"Chino","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Robin","family":"Yabroff","sequence":"additional","affiliation":[{"name":"Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"9","key":"isc250001r2","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1056\/NEJMp2213751","article-title":"Health care reform and equity for undocumented immigrants - when crisis meets opportunity.","volume":"388","author":"Santos","year":"2023","journal-title":"N Engl J Med"},{"issue":"10","key":"isc250001r3","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1001\/jama.2019.0839","article-title":"Immigrant health, value-based care, and emergency Medicaid reform.","volume":"321","author":"Khullar","year":"2019","journal-title":"JAMA"},{"issue":"10","key":"isc250001r9","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1001\/jama.297.10.1085","article-title":"Trends in emergency Medicaid expenditures for recent and undocumented immigrants.","volume":"297","author":"DuBard","year":"2007","journal-title":"JAMA"},{"issue":"6","key":"isc250001r13","doi-asserted-by":"publisher","first-page":"877","DOI":"10.7326\/M23-0202","article-title":"Access to kidney care for undocumented immigrants across the United States.","volume":"176","author":"Rizzolo","year":"2023","journal-title":"Ann Intern Med"},{"issue":"10","key":"isc250001r49","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.2105\/AJPH.2024.307750","article-title":"Navigating the labyrinth of pregnancy-related coverage for undocumented immigrants: an assessment of current state and federal policies.","volume":"114","author":"DiMeo","year":"2024","journal-title":"Am J Public Health"},{"issue":"2","key":"isc250001r54","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1056\/NEJMp2414284","article-title":"Texas executive order GA-46 and the erosion of trust in health care.","volume":"392","author":"Santos","year":"2025","journal-title":"N Engl J Med"},{"key":"isc250001r21","author":"Emergency Medical Assistance"},{"key":"isc250001r1","unstructured":"Model? 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Accessed September 17, 2024. http:\/\/compartners.dreamhosters.com\/pdf\/blog\/2009-09-09_mhlimited_vs_hsn.pdf"},{"key":"isc250001r19","unstructured":"Emergency Medicaid in New York State - Limited Medicaid Coverage for Undocumented Immigrants & Changes for Age 65+ - New York Health Access. Accessed September 17, 2024. http:\/\/health.wnylc.com\/health\/entry\/70\/"},{"key":"isc250001r20","unstructured":"Apple Health Alien Emergency Medical | Washington State Health Care Authority. Accessed September 17, 2024. https:\/\/www.hca.wa.gov\/free-or-low-cost-health-care\/i-help-others-apply-and-access-apple-health\/apple-health-alien-emergency-medical"},{"key":"isc250001r22","unstructured":"pwsmn57. Programs and Services - Emergency Medical Assistance. 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