State-Funded Health Coverage Expands for Undocumented Children and Adults

As of 2023, nearly 3 million children in the U.S. remain uninsured, primarily due to immigration-related exclusions in Medicaid and CHIP federal programs. To address this gap, 14 states and the District of Columbia have implemented state-funded initiatives to provide health insurance coverage to income-eligible children without legal immigration status. These programs reflect a growing trend in state health policy to mitigate the barriers posed by immigration status, reducing charity care burdens on pediatric providers and improving health outcomes for uninsured children.

Illinois pioneered comprehensive coverage for undocumented children in 2006, followed by Washington, Minnesota, New York, Oregon, and California with varying program designs and income eligibility criteria. Some states have integrated these state-funded programs with existing Medicaid or CHIP infrastructure, while others have distinct programs with tailored outreach efforts, including linguistically and culturally competent enrollment support.

By mid-2025, several states extended coverage policies to include undocumented adults, with California leading phased expansions that included young adults, older adults, and eventually all income-eligible adults regardless of immigration status. Notably, states differ on the scope of their expansions and face varying challenges, including budget constraints, administrative complexity, and political hesitancy tied to potential federal government repercussions.

Operational challenges also include enrollment barriers such as language difficulties, lack of awareness, distrust of government, and fear of immigration enforcement. In states limiting coverage to children only, the exclusion of undocumented parents can inhibit overall family enrollment and access. Additionally, the end of Medicaid’s COVID-era continuous coverage provisions has reintroduced eligibility checks, complicating coverage stability for vulnerable populations.

Despite these obstacles, these state-led initiatives have insured nearly 2 million undocumented immigrants, illustrating a shift toward using state funds to fill federal coverage gaps. These policies demonstrate a strategic approach to promoting preventive care access, lowering uncompensated care costs, and fostering long-term population health benefits in immigrant communities. Continued monitoring of program outcomes and state strategies will be critical as more states consider expanding coverage through state-funded models.