Santos Patricia Mae G, Narayan Aman, Hong Arthur S, Persaud Sonia, Silverwood Sierra, Al Ksir Kawther, Cervantes Lilia, Sommers Benjamin D, Chino Fumiko, Yabroff K Robin
Division of Health Services, Outcomes, and Policy, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia.
Department of Health Policy and Management, Emory Rollins School of Public Health, Atlanta, Georgia.
JAMA Intern Med. 2025 Jul 1;185(7):866-873. doi: 10.1001/jamainternmed.2025.0604.
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.
To examine the national policy landscape of EM and other state programs designed to provide health care coverage for undocumented immigrants.
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-including state Medicaid agency websites, policy manuals, and clinician handbooks. Findings were verified via multiple independent manual reviews.
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.
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.
由于联邦限制措施限制了获得负担得起的医疗保险的机会，无证移民在美国未参保人群中所占比例过高。紧急医疗补助（EM）和其他州资助项目提供了获得必要医疗护理的机制，但患者、临床医生和政策制定者对其范围和规定了解甚少。
研究紧急医疗补助和其他旨在为无证移民提供医疗保险的州项目的国家政策情况。
在2024年1月至2024年6月期间，对各州关于紧急医疗补助以及为无证移民提供医疗保险的项目政策进行了审查，包括（1）等同于医疗补助的项目，（2）州计划修正案（SPA），以及（3）通过第1332条豁免的基于市场的项目。所有50个州和华盛顿特区的政策文件均来自公开资料，包括州医疗补助机构网站、政策手册和临床医生手册。研究结果通过多次独立人工审核进行了验证。
37个州（74%）和华盛顿特区仅在紧急情况期间提供紧急医疗补助覆盖。18个州（36%）提供3至6个月的追溯覆盖，而13个州（26%）提供2至12个月的前瞻性覆盖。20个州（40%）和华盛顿特区为终末期肾病患者提供常规透析覆盖，而只有5个州（10%）提供癌症治疗覆盖。12个州（24%）和华盛顿特区提供州资助的等同于医疗补助的计划，其中4个州（8%）和华盛顿特区为所有年龄组提供覆盖。22个州（44%）和华盛顿特区通过从受孕到妊娠结束的州计划修正案选项提供产前覆盖；6个州（12%）提供产后覆盖。在2个州（4%），居民无论移民身份均可购买商业市场计划。
这项全国性分析发现，无证移民可获得的医疗保险存在显著差异。尽管一些州在紧急医疗补助政策措辞上优化了灵活性，以扩大对某些慢性病持续护理的覆盖范围，但仍然存在大量覆盖缺口。等同于医疗补助的计划和基于市场的策略提供了全面覆盖的途径；然而，这些机制受到州预算限制和政治挑战的影响。尽管预计联邦医疗补助资金会减少，但各州必须继续为美国这一重要人群确定可持续和公平的覆盖解决方案。
