Year: 2025
Type: article
Abstract: In May 2025, the Centers for Medicare and Medicaid Services issued a letter to states that signals an important change in practice: states that use federal dollars to provide health care to unauthorized immigrants, beyond narrowly defined emergency services, will face audits, enforcement actions, and potential recoupment of funds.Although the letter technically reiterates current law defining the scope of the Emergency Medicaid program, it marks a departure from decades of practice; states have traditionally exercised substantial discretion in determining what services are covered under the program.The new guidance indicates that the current administration intends to break from precedent and limit state discretion, which states have used to meet the specific health care needs of their immigrant populations.As a result, many immigrants may be unable to access necessary care.Emergency Medicaid is a joint federal-state program that covers emergency medical services for people who would otherwise qualify for Medicaid but are ineligible because of their immigration status.This population includes most authorized immigrants within their first 5 years of U.S. residence as well as unauthorized immigrants who meet income requirements.The program was developed, in part, in response to the enactment of the Emergency Medical Treatment and Labor Act (EMTALA), which mandates that hospitals evaluate and stabilize any patient who presents to an emergency department, regardless of their insurance or immigration status, but doesn't authorize funding for such care.Emergency Medicaid emerged as a limited reimbursement mechanism to compensate hospitals, especially safety-net institutions, for providing federally required emergency care.Federal law leaves states with substantial flexibility to determine what medical care is covered under Emergency Medicaid, stipulating only that emergency care includes management of "acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in (i) placing the health of the individual (or, with respect to a pregnant woman, the health of the Disclosure forms provided by the authors are available at NEJM.org.
Source: New England Journal of Medicine
DOI: 10.1056/nejmp2508944
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
Funder: National Cancer Institute
OpenAlex ID: W4414812506