States roll back undocumented immigrant health care plans after cost overruns
States that expanded their health care options to people without proof of citizenship are looking to scale back or cap those benefits after finding the costs have outpaced revenue. The debates between progressive Democrats and centrists in the party have centered around how to prioritize the tax revenue that’s expected to funnel into state coffers.
The governors of three states making a move that’s roiling their progressive base have one thing in common: they could all find themselves running for president.
California
Medi-Cal, California’s Medicaid program, opened to adults aged 26-49 without proof of citizenship on Jan. 1, 2024. At the time, state officials estimated 700,000 migrants in the country without documentation would qualify for the program’s final expansion. The state also eliminated eligibility requirements for undocumented seniors. With initial cost projections of $2.6 billion annually, Gov. Gavin Newsom worked with lawmakers to allocate $4 billion more in preparation for an increase in the health care rolls.
In practice, the increased cost ultimately amounted to $2.7 billion more than expected. The new enrollees contributed to a $6.2 billion shortfall that required the state to borrow and shift billions of dollars to shore up Medi-Cal’s accounts. Newsom’s office estimated that they were paying $8.5 billion out of the general fund to cover immigrants of all ages without legal status. Still, another official told the state Assembly Budget Committee on Feb. 10 that the figure was $9.5 billion.
In May, Newsom proposed closing Medi-Cal to new enrollees who lack documentation of citizenship, as well as a new $100 monthly fee for migrants without satisfactory immigration status to qualify for federal aid.
Illinois
Illinois began allowing undocumented immigrants aged 65 and older to apply for the state’s Medicaid coverage in 2020 and expanded eligibility to anyone older than 42 in 2023.
Like in California, participation in the program grew faster than anticipated and was more costly per enrollee. A February report from Illinois Auditor General Frank Mautino found the total cost was 286% higher than estimated in recent years. The report said the program was initially expected to support a total of 33,500 enrollees. During the last fiscal year, the programs enrolled 69,767 immigrants.
They also found 6,098 enrollees designated as “undocumented” had a Social Security Number, indicating citizenship. Gov. J.B. Pritzker wrote this finding off as instances of some immigrants’ legal status changing over the years without canceling their participation in the program.
The Health Benefits for Immigrant Adults program is set to end on July 1 after lawmakers included language terminating it in the recently passed budget that starts next month.
Minnesota
Democrats, who in 2023 controlled both chambers of the Minnesota Legislature, passed legislation expanding MinnesotaCare access to state residents without legal status. Gov. Tim Walz considered the issue one of his key priorities. It took effect in January 2025. In the first months, more than 20,000 immigrants enrolled, three times what was initially expected. What was anticipated to be a $220 million program was updated to surpass $600 million, according to the Department of Minnesota Management and Budget.
“This program made Minnesota a magnet for illegal immigration. Even governors in deep-blue states like California and Illinois have had to admit this approach is not sustainable,” state Sen. Jordan Rasmusson, R-Fergus Falls, said in a statement.
Republicans took the majority in the House of Representatives in 2025 and pushed Democrats and Walz to end the program, risking a holdup of the state budget.
Lawmakers sent Walz the compromise budget that included an end to enrollment in MinnesotaCare. The law would remove any undocumented immigrant enrolled in the program at the end of 2025. A legislative report estimates the cost savings at $57 million over the next two years.
“For a group of folks who proclaim to be pro-life, this is the least pro-life piece of legislation I have ever seen,” state Rep. Athena Hollins, DFL-St. Paul said while the bill was being debated.
The lone tie-breaking Democratic-Farmer-Labor Party vote in favor of the bill was former House Speaker Mellissa Hortman, who was later assassinated in her home.
Presidential ambitions
The three governors who have agreed to scale back their states’ health care access to immigrants regardless of legal status have all been mentioned as potential contenders to represent the Democratic Party in the 2028 presidential election.
Walz told the New Yorker in March that he wouldn’t rule out a presidential run in 2028, but hasn’t been asked.
Pritzker’s presidential ambitions have been referred to as “the worst-kept secret in Illinois.”
Newsom’s presidential ambitions have been on full display in his willingness to publicly take on Republican President Donald Trump, in addition to the California governor’s recent slide into centrist politics.
Decisions to roll back health care for immigrants in these governors’ respective states could become campaign fodder once ads start hitting web browsers and television sets in 2028.
About those progressive groups
Immigration advocates and progressive groups have reacted similarly to each state’s decision to pull immigrants from the health care rolls.
“We urge state leaders to build on their progress, rather than placing the health of their residents at risk,” Tanya Broder, the senior counsel for health and economic justice policy at the National Immigration Law Center, told NBC News. “Particularly as extremist politicians scapegoat and target immigrants, we are counting on state officials to do the right thing and hold the line.”
Data from the National Immigration Law Center shows that Colorado, New York, Oregon and Washington state offer similar coverage for immigrants, regardless of their legal status.
Ella Rae Greene, Editor In Chief
