Emergency Medicaid at Risk — Preserving State Authority and Access to Care

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...