Saturday

05-03-2025 Vol 1949

Washington Lawmakers Debate Future of Medicaid-Like Coverage for Low-Income Immigrants

Washington State is currently at a pivotal point regarding its health care policy for low-income immigrants living without legal status. Last year, the state introduced a Medicaid-like coverage program aimed at providing essential health care services for this vulnerable population. Now, as budget discussions for the next two years reach their final stages, legislators are grappling with the future of this expansion amid funding limitations.

Enrollment in this newly established program is currently capped, a limitation stemming from the available funding. Representative My-Linh Thai, a Democrat from Bellevue, introduced a bill early in the legislative session aimed at expanding eligibility to all immigrants who meet specific income guidelines. However, despite its potential impact, the bill never received a hearing, largely due to concerns about its financial implications during a period of budget shortfall. Thai highlighted that there is ongoing debate regarding the language used in the program, particularly the term “Washingtonians” to refer to noncitizens.

“It’s not sustainable to continue covering emergency room visits without providing comprehensive care,” Thai stated.

Federal law significantly restricts noncitizens’ access to Medicaid benefits, yet states have the flexibility to allocate state funds to provide health care programs for this group. In Washington, Medicaid, also known as Apple Health, provides coverage for individuals with low incomes. Currently, about 1.8 million residents in Washington benefit from Medicaid and the related Children’s Health Insurance Program.

On July 1, 2024, Washington launched a program designed to mirror Medicaid, allowing immigrants living in the U.S. without legal authorization to access Apple Health benefits if they meet particular eligibility criteria. Unfortunately, the program was initially limited to 13,000 participants due to funding constraints. Notably, within just 48 hours of its launch, all available slots were filled, and a staggering 17,000 individuals signed up for the waiting list, as reported by Sasha Wasserstrom, policy director at the Washington Immigrant Solidarity Network.

At present, the program is financed with an annual budget of approximately $76.8 million. However, House-approved budget legislation aligns with this funding figure, whilst the Senate’s proposal suggests a lower commitment, providing $67.5 million and $64.6 million for the subsequent two fiscal years. The Senate’s strategy assumes that efficiency improvements will result in cost savings, but this optimism raises concerns among advocates.

Advocates for the expansion assert that since its implementation, the program has enabled individuals to access critical treatments, including cancer and dialysis, that could significantly prolong their lives. “It may sound extreme, but the reality is that people could die without health care access,” said Kaitie Dong, a policy analyst at the Washington State Budget and Policy Center.

On the other side, Republican lawmakers, such as Senate Minority Leader John Braun, emphasize the need for fiscal prudence during a year characterized by a substantial budget deficit. Braun argues that the state should prioritize services for citizens rather than expanding benefits for noncitizens, while still demonstrating compassion.

However, many advocates counter this narrative by emphasizing the contributions of undocumented immigrants to state and local taxes, estimating nearly $1 billion in taxes collected in 2022 alone as per the Institute on Taxation and Economic Policy. “The dominant narrative misconstrues the reality; undocumented immigrants are significant tax contributors and play a vital role in our economy,” clarified Dong.

Furthermore, proponents argue that expanding health care coverage to noncitizens could ultimately save the state money by reducing reliance on costly emergency medical services. Wasserstrom elaborated that proactive, preventive care proves more beneficial not only to individuals but also to the healthcare system as a whole, alleviating strain on emergency resources.

Federal law mandates that emergency rooms treat all patients, regardless of immigration status. However, the absence of health insurance frequently leads many to delay seeking medical attention until their health issues worsen, consequently resulting in crowded emergency rooms, according to Dr. Shaquita Bell, a pediatrician and director at Odessa Brown Children’s Clinic in Seattle.

Dr. Bell noted that some of her patients’ parents lack legal status and have expressed personal health concerns. In those situations, she either connects them with a social worker for assistance or, if the need is urgent, she provides care directly.

As discussions continue regarding budget allocations, advocates remain hopeful that the cap on the Apple Health program will be lifted, allowing all eligible individuals, irrespective of immigration status, to receive health care coverage. “Taking care of immigrants benefits everyone; it’s simply the right thing to do,” asserted Dr. Bell, underscoring the human aspect of health care access.

As this debate unfolds in Washington, the implications extend beyond the state’s budget — they touch on fundamental questions about equity, health care access, and the moral responsibilities toward all residents, regardless of their immigration status.

image source from:https://www.opb.org/article/2025/04/20/washington-health-care-expansion-for-low-income-immigrants-on-track-to-be-maintained/

Charlotte Hayes