Immigration: Claiming to 'Remove Illegal Aliens from Medicaid' When Federal Law Already Prohibits Their Enrollment

Why This Matters for NY-23

When lawmakers claim to be “removing illegal aliens from Medicaid,” they’re describing people who already can’t enroll — federal law has prohibited it since 1996. Meanwhile, the same bill cuts $911 billion from Medicaid overall, threatening the rural hospitals that serve U.S. citizens throughout Allegany, Cattaraugus, Chautauqua, and Steuben counties. The immigration rhetoric obscures what the bill actually does to healthcare access for NY-23 families.

Statement

Source: Press Release, House Energy and Commerce Committee Reconciliation Bill Reported by: Langworthy.house.gov, Wellsville Sun

May 12, 2025: “We are also removing illegal aliens from the Medicaid rolls. American taxpayers should never be forced to subsidize healthcare for those who have broken our immigration laws.”

May 14-15, 2025 (Wellsville Sun op-ed): Langworthy repeated this claim, stating the reconciliation bill would “remove dead people, illegal immigrants, and able-bodied adults who refuse to work from the Medicaid rolls.”

The Law

Federal law has prohibited undocumented immigrants from Medicaid eligibility since 1996.

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 established that people living in the U.S. without legal status are not eligible to receive Medicaid benefits, with one exception: Emergency Medicaid.

What Emergency Medicaid Actually Is:

• Reimburses hospitals for legally-mandated emergency care under the Emergency Medical Treatment and Labor Act (EMTALA)
• Does NOT provide insurance coverage to undocumented immigrants
• Does NOT give undocumented immigrants “free healthcare”
• Hospitals are required by federal law to stabilize emergency patients regardless of ability to pay or immigration status

Per FactCheck.org (May 2025): “People living in the U.S. illegally are not eligible to receive Medicaid benefits other than for emergency medical services.”

Congressional Research Service (Report IF11912): “Noncitizens who are not lawfully present are generally not eligible for Medicaid, with limited exceptions for emergency services.”

The Problem

The claim implies removing people who are already ineligible by law.

If undocumented immigrants cannot enroll in Medicaid except for emergency care that hospitals are required by law to provide, what exactly is being “removed” from the rolls?

What the Bill Actually Does

The reconciliation bill Langworthy supported (which became part of H.R. 1, the One Big Beautiful Bill Act) includes:

Medicaid eligibility verification requirements:

• Enhanced documentation requirements for citizenship/immigration status
• More frequent re-verification of eligibility
• States required to check immigration databases

What it does NOT do:

• It does not “remove illegal aliens from Medicaid” because they were never eligible for enrollment in the first place
• It does not change Emergency Medicaid (hospitals still must provide emergency care)
• It does not address the fundamental eligibility rules established in 1996

The Impact on Rural Healthcare

What this rhetoric obscures:

While claiming to “remove illegal aliens,” the bill Langworthy supported actually:

• Cuts $911 billion from Medicaid over 10 years
• Reduces coverage for 1.3 million dually eligible seniors and people with disabilities (per CBO)
• Threatens rural hospitals already at risk of closure

NY-23 context:

• 45% of NY rural hospitals at immediate risk of closure (CHQPR analysis)
• Medicaid covers approximately 25-30% of rural hospital revenue
• Rural communities disproportionately affected by coverage reductions

The Pattern

This is not an isolated claim. Langworthy has repeatedly used immigration rhetoric to justify healthcare cuts that primarily affect U.S. citizens:

Additional Context: State vs. Federal Programs

Some states provide limited health programs using STATE funds:

• New York’s Emergency Medicaid Plus covers some prenatal care
• California and a few other states have limited coverage for specific populations
• These are STATE-funded programs, not federal Medicaid

Langworthy’s claim specifically references federal reconciliation legislation, which does not affect state-only programs.

In Plain Language

“Removing illegal aliens from Medicaid” sounds like it would save money and reduce fraud. But undocumented immigrants already cannot enroll in Medicaid — that’s been federal law since 1996.

The only exception is “Emergency Medicaid,” which isn’t insurance for immigrants — it’s hospital reimbursement for emergency care that federal law (EMTALA) requires hospitals to provide regardless of immigration status. Hospitals can’t turn away someone having a heart attack.

So what does the bill actually do? It adds paperwork requirements for citizens to prove their eligibility, while cutting $911 billion from the program overall. The immigration framing makes it sound like savings come from removing people who shouldn’t be there — when the cuts actually come from reducing coverage for Americans.

Questions This Raises

1. If undocumented immigrants have been ineligible for Medicaid since 1996, what is actually being “removed”?

2. Why use immigration rhetoric to justify cuts that primarily affect U.S. citizens in rural communities?

3. How many NY-23 constituents understand that Emergency Medicaid is hospital reimbursement for legally-required care, not insurance coverage?

4. Does claiming to “remove illegal aliens” from Medicaid misrepresent the actual impact of $911 billion in cuts to rural healthcare?

Sources

Federal Law:

• Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193)
• Congressional Research Service Report IF11912: “Health Care for Noncitizens”
• Emergency Medical Treatment and Labor Act (EMTALA), 42 U.S.C. § 1395dd

Fact-Checking:

• FactCheck.org: “A False Claim About Illegal Immigration and Medicaid” (May 2025)
• National Immigration Law Center: “Overview of Immigrant Eligibility for Federal Programs”

Langworthy Statements:

• Langworthy.house.gov: “Statement Supporting House Energy and Commerce Committee’s Budget Reconciliation Legislation” (May 12, 2025)
• Wellsville Sun: Op-ed (May 14-15, 2025)

Congressional Budget Office:

• CBO: “Budgetary Effects of H.R. 1, One Big Beautiful Bill Act” (May 2025)
• Medicaid coverage impact analysis

Healthcare Impact Analysis:

• Center for Healthcare Quality and Payment Reform: Rural Hospital Risk Analysis
• Kaiser Family Foundation: “Medicaid’s Role in Rural America”

Note: This entry documents publicly available information from congressional records, federal statutes, and fact-checking organizations. Readers may draw their own conclusions.

Last updated: December 30, 2025