Medicaid and immigration status in Washington

Last week Rep. Macri introduced HB 1697 to expand Medicaid coverage in Washington to all income eligible youth up to age 26 regardless of immigration status.

Since the Affordable Care Act (ACA) expansion in 2014, Washington’s uninsured rate has fallen to around 5.5 percent or around 400,000 people. Many of these are ineligible for either Medicaid or to purchase ACA subsidized coverage because they are undocumented. According a Kaiser Family Foundation report approximately 25 percent of the uninsured are not citizens, or about 100,000 Washingtonians.

Federal Medicaid rules limit eligibility for government assistance programs like Medicaid, SNAP (food stamps), Temporary Assistance for Needy Families (TANF or “welfare”), and Supplemental Security Income (low-income disabled) to “qualified immigrants,” typically refugees and those here legally. Despite these exclusions, states can choose to use their own state funds to cover immigrants.


The costs of being uninsured can be huge, both to the state, in uncompensated care and poorer health outcomes, and to the individual. Yet, Washington has a history of extending coverage to immigrants regardless of status.

Here’s some of who and what Medicaid in Washington already covers for those lacking qualified legal status:

  • Children through Apple Health for Kids
  • Pregnant women through Apple Health for Pregnant women
  • Refugees and asylees
  • Non-eligible immigrants with certain qualifying situations like cancer, kidney dialysis, organ transplants, or emergency room care
  • Legal immigrants after the 5 year waiting period

As the country continues to talk about Medicare for all and steps to universal coverage, expanding coverage to immigrants is becoming an important consideration, whether through Medicaid, or by expanding exchange subsidies.