{
  "schema_version": 1,
  "release": "2026-09-17",
  "source": {
    "id": "cbo-emergency-medicaid-2024",
    "agency": "Congressional Budget Office",
    "organization": "U.S. Congress",
    "dataset_name": "Emergency Medicaid Services for Certain Non-U.S. Nationals",
    "dataset_description": "Table 1: Federal and State Spending for Emergency Medicaid Services, 2017\u20132023",
    "source_url": "https://www.cbo.gov/publication/60805",
    "download_url": "https://www.cbo.gov/system/files/2024-10/Arrington_Letter_EmergencyMedicaid_Immigration_final.pdf",
    "publication_date": "2024-10-02",
    "data_period_start": "2016-10-01",
    "data_period_end": "2023-09-30",
    "retrieved_at": "2026-09-17T19:06:48.263027+00:00",
    "update_frequency": "Ad hoc report; underlying CMS financial reports updated periodically",
    "source_type": "government-reported-expenditure",
    "source_locator": "Table 1, page 3; definitions on pages 1\u20133",
    "underlying_agency": "Centers for Medicare & Medicaid Services",
    "underlying_dataset": "State quarterly CMS-64 financial reports",
    "underlying_source_url": "https://www.medicaid.gov/medicaid/financial-management/state-budget-expenditure-reporting-for-medicaid-and-chip/expenditure-reports-mbes/cbes",
    "retrieval_method": "Verified transcription of Table 1 via web PDF retrieval. Direct archival download returned HTTP 403; no local original PDF or original-file hash is claimed.",
    "raw_url": null,
    "sha256": null,
    "notes": "Reported historical spending, not the projected spending in separate CBO immigration-surge reports. Published precision: millions of nominal U.S. dollars."
  },
  "metric": {
    "id": "us-emergency-medicaid",
    "slug": "emergency-medicaid-certain-noncitizens",
    "name": "Emergency Medicaid for certain noncitizens",
    "category": "public-spending",
    "unit": "USD",
    "geography_level": "national",
    "population_definition": "People otherwise eligible for Medicaid but ineligible for full coverage because of immigration status or the five-year waiting period.",
    "definition": "Federal and state spending on limited emergency Medicaid services for the population defined by CBO. Includes some lawfully present noncitizens and unauthorized immigrants; these groups cannot be separated in this table.",
    "calculation_type": "reported",
    "numerator_description": "Reported dollars spent on covered emergency services",
    "denominator_description": "Not applicable; dollar amounts, not a rate",
    "is_estimate": false,
    "amount_status": "reported-historical-spending",
    "dollar_basis": "nominal",
    "source_precision": "FY 2017\u20132023: nearest million USD; FY 2024: reported USD",
    "start_year": 2017,
    "end_year": 2024,
    "methodology": {
      "formula": "Sum complete selected fiscal years for one funding scope. Retain FY 2017\u20132023 CBO Table 1 unchanged; append FY 2024 CMS national row 84 (B total, C federal, G state). The FY 2023 CMS bridge reconciles to CBO at published precision. Never add totals to their component shares.",
      "inclusions": "Emergency Medicaid spending in the CBO table, including qualifying emergency labor and delivery.",
      "exclusions": "Full-benefit Medicaid, state-only coverage expansions, other benefit programs, tax revenue and economic effects are outside this measure.",
      "known_limitations": "CBO cannot split this spending by specific immigration status. This is one program, not total benefits for all immigrants or net fiscal impact. Annual changes can reflect policy, medical costs, use and reporting as well as population changes.",
      "comparability_notes": "Federal fiscal years end September 30. FY 2017\u20132023 retain CBO\u2019s October 2024 vintage and million-dollar rounding; FY 2024 uses the preserved CMS workbook. Reports include adjustments. FY 2024 is substantially higher; it was verified against all state/territory sheets, not interpreted as population growth.",
      "last_reviewed": "2026-09-17"
    }
  },
  "observations": [
    {
      "id": "us-emergency-medicaid-federal-2017",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2017,
      "period_start": "2016-10-01",
      "period_end": "2017-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "federal",
      "value": 900000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 900,
      "source_locator": "Table 1, page 3, FY 2017, federal column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-state-2017",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2017,
      "period_start": "2016-10-01",
      "period_end": "2017-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "state",
      "value": 635000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 635,
      "source_locator": "Table 1, page 3, FY 2017, state column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-total-2017",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2017,
      "period_start": "2016-10-01",
      "period_end": "2017-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "total",
      "value": 1535000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 1535,
      "source_locator": "Table 1, page 3, FY 2017, total column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-federal-2018",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2018,
      "period_start": "2017-10-01",
      "period_end": "2018-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "federal",
      "value": 1630000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 1630,
      "source_locator": "Table 1, page 3, FY 2018, federal column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-state-2018",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2018,
      "period_start": "2017-10-01",
      "period_end": "2018-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "state",
      "value": 977000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 977,
      "source_locator": "Table 1, page 3, FY 2018, state column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-total-2018",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2018,
      "period_start": "2017-10-01",
      "period_end": "2018-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "total",
      "value": 2607000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 2607,
      "source_locator": "Table 1, page 3, FY 2018, total column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-federal-2019",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2019,
      "period_start": "2018-10-01",
      "period_end": "2019-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "federal",
      "value": 1992000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 1992,
      "source_locator": "Table 1, page 3, FY 2019, federal column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-state-2019",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2019,
      "period_start": "2018-10-01",
      "period_end": "2019-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "state",
      "value": 1118000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 1118,
      "source_locator": "Table 1, page 3, FY 2019, state column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-total-2019",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2019,
      "period_start": "2018-10-01",
      "period_end": "2019-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "total",
      "value": 3110000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 3110,
      "source_locator": "Table 1, page 3, FY 2019, total column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-federal-2020",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2020,
      "period_start": "2019-10-01",
      "period_end": "2020-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "federal",
      "value": 2058000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 2058,
      "source_locator": "Table 1, page 3, FY 2020, federal column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-state-2020",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2020,
      "period_start": "2019-10-01",
      "period_end": "2020-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "state",
      "value": 1018000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 1018,
      "source_locator": "Table 1, page 3, FY 2020, state column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-total-2020",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2020,
      "period_start": "2019-10-01",
      "period_end": "2020-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "total",
      "value": 3076000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 3076,
      "source_locator": "Table 1, page 3, FY 2020, total column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-federal-2021",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2021,
      "period_start": "2020-10-01",
      "period_end": "2021-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "federal",
      "value": 4896000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 4896,
      "source_locator": "Table 1, page 3, FY 2021, federal column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-state-2021",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2021,
      "period_start": "2020-10-01",
      "period_end": "2021-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "state",
      "value": 2154000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 2154,
      "source_locator": "Table 1, page 3, FY 2021, state column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-total-2021",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2021,
      "period_start": "2020-10-01",
      "period_end": "2021-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "total",
      "value": 7050000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 7050,
      "source_locator": "Table 1, page 3, FY 2021, total column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-federal-2022",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2022,
      "period_start": "2021-10-01",
      "period_end": "2022-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "federal",
      "value": 3816000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 3816,
      "source_locator": "Table 1, page 3, FY 2022, federal column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-state-2022",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2022,
      "period_start": "2021-10-01",
      "period_end": "2022-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "state",
      "value": 1585000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 1585,
      "source_locator": "Table 1, page 3, FY 2022, state column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-total-2022",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2022,
      "period_start": "2021-10-01",
      "period_end": "2022-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "total",
      "value": 5401000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 5401,
      "source_locator": "Table 1, page 3, FY 2022, total column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-federal-2023",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2023,
      "period_start": "2022-10-01",
      "period_end": "2023-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "federal",
      "value": 2746000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 2746,
      "source_locator": "Table 1, page 3, FY 2023, federal column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-state-2023",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2023,
      "period_start": "2022-10-01",
      "period_end": "2023-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "state",
      "value": 1029000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 1029,
      "source_locator": "Table 1, page 3, FY 2023, state column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-total-2023",
      "metric_id": "us-emergency-medicaid",
      "source_id": "cbo-emergency-medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2023,
      "period_start": "2022-10-01",
      "period_end": "2023-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "total",
      "value": 3775000000,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "source_value_millions": 3775,
      "source_locator": "Table 1, page 3, FY 2023, total column",
      "revision": "CBO-2024-10-02",
      "lower_bound": null,
      "upper_bound": null,
      "margin_of_error": null
    },
    {
      "id": "us-emergency-medicaid-2024-total",
      "metric_id": "us-emergency-medicaid",
      "source_id": "medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2024,
      "period_start": "2023-10-01",
      "period_end": "2024-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "total",
      "value": 9118148687,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "revision": "2026-09-17",
      "source_locator": "FY 2024 FMR NET EXPENDITURES.xlsx; MAP - National Totals; row 84; B total, C federal, G state"
    },
    {
      "id": "us-emergency-medicaid-2024-federal",
      "metric_id": "us-emergency-medicaid",
      "source_id": "medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2024,
      "period_start": "2023-10-01",
      "period_end": "2024-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "federal",
      "value": 6145943159,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "revision": "2026-09-17",
      "source_locator": "FY 2024 FMR NET EXPENDITURES.xlsx; MAP - National Totals; row 84; B total, C federal, G state"
    },
    {
      "id": "us-emergency-medicaid-2024-state",
      "metric_id": "us-emergency-medicaid",
      "source_id": "medicaid-2024",
      "country": "US",
      "geography_code": "US",
      "year": 2024,
      "period_start": "2023-10-01",
      "period_end": "2024-09-30",
      "period_type": "fiscal_year",
      "funding_scope": "state",
      "value": 2972205528,
      "unit": "USD",
      "is_estimate": false,
      "amount_status": "reported-historical-spending",
      "revision": "2026-09-17",
      "source_locator": "FY 2024 FMR NET EXPENDITURES.xlsx; MAP - National Totals; row 84; B total, C federal, G state"
    }
  ],
  "published_totals_millions": {
    "federal": 18038,
    "state": 8516,
    "total": 26554
  },
  "coverage_notes": [
    "FY 2017\u20132024 now available. FY 2024 increased substantially; the national workbook reconciles to its state and territory sheets. Reporting adjustments, service use and costs can affect changes. The source category does not isolate unauthorized immigrants."
  ],
  "pending_sources": [
    {
      "topic": "FY 2015\u20132016 and FY 2024 onward",
      "status": "TODO: retrieve and validate CMS financial-management workbooks; direct downloads returned 403 during this review. Do not splice unverified values or projections into historical spending."
    },
    {
      "topic": "SNAP, TANF, SSI and housing assistance",
      "status": "TODO: locate annual dollar series for a consistently defined immigrant population. Household participation rates alone are not spending attributable to individual migrants."
    }
  ],
  "sources": [
    {
      "id": "cbo-emergency-medicaid-2024",
      "agency": "Congressional Budget Office",
      "organization": "U.S. Congress",
      "dataset_name": "Emergency Medicaid Services for Certain Non-U.S. Nationals",
      "dataset_description": "Table 1: Federal and State Spending for Emergency Medicaid Services, 2017\u20132023",
      "source_url": "https://www.cbo.gov/publication/60805",
      "download_url": "https://www.cbo.gov/system/files/2024-10/Arrington_Letter_EmergencyMedicaid_Immigration_final.pdf",
      "publication_date": "2024-10-02",
      "data_period_start": "2016-10-01",
      "data_period_end": "2023-09-30",
      "retrieved_at": "2026-09-17T19:06:48.263027+00:00",
      "update_frequency": "Ad hoc report; underlying CMS financial reports updated periodically",
      "source_type": "government-reported-expenditure",
      "source_locator": "Table 1, page 3; definitions on pages 1\u20133",
      "underlying_agency": "Centers for Medicare & Medicaid Services",
      "underlying_dataset": "State quarterly CMS-64 financial reports",
      "underlying_source_url": "https://www.medicaid.gov/medicaid/financial-management/state-budget-expenditure-reporting-for-medicaid-and-chip/expenditure-reports-mbes/cbes",
      "retrieval_method": "Verified transcription of Table 1 via web PDF retrieval. Direct archival download returned HTTP 403; no local original PDF or original-file hash is claimed.",
      "raw_url": null,
      "sha256": null,
      "notes": "Reported historical spending, not the projected spending in separate CBO immigration-surge reports. Published precision: millions of nominal U.S. dollars."
    },
    {
      "id": "medicaid-2024",
      "source_url": "https://www.medicaid.gov/medicaid/financial-management/downloads/financial-management-report-fy2024.zip",
      "raw_url": "/raw/cms/public-spending/2026-09-17/def068767bb0137aa7f14e4c17935cd0e71b3bcac2650ad18765f739d1acfd66.zip",
      "sha256": "def068767bb0137aa7f14e4c17935cd0e71b3bcac2650ad18765f739d1acfd66",
      "retrieved_at": "2026-09-17T19:52:30.288450+00:00",
      "agency": "Centers for Medicare & Medicaid Services",
      "dataset_name": "FY 2024 Financial Management Report",
      "download_url": "https://www.medicaid.gov/medicaid/financial-management/downloads/financial-management-report-fy2024.zip",
      "source_locator": "FY 2024 FMR NET EXPENDITURES.xlsx; MAP - National Totals; row 84; B total, C federal, G state",
      "publication_date": null,
      "retrieval_method": "Preserved original bytes; SHA-256 checked; values validated at the stated source location.",
      "notes": "Data vintage retained as published; later releases must be reviewed separately."
    }
  ]
}