The United States Capitol seen on the morning of the first day of the federal government shutdown on Oct.1, 2025 after President Donald Trump and congressional leaders failed to reach a funding compromise.

At the center of the federal government shutdown is an argument over free and subsidized health care: who should get it and who shouldn't.

Republicans say Democrats won't vote for their funding package unless it includes "free health care for illegals." Democrats say they want to prevent millions of Americans from losing access to Medicaid and lower cost health insurance.

Here's what's behind the political rhetoric.

Can 'illegal immigrants' get federally funded health care?

No.

But some immigrants here legally were among those who lost access in the Republican bill. Democrats want to restore Medicaid and marketplace access to where they were at the start of the summer, to a time when millions more Americans, and some lawful immigrants, could qualify.

What does the Democratic budget proposal say about health care?

Democrats want to go back to the way Medicaid and the healthcare marketplace worked before Republicans passed their big tax-and-spending bill this summer.

The Democrats are proposing a continuing resolution that would fund most programs and government activities at the 2025 level and would reverse deep cuts Republicans made to Medicaid eligibility. It would also preserve a tax credit, set to expire at the end of the year, that helps millions of Americans afford health insurance.

The GOP tax and budget bill, signed into law in July, tightened restrictions on eligibility for Medicaid, including for some immigrant groups, who have been living legally in this country.

Wait, so immigrants can get Medicaid?

Yes, some immigrants lawfully residing in the United States are eligible for Medicaid.

Before Republicans passed the GOP tax and spending bill this summer, certain classes of "qualified" immigrants – with legal status – were eligible for Medicaid coverage if they also met poverty thresholds, according to the nonpartisan Congressional Research Service. They included legal permanent residents, refugees, people granted asylum, people granted humanitarian parole including Ukrainians and Afghans; certain Cubans and Haitians, and certain victims of human trafficking and domestic violence.

Even among these lawful, "qualified" immigrants, several groups were required to wait five to seven years after their arrival in the United States before they could become eligible, according to an April 2025 report by the Congressional Research Service.

The new GOP law reduced Medicaid eligibility to only U.S. citizens, legal permanent residents, and certain Cuban and Haitian immigrants; the other groups no longer qualify.

But undocumented or "illegal" immigrants were not eligible for federal health benefits before, nor are Democrats asking for them to be now.

What about all the asylum-seekers who came to the border under Biden?

People seeking asylum are not ‒ and have not ‒ been eligible for Medicaid. Some people who received asylum were eligible under previous rules.

But requesting asylum is only the first step in a multi-year process that is hard to win; judges were granting asylum in only 36% of asylum cases in late 2024 before President Donald Trump took office.

Claiming asylum at the border is a legal right enshrined in federal law. It was suspended in 2024 by President Joe Biden and again in 2025 by Trump.

Republicans were also upset about millions of people granted humanitarian parole at the border under Biden. So do they get Medicaid? Generally, no, according to the Congressional Research Service. Under the previous rules, parolees were only eligible for federal public benefits if they received at least one year of parole. They were also subject to a five-year bar on applying for public benefits.

Holders of Temporary Protected Status have never been eligible for Medicaid.

Don't some states give benefits to undocumented immigrants?

Medicaid is a joint federal-state program.

Medicaid law allows states to waive the five-year waiting period for some lawfully present immigrant children and pregnant women. It also allows states to cover "non-qualified" immigrants, including people on short-term humanitarian parole, but with state funding only, not federal dollars.

Fourteen states and DC provide some form of health care coverage to some immigrants, often children, no matter their status, but they do so using onlystate dollars, according to KFF, a nonprofit that provides health researching and polling.

KFF reported that an early version of the Republican bill sought to penalize those states by reducing federal Medicaid funding, but that provision wasn't included in the final version of the legislation.

What happens if undocumented immigrants go to the ER?

Under a separate law, called the Emergency Medical Treatment & Labor Act, hospitals are required to stabilize anyone who shows up for emergency care – no matter their immigration status.

Neither the Republican bill nor the Democrat proposal does anything to change that.

What about the Affordable Care Act tax subsidies?

Coverage on the Affordable Care Act marketplaces is currently available to lawfully present immigrants with a "qualified" immigration status and also to other groups of lawfully present immigrants such as those with Temporary Protected Status, and people on valid nonimmigrant visas, like work visas.

The Democrats' plan extends existing enhanced tax subsidies for millions of middle class Americans, but makes no changes to who is eligible to purchase insurance on the marketplace and doesn't extend the subsidies to undocumented immigrants.

Lauren Villagran covers immigration for USA TODAY and can be reached at lvillagran@usatoday.com.

Sarah D. Wire covers politics for USA TODAY and can be reached at swire@usatoday.com.

This article originally appeared on USA TODAY: Health care for 'illegal immigrants'? Here's what's behind the shutdown rhetoric.

Reporting by Lauren Villagran and Sarah D. Wire, USA TODAY / USA TODAY

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