OLYMPIA, WA – Washington began to offer Medicaid-like health care coverage last year for thousands of low-income immigrants living in the state without legal status.

Now, with talks over the next two-year state budget in their final stages, lawmakers are looking to maintain the expansion. But enrollment in the program remains capped based on available funding and legislators are not on track to change that this year.

Rep. My-Linh Thai, D-Bellevue, introduced a bill early in the session that would have opened the program to all immigrants who meet the income eligibility guidelines and other requirements.

Her bill, which would have created additional costs for the state at a time when lawmakers are trying to solve a budget shortfall, never got a hearing. Thai also said there was controversy about language referring to noncitizens as “Washingtonians.”

“We cannot just keep paying for emergency room visits, no coverage,” said Thai. “Charity can only extend for so much, right? I mean, this is responsible governing.”

Federal law largely prevents noncitizens from accessing benefits through Medicaid, but states can use state dollars to create programs for this population.

Medicaid, known as Apple Health in Washington, provides health care coverage to people with lower incomes. In Washington, about 1.8 million residents are covered by Medicaid or the related Children’s Health Insurance Program.

On July 1, 2024, Washington launched a program to offer Apple Health benefits to immigrants in the U.S. without legal authorization who meet certain eligibility guidelines. But the program, which is designed to mirror Medicaid, only had enough funding to cover up to 13,000 people.

Within the first 48 hours, all slots were filled, and an additional 17,000 people signed up to be on the waiting list, according to Sasha Wasserstrom, policy director at the Washington Immigrant Solidarity Network.

Funding for the program is currently around $76.8 million a year. House-approved budget legislation would provide funding in line with that amount. The Senate’s operating budget bill would commit less — $67.5 million and $64.6 million in the next two fiscal years. But the Senate plan banks on changes that would achieve savings in costs for care.

The Apple Health Expansion program, as it’s known, operates only using state funds, as opposed to the traditional Medicaid program, which relies on a combination of federal and state dollars.

Advocates say that since the expansion took place, people have been able to access cancer and dialysis treatments that have extended their lives.

“It sounds so extreme, but it’s genuine, that people will die as a result of not receiving health care access,” said Kaitie Dong, a policy analyst at the Washington State Budget and Policy Center.

Republicans argue that the state needs to be careful with its spending during a year with a substantial budget deficit and that the state shouldn’t be giving services to people who are noncitizens while cutting services for others.

“We should have compassion, but we should also make sure we follow the rule of law,” said Senate Minority Leader John Braun, R-Centralia.

In Washington, immigrants without legal authorization to work in the U.S. contributed nearly $1 billion to state and local taxes in 2022, according to estimates from the Institute on Taxation and Economic Policy.

“The dominant narrative is that people don’t believe that undocumented immigrants pay taxes, but they’re actually some of our greatest tax contributors and economic drivers,” Dong said.

Expanding health care coverage to noncitizens can also save the state money by reducing emergency medical care costs, said Wasserstrom.

“We know that providing preventative medical care is more beneficial to the individual and to the system as a whole, and that causes less strain on the system as a whole,” they added.

Federal law requires emergency rooms to treat people regardless of immigration status. But a lack of health insurance often leads to people waiting until their health concerns worsen to seek care, and they then end up in the emergency room. This can contribute to emergency rooms becoming overwhelmed.

“It’s hard to actually see emergencies when you’re really stuck seeing people who can’t access primary care because they don’t have insurance or feel safe,” said Dr. Shaquita Bell, a pediatrician and director at Odessa Brown Children’s Clinic in Seattle.

At the clinic where Bell works, some of her patients have parents who lack legal status. During her time as a pediatrician, there have been instances where a parent has expressed their own health care concerns. When this happens, she will either connect them with a social worker who will help them or if someone’s in urgent need of care, she will try to help.

Advocates hope that the funding cap for the Apple Health program is removed so that anyone who qualifies, regardless of their immigration status, can have access.

“Caring for immigrants helps everyone, and it’s the right thing to do,” Bell said. “These are people, and every person deserves health care.”

This story first appeared on Washington State Standard.