Enrollment is up in health care program for undocumented Minnesotans. GOP wants it to go.

Minnesota’s new program to offer health care to undocumented residents is popular so far — the number of enrollees in the program since it started in January is triple what the state initially anticipated.

That’s why state Republicans say it needs to end.

They argue the growth is unsustainable and will blow a massive hole in the state budget, while Democrats say they’re miscasting the numbers to grab hold of national GOP talking points against undocumented immigrants.

“It is a political talking point to say we took health care away from undocumented immigrants,” said state Sen. Alice Mann, DFL-Edina, who sponsored the new program.

Sen. Paul Utke, R-Park Rapids, said concerns about undocumented immigrants is the number one issue for residents in his district right now. “I heard about it at every corner,” he said. “People are paying attention.”

The program is now one of the biggest sticking points between the two parties in the narrowly divided Legislature as they try to hash out a budget deal for the next two years. Here’s what you need to know about the program, the numbers behind it and why it’s become a flash point this legislative session:

Two years ago, Minnesota Democrats in control of the government passed a law that allowed undocumented residents to enroll in MinnesotaCare, a state-funded health care program that provides coverage to low-income residents. In order to enroll, undocumented individuals must be residents and meet income limits.

Previously MinnesotaCare was limited to U.S. citizens, lawful residents and individuals with a special immigration status, such as Deferred Action for Childhood Arrivals (DACA).

Enrollment opened on Jan. 1 and Republicans and the state Department of Human Services said 17,396 individuals signed up for the program by the end of March. That’s three times higher than the initial 5,784 enrollees projected to sign up for the program by now, Republicans said.

“We should not be surprised by this dramatic increase, because this program creates an incentive for illegal immigrants to come here to Minnesota,” said Sen. Jordan Rasmusson, R-Fergus Falls.

Republicans said that surge in enrollment means the costs will balloon from a projected $200 million to more than $600 million over four years.

But Jen Amundson, a spokeswoman for the Minnesota Department of Human Services, said 3,378 people enrolled in the program have made claims as of April 1. The coverage is provided on a fee-for-service basis.

The February 2025 forecast projected $3 million in costs for the program in the first three months of the year, which is in line with the $3.3 million the state has spent so far, she said.

“To this point, there is no evidence to suggest expenditures will be significantly higher going forward,” Amundson said. “However, three months of data are not adequate to reliably predict expenditures for the next four years. Several additional months of actual expenditure data for this population will be available for the November 2025 forecast.”

Republicans have said the program provides free health care for undocumented immigrants, but Democrats note enrollees must pay premiums and also contribute taxes that help cover the state portion of the program’s cost.

Undocumented Minnesotans have contributed more than $220 million in state and local taxes, said Mann.

“This is entirely political. They are vilifying immigrants, they are demonizing immigrants, they are blaming immigrants for our health care system,” she said. “It’s one of the most disgusting things I’ve ever seen in my time at the Capitol.”

Minnesota is one of three states, including Oregon and California, that provide public health care coverage to undocumented residents regardless of age. Illinois offers health coverage to adults over the age of 42 regardless of their immigration status, recently lifting a temporary pause they had placed on enrollment.

Republicans are pushing in budget negotiations to stop the program and prioritize health care funding for disability and long-term care services.

They argue money going to undocumented immigrants is leaving federal funding on the table for other services because the state cannot get matching federal grants for undocumented individuals.

Democrats aren’t the only ones backing the program. It has the support of the Minnesota Hospital Association, the Minnesota Medical Association, the union representing state nurses and the Minnesota Catholic Conference.

Supporters note it costs hospitals when people wind up in emergency rooms and don’t have insurance. The Hospital Association said it spent hundreds of millions of dollars in 2023 on charity care.

“When people are healthy and have access to preventive care, taxpayers save in the long run on severe cases and emergency room visits,” Amundson said.

Mann, who is also a physician, argued that the GOP plan would keep the system “teetering on the edge of collapse.”

Republicans and Democrats in the House are still trading offers on the state’s health and human services budget and what do about the program. Human services is the second-largest area of spending in the state budget.

The chamber is divided 67-67 and the bill can’t move forward until the two parties strike a deal.