Executive Order “Ending Taxpayer Subsidization of Open Borders”: The Impact on Health Care Providers

On February 19, 2025, President Trump issued a new Executive Order, entitled “Ending Taxpayer Subsidization of Open Borders,” declaring his administration’s intent to uphold Public Law 104-193 entitled “Personal Responsibility and Work Opportunity Reconciliation Act of 1996” (“PRWORA”).

Title IV of PRWORA restricts welfare and public benefits for immigrants by allowing “qualified aliens” [1] to receive public benefits after five years from the date of their entry into the United States and prohibiting all immigrants who do not meet the criteria to be a “qualified alien” from receiving public benefits. Consistent with Title IV of PRWORA, the Executive Order states that it is national policy that “aliens within the Nation’s borders not depend on public resources to meet their needs,” and that “[i]t is a compelling government interest to remove the incentive for illegal immigration provided by the availability of public benefits.”  To ensure that no unqualified alien receives taxpayer-funded benefits, the Executive Order requires all heads of executive departments and agencies to:

• Identify federally funded programs administered by the agency that “permit illegal aliens” to receive public benefits and align those programs with PRWORA and other applicable laws;
• Ensure that federal payments do not facilitate “subsidization or promotion of illegal immigration” or “abet” sanctuary policies;
• Enhance eligibility verification systems; and
• Identify all other sources of federal funding for illegal aliens.

The Executive Order further directs coordination between OMB and DOGE to identify sources of federal funding for illegal aliens and recommend additional actions to limit such spending and enhance eligibility verification system. Agencies are further required to report improper receipt or use of federal benefits to the DOJ and DHS.

But this does not mean that healthcare providers have to cease services to all nonqualified aliens. Notably, Title IV, Subtitle A of PRWORA provides that any prohibition regarding nonqualified aliens receiving taxpayer-funded benefits does not apply to (i) emergency medical services; (ii) certain emergency disaster relief; (iii) public health immunizations and treatment of communicable diseases; (iv) housing assistance; (v) certain in-kind community services; and (vi) Social Security Act benefits under specified circumstances. 

Moreover, the Emergency Medical Treatment and Labor Act of 1986 (“EMTALA”) requires hospitals to provide emergency care to all patients regardless of immigration status.  Currently, Federally Qualified Health Centers can provide primary and preventive health care regardless of immigration status funded under Public Health Service 330 grants.

Many community-based nonprofit behavioral health providers currently receive state and federal grant funds that allow them to provide care regardless of the patient’s immigration status.  Some states may provide special funding for prenatal care and uninsured children regardless of immigration status. If state and federal grant funds are frozen or removed, unqualified aliens will be limited to seeking their health care from hospital emergency rooms.  However, the reality is that many undocumented unqualified aliens will face barriers to accessing emergency care because of fear of deportation. 

Clearly, many health care providers will be faced with legal and ethical dilemmas in deciding whether to risk funding when providing health care to unqualified aliens.  Those that deny care to unqualified aliens to preserve their federal funding may feel as if they have made a Faustian bargain.  In the end, the provider must reckon with whether care is provided based upon medical need or denied based upon other factors such as immigration status.  If unqualified aliens present to a health care provider, the question will remain whether the health care provider has a clear ethical mandate to deliver care. Perhaps the solution is for better immigration policies, rather than policies that encourage health care providers to deny medically needed care to another human.  We shall see. 

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[1] Section 431 of PRWORA defines a qualified alien to be: (1) a lawful permanent resident; (2) an asylee; (3) a refugee; (4) a parolee under Section 212(d)(5) who has been in the U.S. for at least 1 year; (5) an alien under withheld deportation; and (6) an alien granted conditional entry.