Care for Visitors and New Immigrants

Navigating the US healthcare system is challenging for everyone, but immigrants, visa holders, and visitors face additional complexity: eligibility for programs depends on immigration status; language access is a right that must sometimes be asserted; costs without insurance can be severe; and immigration policy intersects with healthcare decisions in ways that require careful understanding. This guide provides an overview of what healthcare access looks like for people new to the US across a range of situations.

Emergency care: rights that apply regardless of status

The Emergency Medical Treatment and Labor Act (EMTALA) is the starting point. Under this federal law, any hospital with a Medicare agreement and an emergency department must provide:

• A medical screening examination to anyone who presents for evaluation of an emergency medical condition
• Stabilizing treatment (or an appropriate transfer to another facility) if an emergency medical condition is found

These obligations apply to all patients regardless of immigration status, insurance status, citizenship, or ability to pay. A hospital cannot turn away a patient in a medical emergency or demand insurance verification before beginning an emergency medical screening.

Emergency care under EMTALA does not mean free care — hospitals will bill for services and may pursue collection. But it ensures access to initial evaluation and stabilization. Emergency Medicaid, described below, may help cover costs in many states.

Emergency Medicaid

Emergency Medicaid is a federal program that covers emergency medical services for individuals who would be eligible for Medicaid based on income and other criteria, but who are not eligible for full Medicaid due to immigration status. Emergency Medicaid is available in all states and covers emergency services — typically the ER visit, stabilization, and directly related inpatient care.

Emergency Medicaid does not cover non-emergency primary care, dental, or mental health services. The definition of “emergency” is specific — it does not cover follow-up care for the same condition once the patient is stabilized.

Full Medicaid eligibility by immigration status

Full Medicaid eligibility depends on immigration status and state of residence:

US citizens and qualified non-citizens with long-term status: Generally eligible for Medicaid based on income, subject to state rules.

Lawful Permanent Residents (green card holders): Under federal law, most must satisfy a defined waiting period of lawful residence before being eligible for federal Medicaid. Many states use state funds to cover LPRs during this period. Some categories are exempt from the waiting period (refugees, asylees, certain survivors of abuse or trafficking).

Other lawfully present immigrants: Eligibility depends on visa type and duration. Some visa holders are eligible for Marketplace plans and the associated tax credits; fewer qualify for Medicaid. Check healthcare.gov for immigration status eligibility categories.

Undocumented individuals: Generally not eligible for federal Medicaid or Marketplace plans. Eligible for Emergency Medicaid only. Some states — using entirely state funds — have extended coverage to certain groups regardless of documentation status. Rules vary significantly by state.

Health Insurance Marketplace access

Most people in the US with a lawful immigration status can apply for Marketplace coverage through healthcare.gov. This includes many visa holders, green card holders, refugees, asylees, and others. Eligibility for premium tax credits and the ability to enroll depend on both income and immigration status.

Undocumented individuals generally cannot enroll in Marketplace plans. Mixing households with documented and undocumented members is a specific scenario with complex rules — healthcare.gov has eligibility screening tools.

Visitors: travel insurance and paying out of pocket

Visitors to the US on tourist visas (B-1/B-2 or similar) are not eligible for US government health programs and are unlikely to have employer-sponsored coverage. The cost of US healthcare without insurance is extremely high — even a moderate emergency room visit can result in a large bill. Travel health insurance purchased before arrival in the US is strongly recommended.

When choosing travel insurance, compare:

• Whether the policy covers the full cost of hospitalization in the US
• Whether pre-existing conditions are covered
• Whether emergency medical evacuation to your home country is included
• The policy’s definition of “emergency” and any exclusions

If you receive care as an uninsured visitor, ask the hospital about their charity care or uninsured discount policy. Many nonprofit hospitals apply their Financial Assistance Policy to all patients regardless of immigration or insurance status. FQHCs accept all patients on a sliding fee scale.

Federally Qualified Health Centers: the universal resource

Regardless of immigration status, insurance status, income, or documentation, Federally Qualified Health Centers (FQHCs) provide comprehensive primary care services on a sliding fee scale. FQHCs are required by federal law to serve all patients in their service area without discrimination based on immigration status, and they cannot require proof of legal status as a condition of care.

Find the nearest FQHC at hrsa.gov/find-health-center. Services available at FQHCs typically include primary care, dental, mental health, and pharmacy — a broader range than many emergency alternatives.

Note on immigration policy: Rules regarding public charge, benefit eligibility, and immigration status requirements change over time. This guide provides general background, not legal or immigration advice. For questions about how using health programs may affect immigration proceedings, consult a qualified immigration attorney or accredited representative, and check current guidance from USCIS directly.

Comparing healthcare access by immigration and visitor status

Access to US healthcare programs varies significantly depending on your status in the country. The table below summarizes the key differences:

Status	Emergency care (EMTALA)	Emergency Medicaid	Full Medicaid	ACA Marketplace	FQHC sliding fee
US citizen	Yes	Yes	Yes (income-based)	Yes	Yes
Lawful Permanent Resident	Yes	Yes	Yes (after waiting period; states vary)	Yes	Yes
Other lawfully present visa holders	Yes	Yes (some states)	Limited — depends on visa type	Many can enroll	Yes
Visitor (tourist visa)	Yes	Generally no	No	No	Yes
Undocumented	Yes	Yes (emergency only)	No federal Medicaid	Generally no	Yes

Key takeaway: EMTALA emergency care and FQHC sliding-fee primary care are the two access points that apply regardless of immigration or documentation status. For everything else, eligibility depends on your specific status, state of residence, income, and the program in question.

What this looks like in practice

Imagine Hiroshi, a 38-year-old visiting the US from Japan on a B-2 tourist visa for a three-week trip. On his second week, he develops severe abdominal pain and is brought to a hospital emergency department by his travel companion. Under EMTALA, the ER immediately performs a medical screening examination — no one asks for his visa or insurance before starting the evaluation. He is diagnosed with appendicitis and taken into emergency surgery.

Because Hiroshi purchased travel health insurance before leaving Japan, his insurer covers the bulk of the hospitalization and surgery costs. He pays a deductible per his policy. After discharge, the hospital’s financial counselor explains that if Hiroshi had no insurance, he could apply for the hospital’s charity care policy, which applies to uninsured patients regardless of citizenship. The counselor also mentions that a nearby FQHC could provide follow-up wound care visits on a sliding-fee basis if Hiroshi’s recovery extends his stay.

Hiroshi’s case illustrates the layered safety net: EMTALA ensures emergency access, travel insurance handles the bulk of the cost, and the hospital’s own financial assistance policy and nearby FQHCs provide backup resources for uninsured visitors.

Step by step: getting primary care as a new arrival

1. Determine your insurance or program eligibility. Based on your immigration status and income, identify whether you may qualify for Medicaid, a Marketplace plan, a state-specific program, or whether you will pay on a sliding scale. Healthcare.gov has an eligibility screener.
2. Find the nearest FQHC. Regardless of eligibility for other programs, locate an FQHC using the HRSA health center finder at hrsa.gov/find-health-center. Search by zip code and view the services each site offers.
3. Call the FQHC and schedule a new patient appointment. Ask about wait times, what documentation to bring (income information for the sliding fee calculation), and what languages are spoken by staff or available through interpreters.
4. Bring what you have — but know you cannot be turned away for lacking documents. Income documentation helps establish your sliding fee level, but health centers must provide care even if you cannot document income.
5. Request an interpreter if needed. FQHCs are covered entities under Section 1557 and must provide qualified interpreters at no charge. Notify the health center of your language when scheduling.
6. Establish ongoing care with a primary care provider. FQHCs assign patients to a primary care provider or team. Continuity with one provider improves care coordination as your situation evolves.
7. Ask about other services. Many FQHCs offer dental, mental health, pharmacy, and case management at the same or affiliated sites — services that are often unavailable or unaffordable elsewhere for new arrivals.

Documents and terms you’ll see

When navigating healthcare as a visitor or new arrival, you will encounter terms and programs including:

• EMTALA — The federal law requiring hospitals with emergency departments to screen and stabilize all patients regardless of immigration status or insurance
• Emergency Medical Condition — The legal standard under EMTALA: a condition with acute symptoms severe enough that absence of immediate treatment could place health in serious jeopardy
• FQHC — Federally Qualified Health Center; provides comprehensive primary care to all patients on a sliding fee scale regardless of documentation status
• Federally Qualified Health Center — The full designation for HRSA-funded safety-net clinics meeting specific requirements for services, governance, and accessibility
• Sliding Fee — A payment scale tied to income and family size that reduces the cost of care for lower-income patients
• Immigration Status — A person’s legal relationship to the US government as a citizen, visa holder, lawful permanent resident, or other category; affects eligibility for most federal health programs