One of the biggest drivers of New York’s Medicaid enrollment growth over the past decade has been “emergency Medicaid” for undocumented immigrants, newly released state records show.

The program – which is limited to short-term care for emergency conditions – has soared by 440,000 or more than 1,200 percent since 2014, according to Health Department records obtained by the Empire Center under the Freedom of Information Law.

As of March 2024, sign-ups for emergency Medicaid stood at 480,000, or 7 percent of total enrollment.

The only Medicaid cohort that grew by a larger amount was able-bodied, childless adults from 19 to 64, which increased by 796,000 or 68 percent. Overall, enrollment in the New York’s version of the safety-net health plan for the lower-income and disabled was up 1.6 million or 28 percent from March 2014 to March 2024.

Emergency Medicaid enrollment is overwhelmingly concentrated downstate, with 74 percent of recipients living in New York City, 14 percent on Long Island and 12 percent in the Mid-Hudson region.

Officials attributed the spike to a policy change enacted in 2014, as the federal Affordable Care Act went into full effect. Through the state’s newly established insurance exchange, immigrants ineligible for other forms of coverage were invited to pre-register for emergency Medicaid even if they didn’t immediately need emergency care.

Enrollment has been rising at double-digit rates ever since, including a 33 percent spike during the first year of the Covid-19 pandemic and another 26 percent since 2022, as thousands of newly arrived migrants were bused to New York from border states.

Spending on emergency Medicaid has roughly tripled, from $207 million in fiscal 2013-14 to $639 million in fiscal 2023-24, officials said. Because more people were signing up without knowing if they would need care, the share of enrollees who used services in any given year has dropped from 43 percent to 21 percent, and the annual cost per enrollee has declined from $5,700 to $1,300, officials said.

In addition to emergency Medicaid, New York offers government-sponsored coverage through its Essential Plan to another 494,000 non-citizens. These include legal immigrants who arrived less than five years ago and people without green cards who are “permanently residing under color of law,” such as those approved for asylum and people who qualify for President Obama’s Deferred Action for Childhood Arrivals program.

Lower-income legal immigrants who have resided in the U.S. for at least five years are eligible for regular Medicaid.

About 1.5 million non-citizens live in New York City, including 670,000 who are undocumented, according to estimates from the Center for Migration Studies.

The Empire Center obtained the figures on emergency Medicaid as part of a larger request seeking a breakdown of the eligibility categories for all Medicaid enrollees over the past decade. It was expected that this data would shed light on why the safety-net health plan has grown to be millions larger than New York’s population living in poverty, as documented in a recent report.

Despite a delay of eight months, the Health Department’s initial response in January was incomplete – omitting information on almost 1 million enrollees, as the Empire Center reported earlier this month.

The day after that post was published, the department provided a second data set that appeared to be more comprehensive – but which was puzzlingly inconsistent with the figures provided earlier.

The numbers for some eligibility categories went up substantially, while others went down. Categories that were counted separately in the first round were seemingly combined together in the second – and some disappeared completely.

Another issue is plausibility: The state reported Medicaid enrollment of 693,000 in a category for “pregnant consumers,” which seems far too high. The state’s most recently available vital statistics, from 2022, show that 206,000 women gave birth and 68,000 had abortions. Medicaid covered about half of each, indicated pregnant enrollees would have numbered about 137,000.

The Empire Center asked the department to clarify its data and is waiting for a response.