Washington state is funneling roughly $20 million from its long-term care insurance program to cover fewer than 200 immigrants who do not qualify for Medicaid, a per-person cost that dwarfs what the state spends on citizens enrolled in the same system. The spending has drawn sharp criticism from Republican lawmakers who say the program was never designed to serve as a parallel benefits track for noncitizens.
The money flows from the WA Cares Fund, a first-in-the-nation public long-term care insurance program funded by a mandatory payroll tax on Washington workers. Under a 2023 law, the state carved out a separate pot within that fund to pay for long-term care services for immigrants who are ineligible for federal Medicaid due to their immigration status, as the Washington State Standard reported.
The program currently serves fewer than 200 people. The $20 million price tag works out to more than $100,000 per recipient, a figure that has become a flashpoint in Olympia. Republican state Sen. John Braun called the spending "a stunning amount of money for a very small number of people" and questioned whether the legislature intended this outcome when it passed the 2023 expansion.
Supporters of the program argue the recipients are elderly or disabled immigrants who have lived in Washington for years, contributed to their communities, and have no other safety net. Democratic state Rep. My-Linh Thai, who sponsored the 2023 legislation, has said the program fills a gap left by federal policy that excludes certain immigrants from Medicaid regardless of how long they have lived and worked in the United States.
But critics counter that the gap exists for a reason. Federal law has long distinguished between citizens and noncitizens when it comes to public benefits eligibility, and Washington's workaround effectively uses state-collected payroll taxes to override that distinction.
The WA Cares Fund imposes a 0.58% payroll tax on nearly all W-2 employees in the state. In exchange, workers who pay in for a sufficient period become eligible for up to $36,500 in lifetime long-term care benefits. The fund was designed to address a looming crisis: most Americans lack long-term care insurance, and Medicaid only covers such care after a person has spent down nearly all assets.
The program was controversial from the start. Thousands of Washington workers rushed to buy private long-term care policies to opt out of the mandatory tax before a deadline closed that window. Business groups and some employees challenged the program's structure, arguing the benefits were too thin and the tax too rigid.
The 2023 expansion added a new layer of controversy by directing WA Cares dollars to immigrants excluded from Medicaid. The fund's actuary had not originally modeled this population when projecting the program's solvency, raising questions about whether the added cost could strain the fund over time.
Washington is not alone in extending state-funded benefits to immigrants who lack federal eligibility. California, Illinois, New York, and several other blue states have expanded Medicaid-equivalent coverage or other social services to undocumented or otherwise ineligible immigrants in recent years. Those expansions have become a major target for conservative lawmakers and voters who view them as incentivizing illegal immigration and shifting costs onto citizen taxpayers.
The federal government under the Trump administration has pushed aggressively in the opposite direction. A public charge regulation first drafted during Trump's first term sought to deny green cards to applicants likely to rely on taxpayer-funded programs including Medicaid, SNAP, and housing assistance. Then-DHS Secretary Kirstjen Nielsen framed the rule in straightforward terms:
"Under long-standing federal law, those seeking to immigrate to the United States must show they can support themselves financially."
Mark Krikorian of the Center for Immigration Studies praised that effort at the time, saying the country had for years "defined public charge in a fictional way in order to facilitate high levels of low-skilled immigration." The regulation designated receipt of benefits including TANF, SSI, Medicaid, SNAP, and Section 8 housing as heavily weighted negative factors in green card decisions.
The Trump administration's broader immigration enforcement posture has only intensified during its second term. The DOJ has launched what officials describe as the largest denaturalization campaign in U.S. history, targeting individuals accused of fraud in obtaining citizenship.
The $100,000-plus per-recipient figure is the political weak point for the program's defenders. Long-term care is expensive by nature. Nursing home care in Washington averages well over $10,000 per month, and even in-home care runs several thousand. A single recipient needing intensive services for a year or more can easily generate six-figure costs.
Program supporters say the per-person number looks inflated because the eligible population is small and the needs are acute. They argue it would be far more expensive for these individuals to end up in emergency rooms or crisis care without any coverage at all.
Republican critics reject that framing. Sen. Braun and other GOP lawmakers have argued that the state has no obligation to build a parallel benefits system for people who are not eligible for federal programs. They point out that the payroll tax funding the WA Cares Fund was sold to workers as a way to pre-fund their own future care needs, not to subsidize coverage for noncitizens.
The tension reflects a fundamental disagreement over what state governments owe to residents who lack federal immigration status. That disagreement has played out in courtrooms and legislatures across the country, with federal courts recently upholding state-level immigration enforcement measures that push in the opposite direction from Washington's approach.
The WA Cares Fund's long-term financial health remains an open question. The program's actuaries have projected solvency under certain assumptions about workforce participation, wage growth, and claims rates. Adding an uncapped obligation to cover immigrants outside the original risk pool introduces a variable those projections did not fully account for.
State officials have said the immigrant coverage component represents a small fraction of the overall fund. But small fractions have a way of growing. If the eligible population expands through future legislation or if per-person costs rise faster than projected, the strain on the fund could become material.
Washington lawmakers have not publicly released updated actuarial projections that account for the immigrant coverage expansion at its current cost trajectory. Investigators and auditors will need to determine whether the fund can absorb this obligation without raising the payroll tax rate or reducing benefits for the workers who pay into it.
The spending also raises questions about accountability and oversight. Authorities have not publicly confirmed whether the state conducts regular audits of eligibility determinations for the immigrant coverage track, or what safeguards exist to prevent enrollment by individuals who do not meet the program's residency or disability requirements.
The WA Cares immigrant spending is likely to surface as a campaign issue in Washington's 2026 legislative races. Republicans have seized on the $20 million figure as evidence that the Democratic majority in Olympia prioritizes noncitizens over the workers forced to fund the program through mandatory payroll deductions.
Democrats face a difficult messaging challenge. The program's beneficiaries are a sympathetic population: elderly and disabled people who need help with basic daily tasks. But the math is hard to spin. Telling workers who earn $50,000 a year that $290 of their annual payroll tax is partly funding six-figure benefits for fewer than 200 noncitizens is a tough sell, even in a blue state.
The debate connects to a larger national argument about the boundaries of the social safety net. The Trump administration has moved aggressively to tighten immigration enforcement and revoke benefits from noncitizens, while blue-state legislatures have moved just as aggressively to fill perceived gaps in federal coverage.
Federal courts have increasingly weighed in on where state authority ends and federal immigration policy begins. Recent rulings on executive deportation authority suggest the judiciary is giving the federal government wide latitude to set the terms of immigration enforcement, which could eventually put pressure on state-level benefit expansions that cut against federal policy.
The Washington legislature will revisit the WA Cares Fund's structure in its next session. Republican lawmakers have signaled they will push to strip the immigrant coverage provision or at least cap its spending. Democrats hold the majority but face internal divisions on immigration-related spending, particularly as housing and education costs dominate constituent concerns.
The fund's administrators will also need to publish updated financial projections that account for the immigrant coverage track's actual costs. Those numbers will determine whether the current payroll tax rate can sustain the program's promises to all enrollees, citizen and noncitizen alike.
When a state takes money from workers' paychecks and promises to hold it for their future care, spending it on a population those workers were never told about is not compassion. It is a breach of the deal.
