“State medical aid for illegal aliens is too expensive.” True or false ?

• State Medical Aid (AME) came into force in 2000 with an initial budget of 139 million euros. In 2023, its cost rises to 1.141 billion for 400,000 beneficiaries, or 0.48% of healthcare spending in France.

• AME care is paid for by health insurance, which benefits from a flat-rate subsidy from the State. The Court of Auditors pointed out the difficulties in anticipating the amount of this subsidy each year; the Senate, which is requesting a modification of the system, accused the State of undervaluing this budget.
• Health expenditure per beneficiary of AME (2,610 euros in 2020) turns out to be lower than the average expenditure per capita covered by health insurance (3,100 euros).
• But AME expenses are soaring: + 9.9% per year, on average, since 2000. A direct consequence of the increase in the number of beneficiaries, even if 49% of those entitled do not request it. This growth will accelerate further in 2023. Faced with this increase, since 2019, access to certain care has been delayed by nine months.
• The AME, granted under certain residence conditions (length of effective and irregular residence in the territory) and resources, includes a basket of care: 100% coverage of essential medical and hospital care, dental care, costs of analyses, hospitalization and surgical intervention , or linked to certain screenings and vaccinations, contraception, voluntary termination of pregnancy; coverage of medications within the limit of their reimbursement of 100%, 65% or 30%. Beneficiaries of AME are not entitled to spa treatments, medically assisted procreation, or expenses for disabled minors, unlike other health insurance beneficiaries.
• The AME is the benefit managed by health insurance with the highest control rate (14% of files), which made it possible to detect anomalies which remain nationally at a rate of less than 3%.
• The Prime Minister announced a reform of this state medical aid before the summer.

Sources: “First steps” survey, IRDES, 2019; Joint IGAS-IGF report, 2019; Budget execution analysis note, Court of Auditors, 2021; Key figures from Social Security, 2022; Health spending in 2022, DREES; Information report of the National Assembly, 2023; Évin-Stefanini report, 2023.