"Illegals" can't use full Medicaid, they can only receive emergency care which hospitals are required to give by law. That's what that $4.5B figure is – emergency care, labor, delivery, etc. Furthermore, undocumented immigrants pay billions in taxes each year, including the payroll taxes that fund Medicaid and Medicare. Taxpayers aren't on the hook, because these immigrants are already paying in for services they can't even use.