Two new decrees regulating State Medical Aid (AME) have been put into effect. For the government, these measures are intended to combat fraud in applications. For associations, on the contrary, these decrees represent a new obstacle in the already fraught journey of undocumented immigrants in France.
On February 8, two decrees modifying State Medical Aid (AME) were put into effect. The first decree stipulates that it will now be mandatory to provide official identity documents bearing a "passport photo."
Until now, in the absence of identity documents, it was possible to provide "any other document capable of proving the identity of the applicant and their dependents."
"More than a third of the people we receive in our centers do not have photo identification because their documents are lost, stolen, confiscated, or impossible to renew," Matthias Thibeaud, representative of Doctors of the World (MdM) explained.
"This decree exacerbates the already widespread issue of access to AME (State Medical Assistance), delaying or preventing care, and leading to deteriorating health outcomes for those concerned, with a direct impact on public health. Not to mention the real cost of non-take-up of that insurance: excluding people today means more expensive hospitalizations tomorrow," MdM further warned in a press release published on February 5, ahead of the introduction. "This is part of an unprecedented offensive against access to healthcare," they concluded.
The second decree "modernizes the state's IT systems so that all civil servants in charge of the file [particularly those at consulates, editor's note] can access them," French Prime Minister Sébastien Lecornu explained.
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The government is not challenging the AME healthcare coverage.
For the time being, there is no question of challenging the AME healthcare coverage, which is regularly targeted by the right and far right. The Prime Minister believes that it "will probably have to be reformed," but "things are not ready" at this stage to do so, he indicated.
For the government, these two decrees strengthen "the fight against fraud" in submitted applications, "with the prospect of savings of 180 million euros."
The president of the National Rally (RN), Marine Le Pen, has already accused Sébastien Lecornu of "exacerbating one of the factors contributing to migration," essentially, she believes creating a 'pull' factor for migrants, via the prospect of free health care, costs which Le Pen branded "[an] exorbitant cost ... to public finances (more than 1.3 billion euros), [which] is no longer tolerable."
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'A useful healthcare system?'
In fact, less than one percent of the French population benefits from AME. State Medical Aid represents 1.3 billion euros per year of the national health insurance system's expenditure. But contrary to what Marine Le Pen claims, this amount is not "exorbitant"; it represents approximately 0.4 percent of overall healthcare spending (known as ONDAM, estimated at 270 billion euros in 2026). This proportion has remained stable for years. It is therefore a drop in the ocean compared to the state budget.
It is also worth recalling that Sébastien Lecornu met shortly after his arrival in his role as Prime Minister in September 2025 with the authors of a 2023 report on State Medical Aid. In this document, the authors, former Socialist minister Claude Evin and senior civil servant Patrick Stefanini of the Republicans party, generally defended State Medical Aid, describing it as "a useful healthcare system, [which is] largely under control."
They also pointed out that its 466,000 beneficiaries represent less than 1 percent of the French population.
More generally, AME (State Medical Assistance) is a social welfare program that guarantees undocumented immigrants who have been in France for at least three months coverage for certain medical treatments. It is the only assistance available to undocumented immigrants in France. The treatments covered are reimbursed by the state, but based on the Social Security reimbursement rates. This means that the migrants often have additional expenses to cover that are not covered by AME tarifs.
For example, if an undocumented immigrant needs a dental crown costing 500 euros and the reimbursement rate is 100 euro, the migrant will have to pay 400 euros out of their own pocket.
A lack of access to AME could overwhelm the public hospital system
Above all, AME addresses a humanitarian and public health imperative: enabling the most vulnerable to receive treatment before overwhelming an already strained hospital system. "If we don’t allow foreigners to receive treatment, they will get sick. And if they get sick, there’s a good chance the general population will also get sick […] If migrants no longer have access to AME, they will overwhelm the public hospital system," Mathieu Quinette, coordinator of the unaccompanied minors program at Doctors of the World, lamented in 2024.
Yet, the right and far right want to reduce, or even eliminate, AME in the name of a supposed "pull factor for migration." Since the 2000s, the range of healthcare services to which undocumented immigrants are entitled has been reduced. Undocumented immigrants can no longer benefit from "spa treatments," "accommodation costs for disabled children and adolescents," "oral examinations for children," or "assisted reproductive technology (ART)." These services remain entirely at the patient's expense.
Apart from this list, AME beneficiaries can access all other healthcare services (general practitioner, dentist, ophthalmologist, etc.), just like any other insured individual.
However, in everyday practice, the level of coverage provided by AME proves insufficient to cover the actual cost of care, such as a pair of eyeglasses. "It's a real problem for children's glasses, for example. Two single lenses for children's glasses should cost around 200 euros. If the social security reimbursement rate is 60 euros, how will parents find the rest of the sum?" Didier Maille, coordinator of the social hub of Comede (Committee for the health of migrants) in Paris, explained in 2022.