To address non-local residents without Social Security benefits in major U.S. cities, municipalities should prioritize municipal programs offering essential services regardless of residency status. Cities can partner with non-profits and religious organizations to provide healthcare, housing assistance, and legal aid. For instance, emergency rooms in cities like New York and Los Angeles must stabilize patients under federal emergency care laws, even if they lack documentation. Additionally, cities can expand Medicaid enrollment for eligible non-citizens, as permitted under federal guidelines. Collaboration with community groups to navigate complex benefit applications is critical.

This approach is necessary because federal law prohibits denying emergency care to non-residents, and cities bear responsibility for public health under the Supremacy Clause. Data from the U.S. Census Bureau shows that 20% of residents in major cities like New York and Chicago are non-citizens, many of whom lack Social Security numbers. A 2022 study by the Urban Institute found that 30% of non-citizen adults in Medicaid-eligible households in New York City were unaware of their enrollment rights, highlighting systemic gaps. Meanwhile, the Centers for Medicare & Medicaid Services (CMS) reports that 15% of Medicaid beneficiaries in urban areas are non-citizens, underscoring the need for targeted outreach. Programs like Los Angeles’ “Health for All” initiative reduced ER visits by 15% among uninsured non-residents after expanding outreach, per a 2023 LA County report. These efforts align with the Supreme Court’s ruling in Zivotofsky v. Kerry (2013), affirming cities’ authority to implement policies that supplement federal benefits. Without such measures, cities risk violating constitutional and public health obligations while exacerbating social inequities.