The Aide médicale d’État, or State Medical Aid Scheme (AME), is currently the only mechanism allowing undocumented people access to healthcare in France.
Without the right to work and excluded from any form of social assistance (the Pasqua Law of 1993 explicitly bars undocumented people from all social protection in France), AME is their only lifeline for accessing essential healthcare: contraception, diabetes treatment, HIV medication, and more.
On 29 August 2025, just days before the resignation of the Bayrou government, two draft decrees reforming AME were submitted to the CNAM.
Women for Women France obtained copies of these drafts. One of them proposed including the income of an insured spouse in the assessment of eligibility for AME. In practice, this would mean that any person living with a partner whose income exceeded a very low threshold would lose their right to AME and therefore to any access to healthcare in France.
According to Women for Women France estimates, more than 100,000 people, the vast majority of them women, would lose access to AME if this reform went ahead.
Although suspended for now, these draft decrees could be signed at any moment following the formation of the new government. Prime Minister Sébastien Lecornu has already been reported to have met Claude Évin and Patrick Stefanini, authors of the 2023 report recommending this reform.
A chain of legal errors and the correction made by Senator Delahaye
The proposal to include the income of an insured spouse among AME eligibility criteria stems from the Évin-Stefanini report of 2023, as well as from the interpretation given by the drafters of the decree of the report authored by Senator Vincent Delahaye in 2025. On page 64 of that report, the following can be read: “... it would appear more relevant also to take into account the resources of the spouse or cohabiting partner, especially as they automatically benefit from health protection as a dependent.”
The problem is that this recommendation rested on a legally incorrect assumption: that a woman living with a French citizen or a person with regular status could benefit from her partner’s healthcare coverage as a “dependent.” However this is false. No one in France is able to benefit from their spouse’s state health coverage since the dependent status was abolished by the 2016 reform introducing Universal Health Protection (PUMa).
Alerted by the technical and legal team at Women for Women France, Senator Delahaye acknowledged the misinterpretation made by the decree’s authors and published a statement on X (formerly Twitter), firmly opposing the inclusion of spousal income in any reform of AME. He also recognised that such a measure would be catastrophic and would deprive many women of all access to healthcare in France.
A responsible decision welcomed by Women for Women France
“We welcome Senator Delahaye’s decision to oppose the inclusion of spousal income in determining eligibility for State Medical Aid (AME).
“In a climate where public debate is too often marked by confrontation and discrediting, I wish to thank Senator Delahaye for keeping his door open to dialogue with myself and Women for Women France. Together, we shared a common objective: a healthcare system that is fair, protective of everyone, economically responsible, and which does not leave the most vulnerable women without autonomy over their bodies and health.
“By clarifying his position as expressed in his report publicly, Senator Delahaye demonstrates a model of serious and constructive leadership that is so urgently needed today.
“For many years, he has been active in his constituency in Essonne on issues of women’s safety. We thank him for extending this commitment to the fundamental rights of our sisters who, without having chosen it, live in an irregular situation in France. This embodies the true values of universalism that France upholds.
On behalf of the entire team and members of Women for Women France, I warmly thank Senator Delahaye for his responsiveness and sense of responsibility. We look forward to continuing this work together in the future,” declared Sarah McGrath, Chief Executive Officer, Women for Women France
Women for Women France’s call to the new government
Women for Women France calls on the new government to remove any reference to the inclusion of spousal income in calculating AME eligibility from its draft decree, acknowledging that such an error would have endangered 100,000 women, public health, the hospital system, and public finances.
“We call for more serious and rigorous consultations before any future decree is drafted by government cabinets. The lives and health of the most vulnerable women in France, and of public health as a whole, must not be treated so recklessly in the future,” stressed Sarah McGrath.
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