Public Healthcare for Foreigners Without Legal Residence in Spain: Royal Decree 180/2026

Spain's Royal Decree 180/2026 regulates access to free public healthcare for foreigners without legal residence. Learn about the new procedure, required documentation, provisional access from the moment of application, and special protections for vulnerable groups.

On 12 March 2026, Spain published Royal Decree 180/2026 in the Official State Gazette (BOE), regulating access to publicly funded healthcare for foreigners who are in Spain but do not have legal residence. The decree entered into force on 13 March 2026.

This regulation develops Article 3 ter of Law 16/2003 (the National Health System Cohesion Act) and aims to standardise the procedure across all Autonomous Communities, reducing administrative barriers that had been detected since the reform introduced by Royal Decree-Law 7/2018.

What the New Regulation Establishes

The decree sets out a clear procedure for recognising the right to health protection and publicly funded healthcare for foreigners without legal residence in Spain.

To obtain recognition, the applicant must submit a declaration of responsibility (*declaración responsable*) in the prescribed form, declaring among other things that:

  • They are not required to hold private health insurance
  • They do not have public healthcare coverage through any other channel
  • They cannot export healthcare rights from another country
  • There is no third party obliged to cover the costs
  • They do not hold a valid stay visa or residence documentation

If the person comes from a country with which Spain has a Social Security agreement that includes healthcare coverage, they must additionally provide a certificate from the relevant institution confirming that exportation of that coverage is not possible.

Proving Identity and Habitual Residence

The decree details acceptable documentation for proving identity: passport, official identity document, or alternatively another document issued by the administration of the country of origin with a photograph. For minors, birth certificates, family books, or official guardianship documentation are accepted.

To prove habitual residence in Spain, the primary document is the *certificado de empadronamiento* (municipal register certificate). However, the decree accepts alternative evidence when this cannot be provided, including:

  • School enrolment certificates
  • Consular travel documents
  • Certificates from social services or social workers from accredited NGOs
  • Utility bills
  • Police registration certificates (*cédula de inscripción*)
  • Consular registration documents
  • Certificates from the public migration centres network

Critically, the regulation does not require a minimum period of residence for the general recognition of the right.