Timely medical care is crucial for optimal outcomes in children with cleft lip and palate. Undocumented migrant children face significant healthcare barriers. This study assesses the demographic characteristics and unmet surgical needs of undocumented children at our institution and analyzes state-level policies affecting their care. A retrospective review was conducted at a single institution between 2023 and 2024. Medicaid and Children's Health Insurance Program policies were reviewed as of August 2024, categorizing states by immigrant child healthcare coverage. Multidisciplinary cleft clinic in a pediatric referral center. Ten undocumented children were included, with clinical data and immigration status collected from social work and insurance records. Timing of initial cleft surgery, additional surgical needs, and surgical completion were assessed. Ten undocumented children were identified, with a mean age of 7 (range 1-10) years. Eight received primary cleft surgery in their home countries, but many had unmet surgical needs, including alveolar bone grafting (n = 4), oronasal fistula closure (n = 5), and dental care (n = 3). Twelve states provide comprehensive coverage regardless of immigration status, with 2 more expected by 2025. Twenty-three states cover only certain noncitizens without a waiting period, while 14 impose a 5-year delay. Broad coverage was concentrated in the Northeast and West (