On October 1, 2026, a major change to who can receive government health coverage in the United States quietly took effect. Under the 2025 budget reconciliation law, federally funded Medicaid and the Children's Health Insurance Program (CHIP) are now limited to U.S. citizens and three groups of non-citizens: lawful permanent residents (green-card holders), Cuban and Haitian entrants and migrants from the Compact of Free Association (COFA) nations of Micronesia, the Marshall Islands and Palau [1]. Similar restrictions are rolling out across Medicare and the Affordable Care Act (ACA) marketplaces. Together, an analysis cited by Georgetown University's Center for Children and Families estimated that about 1.4 million lawfully present immigrants could lose health coverage because of the changes [1].
Who is affected
The people losing eligibility are immigrants who are in the country legally but do not hold green cards. That includes refugees, people granted asylum, people with Temporary Protected Status (TPS) and survivors of trafficking and certain crimes who hold special visas [1][2]. Many of these groups had been eligible for Medicaid for decades, often immediately on arrival, because federal policy treated refugees and asylees as humanitarian admissions [3]. It is important to note what the law does not change. Undocumented immigrants were already ineligible for federally funded Medicaid, Medicare and marketplace subsidies under longstanding federal policy, and that remains true [1]. Emergency Medicaid, which pays hospitals for emergency treatment regardless of immigration status, is a separate category.
A staggered timeline
The changes take effect in stages, which has made them confusing for families and state agencies alike [1][4]: • January 1, 2026: Lawfully present immigrants with incomes below the federal poverty level who were ineligible for Medicaid lost access to marketplace premium tax credits.
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October 1, 2026: Federal Medicaid and CHIP eligibility narrowed to citizens, green-card holders, Cuban/Haitian entrants and COFA migrants.
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November 1, 2026: When open enrollment for 2027 begins, marketplace subsidies are limited to the same three immigrant groups.
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January 4, 2027: Current Medicare enrollees who are not in an eligible category lose their Medicare coverage. For new Medicare applicants, the restriction took effect immediately when the law was signed in July 2025. The Medicare change stands out because many of the affected seniors have worked and paid Medicare payroll taxes for years. Justice in Aging, an advocacy group for low-income older adults, warns that some older immigrants enrolled in both Medicare and Medicaid could lose both within about three months [3].
States respond
States administer Medicaid, so they are the ones sending termination notices. In Washington state, about 14,000 residents were expected to lose Medicaid on October 1, according to public radio station KUOW [5]. Ryan Moran, director of the Washington State Health Care Authority, said the change would affect not only the individuals losing coverage but also the health system more broadly, since the newly uninsured will still need care. Because these same immigrants will also be ineligible for subsidized marketplace plans in 2027, the state expects most of them to become uninsured [5]. States do have some options. Under an existing federal option known by the acronym ICHIA, states can cover lawfully residing children and pregnant people with federal matching funds, and Georgetown researchers note that this coverage should continue after October 1 in states that have adopted it [1]. Some states, including California, also fund coverage for certain immigrants with their own money, though those programs face growing budget pressure.
The arguments
Supporters of the law argued that federal health benefits should be reserved for citizens and permanent residents and that narrowing eligibility saves federal money at a time of high deficits. They also note that the affected immigrants can still buy private coverage and that green-card holders, the largest group of non-citizen immigrants, remain eligible. Critics, including health care providers and immigrant advocates, respond that the affected groups are, by definition, in the United States legally, and that refugees and asylees often arrive with significant health needs and limited resources. They warn that uninsured patients tend to delay care and rely more on emergency rooms, shifting costs to hospitals and state governments [3][5].
The bigger picture
The immigrant eligibility changes are one piece of a broader set of coverage changes from the 2025 law, which also created Medicaid work requirements and more frequent eligibility checks. KFF Health News has reported that hundreds of thousands of immigrants with legal status have already become ineligible for government health insurance as the provisions take effect [6]. For hospitals and clinics in communities with large refugee populations, the cuts may show up first as more uninsured patients in the waiting room.
What families should know
Advocates encourage affected individuals to read any notice from their state Medicaid agency or the Social Security Administration carefully, confirm their immigration category and ask whether children or pregnant family members remain eligible under state options [4]. Because eligibility depends on each person's status, a single household can contain some members who keep coverage and others who lose it. A citizen child of a parent who loses Medicaid, for example, generally remains eligible on their own.
What to watch next
The next major milestone is January 4, 2027, when Medicare coverage ends for current enrollees who are not in an eligible immigration category [1]. Justice in Aging reports that affected people were expected to receive termination notices during 2026 [3]. Because Medicare is run by the federal government rather than by states, those notices come from federal agencies, and advocates are urging older immigrants to make sure their contact information is up to date so that they do not miss them. Researchers will also be watching state uninsured rates in 2027, which will offer the first hard data on how many of the affected immigrants found other coverage and how many went without.
Why it matters
For decades, U.S. health programs drew a basic line between people in the country legally and those who were not. The 2025 law moves that line, drawing a new distinction between green-card holders and other lawfully present immigrants. Over the next three months, as the Medicaid, marketplace and Medicare provisions all take hold, the country will get its first real measure of how many people that shift leaves without coverage.
Sources
- 1. "New Immigrant Eligibility Restrictions Coming to Federally-Funded Health Coverage," Georgetown University Center for Children and Families, October 1, 2025. https://ccf.georgetown.edu/2025/10/01/new- immigrant-eligibility-restrictions-coming-to-federally-funded-health-coverage/
- 2. "2027 ACA open enrollment: What's changing," healthinsurance.org, September 2, 2026. https://www.healthinsurance.org/blog/2027-aca-open-enrollment-whats-changing/
- 3. "Understanding the Impact of H.R. 1 on Older Immigrants' Access to Health Care," Justice in Aging, 2026. https://justiceinaging.org/understanding-the-impact-of-h-r-1-on-older-immigrants-access-to-health-care/
- 4. "New Immigration FAQ: Medicaid, CHIP, Medicare, and Marketplace," Health Reform: Beyond the Basics, June 2026. https://www.healthreformbeyondthebasics.org/wp-content/uploads/2024/08/New-Immigration- FAQ-REV-June-25.pdf
- 5. Eilís O'Neill, "14,000 Washington residents expected to lose Medicaid Oct. 1," KUOW/OPB, September 30,
- 2026. https://opb.org/article/2026/09/30/washington-residents-losing-medicaid-october
- 6. "Morning Briefing, Thursday, October 8, 2026," KFF Health News. https://kffhealthnews.org/morning-briefing/thursday-october-8-2026 Information in this article is current as of October 9, 2026. Bracketed numbers refer to the sources listed above.