(CALIFORNIA) — Congress and the White House enacted H.R. 1 in July 2025, setting in motion a phased rollback of federally funded health coverage that state officials and advocates say will hit many lawfully present older immigrants in California starting later in 2026.
The law restricts federally funded Medi-Cal and Medicare eligibility for many older immigrants by limiting coverage to U.S. citizens, lawful permanent residents (LPRs), Cuban/Haitian entrants, and Compact of Free Association residents, with Medicaid changes effective October 1, 2026, and Medicare terminations tied to July 4, 2025, the bill’s summary explains.
Older immigrants stand out because many rely on Medi-Cal, Medicare, or both for ongoing treatment, prescriptions, and help managing chronic conditions. California administers Medi-Cal, but the new limits focus on what categories the federal government will fund, changing how far the state can rely on federal matching dollars.
H.R. 1 narrows immigration categories for federally funded benefits, shifting refugees, asylees, humanitarian parolees, trafficking survivors, Amerasian immigrants, and people with withholding of deportation off federally funded full-scope coverage in Medi-Cal and, for many, out of Medicare eligibility as well. California can continue some coverage, but the changes move many people into state-funded restricted-scope Medi-Cal without federal matching funds.
Section 71109 of H.R. 1 tightens Medi-Cal’s federal eligibility by narrowing “qualified non-citizen” status. The measure ends federal funding for non-LPR groups that previously qualified after five years of lawful presence, affecting older immigrants who had been enrolled in full-scope Medi-Cal.
For those affected, the shift begins October 1, 2026, when older immigrants in the excluded categories lose full-scope coverage and transition to restricted-scope Medi-Cal. The restricted program covers only emergency and pregnancy services, the summary states, a change that can leave routine primary care, chronic disease management, and many prescriptions outside coverage.
Medicare changes take effect on a different timetable and through a different mechanism. Starting July 4, 2025, Medicare eligibility requires U.S. citizenship, LPR status, Cuban/Haitian entrant status, or Compact of Free Association residency.
Current Medicare enrollees who do not meet those requirements, including lawfully present seniors, face termination by January 2027, the summary says. For people who also depend on Medi-Cal, the shift threatens the stability of dual coverage at an age when gaps can quickly become medical crises.
H.R. 1 also reshapes access to Affordable Care Act marketplace help by cutting off premium tax credits for people who lose “qualified” status under the new rules. The summary describes two cutoffs: premium tax credits end for non-qualified immigrants below 100% federal poverty level by October 1, 2026, and for those at or above 100% federal poverty level by January 1, 2027.
The combined effect, as described in the analysis of the law’s impact, is that some older immigrants who lose full-scope Medi-Cal and cannot rely on Medicare will also lose the subsidy support that can make private plans affordable. Administrative checks and verification delays can also create gaps, including interim coverage denials even for citizens, the summary warns.
In California, the scale of disruption described in the draft runs well beyond a small set of cases. Up to 200,000 immigrant Medi-Cal members shift to “unsatisfactory status,” and statewide 3.4 million could lose coverage, including older non-LPRs, amid $30 billion annual federal funding cuts, the analysis says.
Nationally, the summary estimates that 1.3 million more immigrants become uninsured. It also points to $1 trillion in national Medicaid cuts over a decade, a figure that limits what states can replace with state-only programs.
The day-to-day consequences in clinics and hospitals can differ from county to county, but the analysis flags a common pattern: restricted-scope coverage reduces access to the preventive and lower-acuity services that often keep people out of the emergency room. For older immigrants, losing regular doctor visits and medication coverage can translate quickly into uncontrolled diabetes, unmanaged heart disease, or untreated depression.
Behavioral health systems also sit in the path of the funding shift. The analysis says reduced funding strains Medi-Cal behavioral health reforms and can cut services such as counseling and medications, increasing reliance on county crisis care. It adds that older immigrants face heightened hospitalization or incarceration risks.
California’s budget exposure extends beyond covering individual services. The analysis says H.R. 1 bans provider taxes, including the MCO tax, and caps rates in ways that end federal matching, forcing California to cover restricted services with state funds or cut benefits.
The draft also points to a specific match-rate change: emergency Medicaid match drops from 90% to regular FMAP. That shift would increase the state share of costs for emergency services even as more residents fall into emergency-only coverage.
The groups most affected are defined by immigration category and by whether a person depends on Medicare, Medi-Cal, or both. Refugees and asylees, who previously qualified for full Medi-Cal and Medicare, move to restricted-scope Medi-Cal only under the federal funding rules, with Medi-Cal changes dated Oct 1, 2026, and Medicare changes dated Jul 4, 2025, the quick-reference table shows.
Humanitarian parolees and trafficking survivors, listed as previously eligible for full Medi-Cal, shift to “None federally funded” coverage with an effective date of Oct 1, 2026, the table says. The analysis links that change to “Loss of preventive care,” reflecting how emergency-only coverage can leave routine treatment uncovered.
Dual-eligible Medicare beneficiaries who are not LPRs face a different cliff. The table lists “Medicare Dual Eligibles (non-LPR)” as previously covered by both programs and, post-H.R. 1, eligible for neither, with a termination point of Jan 2027 and “Full coverage termination” as the California impact.
Those timelines also intersect with the premium tax credit schedule. For refugees and asylees, the table notes “no PTCs by Jan 1, 2027,” aligning with the broader subsidy cutoff in the summary that ends premium tax credits for people at or above 100% federal poverty level by January 1, 2027.
The practical meaning of “from full to restricted” coverage is not a paperwork label but a change in what care is paid for. Full-scope Medi-Cal generally supports ongoing care for chronic conditions, prescriptions, and preventive services; the restricted-scope program described in the analysis covers emergency and pregnancy services, a narrower package that can leave people waiting until symptoms become emergencies.
“No federally funded coverage” carries a different implication: it signals that the state cannot claim federal matching dollars for the person’s care under the categories described, even if California chooses to offer state-funded help. The analysis frames this as a central tension for California, which can administer benefits but cannot compel the federal government to match spending that the law excludes.
The administrative side of the shift could add another layer of disruption. The summary says verification delays risk interim coverage denials even for citizens, a warning that reverification processes can interrupt access when agencies seek documentation or eligibility proof.
H.R. 1’s health coverage changes arrive alongside work requirements and six-month reverifications that the analysis says could disenroll 400,000 low-income individuals, including seniors, and raise uninsured rates. For older adults, the analysis suggests that paperwork barriers and frequent renewals can trigger loss of coverage even when someone remains eligible under the narrowed categories.
Because the law changes federal funding rules, state options to backfill coverage depend on California’s willingness and capacity to pay with state dollars. The analysis links that question to the broader fiscal environment, citing $30 billion annual federal funding cuts and a decade-long $1 trillion national Medicaid cut figure that constrains state-only alternatives.
California’s health system could also face knock-on effects that are not limited to those who lose coverage directly. When people shift from full benefits to emergency-only coverage, care often moves from scheduled visits to crisis settings, raising pressure on emergency departments and county safety-net systems, the analysis says.
The next steps for Californians who rely on Medi-Cal or Medicare will play out through implementation guidance and routine program communications. The analysis points readers toward renewal notices, managed care plan communications, and county eligibility office procedures as the places where reverification and termination timelines can translate into real coverage changes.
With October 1, 2026 approaching for Medi-Cal federal funding restrictions and January 2027 flagged for Medicare terminations for non-qualifying enrollees, the timeline in the draft sets up a staggered shift that families may feel first in mailboxes and enrollment systems, then in doctors’ offices when coverage no longer pays for routine care.
H.R. 1 Could Expand Medi-Cal Access for Older Immigrants
The implementation of H.R. 1 marks a major shift in healthcare access for older immigrants. By restricting federal funding to specific immigration categories, the law forces hundreds of thousands of Californians into emergency-only coverage. With Medi-Cal changes effective October 2026 and Medicare cuts in 2027, seniors face losing primary care and prescriptions, potentially leading to increased emergency room reliance and a $30 billion annual state funding deficit.
