- From October 1, 2026, federal Medicaid and CHIP funds cover only citizens, green card holders, Cuban/Haitian entrants and COFA migrants.
- Refugees, asylees, parolees and trafficking survivors keep emergency Medicaid, and children and pregnant people stay covered in 39 states plus DC using the CHIPRA 214 option.
- States must review each enrollee and give at least 10 days’ notice with a fair hearing right before ending coverage.
Starting Thursday, October 1, 2026, refugees, asylees, humanitarian parolees, survivors of human trafficking and several other groups of lawfully present immigrants lose access to full, federally funded Medicaid and CHIP. The change comes from Section 71109 of H.R. 1, the 2025 budget law (Public Law 119-21, often called the One Big Beautiful Bill Act), signed on July 4, 2025.
From October 1, federal Medicaid and CHIP funding for noncitizens is limited to four groups: lawful permanent residents (green card holders), Cuban and Haitian entrants, people living in the U.S. under the Compacts of Free Association with the Marshall Islands, Micronesia and Palau, and U.S. citizens and nationals. Everyone else loses full coverage unless they fit one of three narrow exceptions, including emergency Medicaid and a state option that covers lawfully residing children and pregnant people.
Free toolUSCIS Receipt Number DecoderThe Congressional Budget Office estimated the Medicaid and CHIP restriction would cut federal spending by $6.2 billion and leave about 100,000 more people uninsured by 2034. Separate H.R. 1 provisions tighten Medicare eligibility starting January 4, 2027 and ACA Marketplace subsidies starting January 1, 2027.
Coverage does not simply switch off at midnight. Federal rules require states to review each affected person, check for any other route to coverage, and send advance written notice with the right to a fair hearing before ending benefits. This article explains who is affected, who keeps coverage, what states can still do, and the steps to take this week.
What Changes on October 1
Section 71109 does not rewrite who counts as a “qualified” immigrant under the 1996 welfare law. Instead, it changes who the federal government will pay for. It amends Sections 1903(v) and 2107(e)(1) of the Social Security Act so that federal matching funds for full Medicaid and CHIP benefits flow only for the four protected groups. The Centers for Medicare and Medicaid Services (CMS) confirmed in a State Health Official letter, SHO #26-001, dated April 8, 2026, that the limit applies to new applicants and to people already enrolled on and after October 1.
CMS also decided that states are not required to replace the lost coverage with their own money. In the agency’s words, “CMS will not require states to provide state-only funded health coverage to qualified noncitizens for whom FFP is not available,” naming “asylees, refugees, parolees, or victims of trafficking” as examples. Any coverage a state pays for entirely on its own is not considered Medicaid.
A companion provision, Section 71110, also takes effect October 1. It ends the enhanced 90% federal match states received for emergency Medicaid services given to noncitizens in the adult expansion group, capping it at each state’s regular match rate. That shifts costs to states but does not by itself remove anyone’s coverage.
Who Loses Coverage and Who Keeps It
The groups hit hardest are those Congress had long treated as refugees for benefits purposes. Under the 1996 welfare law, refugees and asylees could enroll in Medicaid right away, with no five-year waiting period. Other federal laws extended that “refugee” treatment to certain survivors of human trafficking and to certain Afghan and Ukrainian parolees. From October 1, none of those groups qualifies for federal matching funds unless the person also holds a green card or fits an exception.
Green card holders keep eligibility, but the old rules still apply to them. CMS told states to “continue to apply the five-year waiting period to LPRs” unless an exception applies. According to KFF’s review of the guidance, refugees and asylees who later adjust to permanent residence stay exempt from that waiting period, so a former refugee with a green card is not newly locked out.
The Exceptions That Survive
The law carves out exactly three exceptions, and CMS said Section 71109 “did not make any changes” to the first two.
- Emergency Medicaid. People who meet a state’s income and residency rules can still get coverage for treatment of an emergency medical condition, including labor and delivery, regardless of immigration status.
- The CHIPRA 214 option. States may cover lawfully residing children (up to age 21 in Medicaid and age 19 in CHIP) and pregnant people with federal funds. As of April 2026, 39 states, the District of Columbia and three territories had elected it. CMS confirmed that refugees and other qualified noncitizens count as “lawfully residing,” so a refugee child or a pregnant asylee in those states keeps full coverage.
- Health Services Initiatives. State-designed CHIP programs that improve the health of low-income children remain fundable.
Newly arrived refugees also have a separate program. The federal Office of Refugee Resettlement pays for Refugee Medical Assistance for refugees who do not qualify for Medicaid. ORR cut that benefit from 12 months to 4 in March 2025, then raised it to 8 months in a Federal Register notice published July 14, 2026, for people whose eligibility date is on or after January 1, 2026. Refugee Medical Assistance does not restart when Medicaid ends: a person gets only the months left in their original window.
What Happens to People Already Enrolled
CMS told states to treat October 1 as a change in circumstances that requires a fresh look at every potentially affected enrollee. States must first try to confirm each person’s status through the Department of Homeland Security’s SAVE database without contacting them. If that fails, the state must ask the enrollee for information and give “a reasonable period of time” to respond before taking any adverse action.
If an enrollee reports a new status the state cannot verify, such as a recently approved green card, the state must give a 90-day reasonable opportunity period to prove it. Before ending coverage, the state must check every other basis of eligibility, including the CHIPRA 214 option and emergency Medicaid, and must send written notice at least 10 days before termination, with the right to a fair hearing.
Two groups face sharper cutoffs. Adults and children in a Medicaid continuous eligibility period, including people in continuous postpartum coverage, drop to emergency Medicaid for the rest of that period unless they qualify under the CHIPRA 214 option. In a separate CHIP program, federal funding for affected children ends on October 1 because separate CHIP has no emergency coverage category.
What States Can Still Do
H.R. 1 does not bar states from paying for coverage themselves, and a few are trying. KFF reports that California and Oregon are moving affected immigrants into state-funded programs. In New York, a longstanding state court ruling requires state-funded coverage for lawfully present immigrants who would qualify for Medicaid except for their immigration status.
The broader trend runs the other way. KFF has tracked states that eliminated some adult coverage in their immigrant health programs, including Illinois, Minnesota and the District of Columbia, and states that closed enrollment or lowered caps, including California, Colorado, DC and Washington. Whether an affected person keeps any coverage after October 1 depends heavily on where they live.
We found no lawsuit that has blocked Section 71109. Separate litigation over Medicaid work requirements and the new DHS public charge rule, which took effect September 18, does not affect the October 1 eligibility change.
Medicare and Marketplace Changes Come Next
Medicaid is the first of three H.R. 1 health restrictions built around the same four protected groups. Medicare (Section 71201) already applies the new limits to anyone applying since July 4, 2025. People enrolled before that date who lack a qualifying status lose Medicare starting January 4, 2027. The Social Security Administration had until July 4, 2026 to identify them and must notify them. CBO estimated about 100,000 more uninsured people from this change by 2034.
ACA Marketplace subsidies change in two steps. From the 2026 tax year, lawfully present immigrants with income under 100% of the federal poverty level, who could previously get premium tax credits when barred from Medicaid by status, lost that option. From tax years beginning after December 31, 2026, premium tax credits are limited to green card holders, Cuban and Haitian entrants and COFA migrants. Georgetown University’s Center for Children and Families estimates those two changes leave about 300,000 and 900,000 people uninsured, respectively. Our coverage of IRS Revenue Procedure 2026-26 on 2027 premium tax credits covers the dollar figures.
Does Using Coverage Hurt a Green Card Case?
Many families worry that using any health program will count against them under the public charge rules. For refugees and asylees, the answer is clearer than for most: people adjusting status under Section 209 of the Immigration and Nationality Act as refugees or asylees are not subject to the public charge ground of inadmissibility. Emergency Medicaid or state-funded coverage does not change that.
Other families should check how the rules apply to them before dropping coverage out of fear. Our explainer on whether a U.S. citizen child’s Medicaid or SNAP use can affect a parent’s green card case walks through the current rule. For refugees and asylees, the most useful long-term step is adjusting to permanent residence, since green card holders keep federal eligibility. Our guide to Form I-485 filing covers the application.
What to Do Before and After October 1
Most affected enrollees will hear from their state Medicaid agency by mail or through an online account. The steps below apply whether or not a notice has arrived yet.
Refugees and asylees who have waited to file for a green card have a stronger reason to move now. Refugees must apply for adjustment after one year in the U.S., and asylees may apply after one year. Permanent residence restores federal eligibility for Medicaid, Medicare and Marketplace subsidies under all three H.R. 1 provisions.
For background on how the five-year waiting period and state-only programs worked before this change, see our guide to Medicaid rules for immigrants. VisaVerge will update this article if CMS issues new guidance or a court acts on Section 71109.
Frequently Asked Questions
Do refugees lose Medicaid on October 1, 2026?
Refugees without a green card lose full federally funded Medicaid on October 1, 2026 under Section 71109 of H.R. 1. They can still get emergency Medicaid, and refugee children and pregnant people keep full coverage in states that use the CHIPRA 214 option.
Which immigrants can still get Medicaid after October 1, 2026?
Federal Medicaid and CHIP funding covers U.S. citizens and nationals, lawful permanent residents, Cuban and Haitian entrants, and COFA migrants from the Marshall Islands, Micronesia and Palau. Lawfully residing children and pregnant people also stay covered in the 39 states, DC and three territories using the CHIPRA 214 option.
Do asylees keep Medicaid in 2026?
Asylees keep Medicaid only through September 30, 2026. From October 1, asylees without a green card qualify only for emergency Medicaid, unless they are children or pregnant people in a CHIPRA 214 state or live in a state that pays for coverage with its own funds.
Will my Medicaid be cut off immediately on October 1?
Not automatically. CMS letter SHO #26-001 requires states to check your status through SAVE, ask for information if needed, consider every other basis for coverage, and send written notice at least 10 days before ending benefits, with the right to a fair hearing.
Do refugees and asylees with a green card face the five-year Medicaid waiting period?
No. Green card holders keep federal eligibility after October 1, and refugees and asylees who adjust to permanent residence remain exempt from the five-year waiting period under 8 U.S.C. 1613(b), according to KFF’s analysis of the CMS guidance.
Is emergency Medicaid still available to immigrants after October 1?
Yes. Section 71109 did not change emergency Medicaid, which covers treatment of emergency medical conditions, including labor and delivery, for people who meet state income and residency rules. Separate CHIP programs have no emergency category.
When do immigrants lose Medicare and Marketplace subsidies under H.R. 1?
Current Medicare enrollees without a qualifying status lose coverage starting January 4, 2027. ACA premium tax credits are limited to green card holders, Cuban and Haitian entrants and COFA migrants for tax years beginning after December 31, 2026.
Can states keep covering refugees and asylees with their own money?
Yes. H.R. 1 does not bar state-funded coverage, but CMS will not require it and does not treat it as Medicaid. KFF reports California and Oregon are moving affected immigrants into state programs, while several states have cut back immigrant coverage.
