For older immigrants and their families, the calendar is already counting down to a healthcare crisis that federal law has made certain.
On October 1, 2026 — just 100 days from the publication of this article — the federal eligibility rules for Medicaid will change in ways that eliminate coverage for hundreds of thousands of people who are in the United States lawfully and have done nothing wrong. On January 4, 2027 — three months after that — a parallel Medicare cut will take effect, removing coverage for current Medicare enrollees who do not meet the narrowed eligibility criteria.
For some older immigrants, the result will be the sequential loss of both healthcare programs within four months.
These changes were enacted in H.R. 1 (P.L. 119-21), the federal budget reconciliation bill signed into law in July 2025, which is also referred to as the "One Big Beautiful Bill Act" or the "Working Families Tax Cuts Act." The Congressional Budget Office (CBO) estimates that the immigration-related provisions will cause at least 100,000 people in Medicaid and 100,000 people in Medicare to lose their health coverage, plus approximately 900,000 to lose marketplace coverage by 2034, with a total of more than 1.4 million lawfully present immigrants losing some form of health coverage.
Who Loses Coverage — and When
The specifics matter enormously. Under H.R. 1 Section 71109, beginning October 1, 2026, federal Medicaid and CHIP funding will be restricted to only four categories of non-citizens: lawful permanent residents (green card holders), Cuban and Haitian entrants, COFA migrants (citizens of the Marshall Islands, Micronesia, and Palau residing in the U.S.), and, at the state option, lawfully residing children and pregnant adults.
This means that individuals with the following legal statuses, who were eligible for Medicaid before H.R. 1, will lose federal Medicaid coverage on October 1, 2026:
- Refugees
- Asylees (people granted asylum)
- Parolees who have been present at least one year
- Holders of Temporary Protected Status (TPS)
- Survivors of domestic violence and trafficking (T Visa and related holders)
- Special immigrant visa holders (many SIV holders are Afghan and Iraqi individuals who assisted U.S. military operations)
- Other lawfully present immigrants who do not fall into the four permitted categories
Under a separate provision, H.R. 1 Section 71201, Medicare eligibility has been similarly narrowed. People who became newly eligible for Medicare on or after July 4, 2025, must now be in one of the four permitted categories to enroll. Current Medicare enrollees who are not in one of those categories, and who enrolled before July 4, 2025, may stay enrolled for now, but will have their Medicare coverage terminated on January 4, 2027.
| Coverage Change | Effective Date | Who Is Affected |
| Medicaid eligibility narrowed | October 1, 2026 | Refugees, asylees, TPS holders, trafficking survivors, parolees, other lawfully present immigrants |
| New Medicare enrollment restricted | July 4, 2025 (already in effect) | Non-citizens outside 4 permitted categories newly enrolling in Medicare |
| Current Medicare enrollees lose coverage | January 4, 2027 | Current Medicare enrollees not in permitted categories |
| ACA marketplace subsidies eliminated below 100% FPL | January 1, 2026 (already in effect) | Lawfully present non-citizens below the poverty line |
| ACA marketplace subsidies restricted | January 1, 2027 | Most lawfully present non-citizens |
| Total estimated coverage losses | Gradual through 2034 | ~1.4 million lawfully present immigrants (KFF/CBO estimates) |
The Human Impact — Particularly for Older Immigrants
Justice in Aging — an elder law advocacy organization focused on older adults living in poverty — has published the most detailed analysis of the effect on older immigrants. Their assessment is direct: some older immigrants who are dually eligible for Medicare and Medicaid will lose both sources of coverage within a four-month window. For these individuals — many of whom have chronic diseases, are in the middle of ongoing treatments, and cannot afford private insurance — the loss of both programs is effectively the loss of all healthcare access.
As NPR reported in April 2026, the categories of immigrants now losing coverage do have legal status. Many are longtime U.S. residents. Many are people who fled violence, famine, or persecution and were granted humanitarian protection by the United States government. TPS holders — many of whom have lived in the U.S. for 20 to 30 years — are among those affected. One person NPR profiled had worked in the U.S. for decades, paid into Social Security and Medicare, and now faces losing both Medicare coverage and the possibility of Social Security benefits.
The Commonwealth Fund analysis notes that while emergency departments are legally required under EMTALA to provide stabilizing care for any patient regardless of citizenship status, that provision does not cover ongoing chronic disease management, prescription drugs, specialist care, preventive care, or any non-emergency services. For people managing diabetes, heart disease, kidney disease, cancer, or other chronic conditions through Medicaid or Medicare, losing coverage means losing the ongoing care that prevents emergencies from occurring in the first place.
What Affected Individuals and Advocates Are Doing
State governments are the first line of response. Beyond the Basics notes that states may use their own funds to provide coverage to people beyond the federally permitted categories, meaning that whether or not an affected person has any coverage after October 1 depends significantly on which state they live in. California, New York, Illinois, and Washington are among the states that have indicated willingness to explore state-funded coverage options. In California, State Assembly member Mia Bonta has announced she is working on a legislative budget solution. However, budget constraints and timeline challenges make state action uncertain in many cases.
Advocacy organizations including Justice in Aging, the Center for Children and Families at Georgetown University, and the National Immigration Law Center are urging affected individuals to verify their immigration status category, seek legal aid assistance to determine whether naturalization or another pathway to permanent residency is achievable before October 1, and explore state-specific programs, community health centers, and charity care options that may be available regardless of immigration status.
Community health centers funded under Section 330 of the Public Health Service Act are required to serve patients regardless of ability to pay or immigration status — though Justice in Aging notes that the administration's reinterpretation of PRWORA verification processes may further chill access among older immigrants who fear that seeking care could affect their immigration status.
Frequently Asked Questions
What happens to immigrants' Medicaid on October 1, 2026?
Under H.R. 1 Section 71109, beginning October 1, 2026, federal Medicaid and CHIP funding will only be available for lawful permanent residents (green card holders), Cuban/Haitian entrants, COFA migrants, and, at the state option, lawfully residing children and pregnant adults. All other lawfully present immigrants — including refugees, asylees, TPS holders, trafficking survivors, and parolees — will lose federal Medicaid coverage.
When does Medicare change for immigrants?
Under H.R. 1 Section 71201, new Medicare enrollees as of July 4, 2025 must already meet the narrowed eligibility criteria. Current Medicare enrollees who do not meet those criteria will have their Medicare coverage terminated on January 4, 2027.
Which immigrants are NOT affected by these changes?
Lawful permanent residents (green card holders), certain Cuban and Haitian entrants, and COFA migrants (from the Marshall Islands, Micronesia, and Palau) retain Medicaid, Medicare, and marketplace subsidy eligibility. U.S. citizens are not affected by these changes.
How many people will lose health coverage?
The Congressional Budget Office estimates at least 100,000 Medicaid enrollees and 100,000 Medicare enrollees will lose coverage due to the immigration-related provisions, plus approximately 900,000 marketplace enrollees by 2034, for a total exceeding 1.4 million lawfully present immigrants, according to KFF analysis.
What options do affected immigrants have?
Affected individuals should contact an immigration attorney or legal aid organization immediately to determine whether naturalization or adjustment of status is achievable before October 1, 2026. Community health centers funded under Section 330 must serve patients regardless of ability to pay or immigration status. Some states are developing state-funded coverage programs. Contact Justice in Aging at 1-800-725-8986 or the National Immigration Law Center for specific guidance.
