New federal rules taking effect October 1 will significantly change Medicaid eligibility for certain lawfully present immigrants in the United States, putting some refugees, asylum seekers and other legal immigrants at risk of losing federally funded health coverage.
The changes stem from the 2025 federal reconciliation law and will restrict federal Medicaid and Children’s Health Insurance Program (CHIP) funding for several categories of noncitizens who were previously eligible. Under the new rules, federally funded Medicaid eligibility will generally be limited to lawful permanent residents, certain Cuban and Haitian entrants, people from the Compact of Free Association (COFA) countries, and lawfully residing children and pregnant people in states that have adopted the relevant coverage option.
As a result, many other lawfully present immigrants—including refugees and asylum seekers who have not obtained green cards—could lose eligibility. Other affected groups include some people with humanitarian immigration statuses, such as certain U visa holders and individuals with Temporary Protected Status.
Medicaid is one of the United States’ largest public health insurance programs, providing coverage to millions of low-income Americans. Under the new rules, states must review the eligibility of potentially affected existing enrollees and verify whether they have an immigration status that qualifies under the revised federal requirements. States may use federal databases, including the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) system, before requesting additional documentation from beneficiaries.
Not every immigrant will be affected in the same way. Eligibility will depend on immigration status, income, state of residence and other Medicaid requirements. Lawful permanent residents, for example, remain eligible under the new rules, although some may still be subject to Medicaid’s existing five-year waiting period depending on their circumstances. Refugees who later obtain green cards can also remain eligible under applicable rules.
States retain some options to continue coverage using their own funds. In addition, federal Medicaid matching funds will remain available for emergency medical conditions when other Medicaid eligibility requirements are met. States may also continue to provide federally supported Medicaid and CHIP coverage to certain lawfully residing children and pregnant people under an existing federal option.
The changes could create significant challenges for immigrant families who lose coverage. Without Medicaid, families may have to pay more directly for doctor visits, prescription medicines and other medical services.
The Congressional Budget Office estimates that the new Medicaid and CHIP immigrant eligibility restrictions will reduce federal spending by about $6.2 billion and result in an additional 100,000 people becoming uninsured by 2034.
States are therefore preparing to notify potentially affected beneficiaries and conduct new eligibility reviews. People who receive notices about their Medicaid status may need to provide updated immigration documentation or seek information from their state Medicaid agency to determine whether they remain eligible under the new rules.
