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All states Immigrants & Medicaid after October 1

In effect since October 1, 2026

Immigrants and Medicaid: who still qualifies, who doesn't, and what to do

A federal law passed in 2025 (H.R. 1) changed which immigrants the federal government will pay Medicaid and CHIP for. The change took effect on October 1, 2026, in every state. It does not affect U.S. citizens. It does affect many people who are in the country legally and were covered on September 30.

In effect in all 50 states & D.C. Marketplace follows Jan 1, 2027 Emergency Medicaid continues

Legal status is no longer enough on its own.

Before October 1, most immigrants with a "qualified" status — refugees, people granted asylum, parolees, trafficking survivors — could get Medicaid like anyone else. Now federal money only pays for four groups. Here is the plain version:

✕ What it does not mean

It does not mean all immigrants lost coverage. Green-card holders, Cuban and Haitian entrants, COFA citizens, and — in most states — children and pregnant people keep full Medicaid. Emergency care is still covered for everyone who meets income rules.

✓ What it does mean

If you are a refugee, asylee, parolee, trafficking survivor, or have TPS and you don't have a green card, your full Medicaid ended on or around October 1 unless your state is paying for it with its own money or you fit an exception below.

Check this first

Who still qualifies for full Medicaid and CHIP

If any of these describes you, the October 1 change should not have ended your coverage. If it did, that is a records problem to fix, not a final answer.

U.S. citizens and nationalsNothing changed for you.
Green-card holders (lawful permanent residents)Usually after the five-year waiting period, as before. If you got your green card recently, tell the state — you have 90 days to prove it while coverage continues.
Cuban and Haitian entrantsNo waiting period.
COFA citizensPeople from the Marshall Islands, Micronesia and Palau living in the U.S. No waiting period.
Lawfully residing children — in 38 states and D.C.Under 19 in CHIP, under 21 in Medicaid, in states that chose the CHIPRA 214 option. Refugee and asylee children count.
Lawfully residing pregnant and postpartum people — in 32 statesThrough pregnancy and the postpartum period, in states that chose the option.

Not sure whether your state covers children or pregnant people this way? Your state Medicaid agency can tell you in one call, and the number is on every notice you've received. Our state guides list it too.

Who the change affects

Who lost full Medicaid on October 1

These groups are in the United States legally and were eligible before. From October 1, federal Medicaid pays only for emergency care for them, unless they also hold a green card or fit one of the exceptions above.

Refugees without a green cardIncluding people admitted in the last several years who are still waiting to adjust status.
People granted asylum without a green cardAsylum itself no longer qualifies you for federal Medicaid.
Humanitarian paroleesIncluding many Afghan and Ukrainian parolees.
Survivors of trafficking and certain abused spouses or childrenPreviously treated like refugees for benefits.
Temporary Protected Status (TPS)TPS holders were already ineligible for most Medicaid; the law now also removes them from Marketplace subsidies on January 1, 2027.
Anyone without a lawful statusUnchanged: not eligible before, not eligible now. Emergency Medicaid still applies.

How many people? States had to recheck every potentially affected enrollee by October 1. Reporting by KFF Health News counted more than 281,000 people expected to lose coverage in just nine states and D.C. — about 177,000 in Florida alone. Final numbers come later this fall.

Your letter explained

If you got a notice that your Medicaid is ending

States were required to check your status in a federal database first, then write to you if they couldn't confirm it. The rules give you real rights here. Use them.

If your status changed

If you now have a green card, or another status on the "still qualifies" list, tell the state immediately — by phone, online, or in person. You are entitled to a 90-day reasonable opportunity period to provide documents, and your coverage must continue during it.

If you think the decision is wrong

You have the right to a fair hearing. The state must give at least 10 days' written notice before ending coverage. If you request a hearing before the end date on the letter, your coverage usually continues until the hearing is decided.

Children's letters deserve a second look. In the 38 states that cover lawfully residing children, a refugee or asylee child should not have been terminated. Advocates in Florida reported families receiving termination notices for children who are still eligible. If that's your letter, call the number on it and ask for a review.

If you no longer qualify

Your options now

None of these replaces full Medicaid. Together they cover more than you might expect.

Emergency MedicaidHospitals are paid for emergency care — including labor and delivery — for anyone who meets income and residency rules, regardless of status. Ask the hospital's financial counselor to file it.
Community health centersPrimary care, prescriptions, and dental on a sliding fee scale for everyone. Find one near you.
State-funded coverage, where it existsCalifornia (through July 2027), New York, Oregon and Pennsylvania are using state money to keep many affected people covered. Ask your state agency whether a program applies to you.
Hospital financial assistanceNonprofit hospitals must have a financial assistance (charity care) policy. Ask for it before or after a visit — it applies regardless of immigration status.
Marketplace coverage — until December 31Through the end of 2026, lawfully present immigrants can still buy a Marketplace plan with tax credits. On January 1, 2027, subsidies narrow to the same four groups.
Legal help with your immigration statusIf a green card is within reach, it restores eligibility. Nonprofit legal aid can tell you where you stand. We don't collect any personal information here — talk to them directly.
Questions people are asking

Plain answers

Who can still get full Medicaid or CHIP after October 1, 2026?U.S. citizens and nationals; lawful permanent residents (green-card holders, usually after the five-year waiting period); Cuban and Haitian entrants; and COFA citizens of the Marshall Islands, Micronesia and Palau. In 38 states and D.C., lawfully residing children keep full coverage, and in 32 states lawfully residing pregnant and postpartum people do too, under a state option called CHIPRA 214.
Who lost Medicaid eligibility on October 1?Lawfully present immigrants who are not in the groups above: refugees and asylees who do not yet have a green card, humanitarian parolees (including many Afghan and Ukrainian parolees), survivors of trafficking, certain abused spouses and children, and people with Temporary Protected Status, among others. Being in the country legally is no longer enough on its own.
Does Emergency Medicaid still exist?Yes. Emergency Medicaid still pays hospitals for emergency care — including labor and delivery — for anyone who meets the state's income and residency rules, regardless of immigration status. It covers the emergency only, not ongoing care or prescriptions.
My child is a refugee or asylee. Did they lose coverage too?In most states, no. 38 states and D.C. chose to cover lawfully residing children under the CHIPRA 214 option, and the federal government has confirmed that refugees, asylees and other previously qualified groups count as lawfully residing. If your child received a termination notice in one of those states, ask the state to review it and request a fair hearing before the end date.
I got a letter saying my Medicaid is ending. What should I do?Read the date and the reason. If your status has changed — for example you now have a green card — tell the state right away; you are entitled to a 90-day reasonable opportunity period to prove it while your coverage continues. If you believe the decision is wrong, request a fair hearing before the termination date; asking before that date usually keeps your coverage running until a decision. The state must give at least 10 days' written notice before ending coverage.
What are my options if I no longer qualify?Community health centers treat everyone on a sliding fee scale regardless of status. Some states — including California, New York, Oregon and Pennsylvania — are paying for coverage with state money; ask your state agency. Hospital financial assistance and charity care programs are available to the uninsured. Marketplace plans with tax credits remain open to the groups above through December 31, 2026, then narrow to the same list on January 1, 2027.

MedicaidMatters is not a government website and is not affiliated with CMS or any state Medicaid agency. We never ask for your Social Security number, case number, or immigration documents. Every action here links to an official source. Sources: CMS State Health Official letter SHO #26-001 (April 8, 2026); KFF, "Implementation of Medicaid Immigrant Eligibility Restrictions Under the 2025 Reconciliation Law" (September 22, 2026); KFF Health News (September 30, 2026); H.R. 1 §§71109, 71110, 71301.

Open the letter. Check the list. Make the call.

If you still qualify, the fix is a phone call and a document. If you don't, there are still places to get care — and a deadline worth knowing for Marketplace coverage.

Find your state's agency →