Medicaid Eligibility Narrows for Immigrants as New Federal Rules Take Effect

More than 281,000 immigrants identified by nine states and Washington, D.C., are expected to lose federally supported Medicaid coverage in October as new eligibility restrictions under President Donald Trump’s 2025 tax and spending law take effect.

By yourNEWS Media Newsroom

Hundreds of thousands of immigrants are beginning to lose Medicaid eligibility under federal rules that took effect Oct. 1, marking one of the first major health-coverage provisions of President Donald Trump’s One Big Beautiful Bill Act to reach implementation.

The changes narrow the categories of noncitizens for whom states can receive federal Medicaid and Children’s Health Insurance Program funding. State data collected by KFF Health News identified more than 281,000 immigrants in nine states and Washington, D.C., who are expected to lose Medicaid coverage during October. Final enrollment-loss figures will not be available until states complete the disenrollment process later this fall.

The immediate state totals are considerably larger than the Congressional Budget Office’s estimate that the Medicaid and CHIP immigration provisions would result in approximately 100,000 additional people being uninsured by 2034. The figures measure different outcomes: state estimates count people expected to lose Medicaid, while the CBO estimate counts how many ultimately remain uninsured after accounting for people who obtain other coverage.

Florida reported the largest known group, identifying nearly 177,000 enrollees who could lose eligibility. North Carolina estimated approximately 29,000, Arizona nearly 28,000, New Jersey between 15,000 and 25,000, and Washington state approximately 11,000, according to KFF Health News.

The restrictions stem from the reconciliation law Trump signed July 4, 2025. Beginning Oct. 1, 2026, federally funded Medicaid and CHIP eligibility for noncitizens is generally limited to lawful permanent residents, commonly known as green-card holders; qualifying Cuban and Haitian entrants; and people living in the United States under Compacts of Free Association with the Marshall Islands, Micronesia and Palau. States may also continue using an existing option to cover lawfully residing children and pregnant women.

Groups losing federal eligibility include many refugees and asylees who have not yet obtained permanent residency, along with some humanitarian immigrants who previously qualified for Medicaid when they satisfied income and other program requirements. KFF Health News reported that affected populations also include some trafficking victims and Afghan interpreters who assisted U.S. forces.

The policy does not represent a new removal of undocumented immigrants from ordinary federally funded Medicaid. People without qualifying immigration status were already generally prohibited under longstanding federal law from receiving full Medicaid benefits, although they can receive Emergency Medicaid when they otherwise meet eligibility requirements and require qualifying emergency treatment.

Emergency Medicaid remains available under the new law. The Centers for Medicare & Medicaid Services also said the restrictions do not eliminate states’ authority to cover qualifying lawfully residing children and pregnant women under existing Medicaid and CHIP options.

States were directed to review potentially affected Medicaid beneficiaries before the Oct. 1 implementation date. Under CMS guidance, agencies are expected to first attempt to confirm immigration status through existing records and federal databases before requesting additional documentation from beneficiaries.

People whose qualifying status cannot immediately be verified can receive additional time to submit documentation. Medicaid agencies must also provide advance notice and appeal rights before terminating coverage, meaning some people identified as potentially affected may ultimately remain eligible.

The administration has framed the restrictions as part of a broader effort to concentrate federal health spending on eligible Americans and tighten controls over Medicaid spending.

Trump has repeatedly said his health-policy changes are intended to protect benefits for children, pregnant women, seniors, people with disabilities and other low-income Americans while reducing waste, fraud and abuse. The White House has separately promoted Medicaid work and community-engagement requirements as a way to encourage employment, training and greater economic self-sufficiency among able-bodied adults.

The administration has also argued more broadly that taxpayer-supported public benefits should not encourage dependence among people who lack qualifying immigration status. A February 2025 executive order on federal benefits directed agencies to enforce existing eligibility laws and protect federal resources for people legally entitled to receive them.

CMS Administrator Dr. Mehmet Oz described implementation of the new Medicaid rules as a statutory responsibility when the agency issued guidance to states in April.

“The Trump Administration has a public mandate, a statutory obligation, and a moral duty to safeguard our federal healthcare programs,” Oz said. “Today, we’re honoring all three by providing clear guidelines to help states follow the law and safeguard taxpayer dollars.”

The CBO estimates that restricting Medicaid and CHIP eligibility for the affected immigration categories will reduce federal spending by approximately $6.2 billion and increase the number of uninsured people by roughly 100,000 in 2034.

Those figures represent only one portion of the health-related immigration provisions contained in the 2025 law.

Beginning Jan. 1, 2027, eligibility for federal subsidies used to purchase Affordable Care Act marketplace insurance will also be narrowed. Subsidized marketplace coverage will generally remain available to lawful permanent residents, Cuban and Haitian entrants and people residing in the United States under the Compact of Free Association, while other lawfully present immigrants may still purchase marketplace insurance without federal financial assistance.

CBO estimated that the marketplace restriction will reduce enrollment among immigrants receiving ACA coverage by an average of about 800,000 annually over the 2025-2034 budget window. KFF Health News reported that roughly 1 million lawfully present immigrants are projected to lose eligibility for marketplace subsidies by 2034.

Separate Medicare changes are expected to affect approximately 100,000 immigrants, according to the CBO estimates cited by KFF. Combining the Medicaid, marketplace and Medicare provisions, approximately 1.4 million lawfully present immigrants could ultimately become uninsured by 2034, although those figures are projections rather than a count of people who have already lost insurance.

The distinction has become increasingly important as the first Medicaid terminations begin.

The 281,000 figure represents people whom participating states and Washington, D.C., identified as expected to lose Medicaid during October. It does not mean all 281,000 will become uninsured. Some may qualify under another immigration category, move to employer-sponsored insurance, purchase private coverage or receive benefits through programs financed entirely by their states.

Several states are already using their own money to preserve coverage for at least some residents who no longer qualify for federal matching funds.

California expects roughly 148,000 immigrants to lose federally supported Medicaid eligibility but has allocated approximately $365 million for a separate state-financed program designed to keep them insured through July 2027. New York and Pennsylvania also maintain state-funded coverage for many people affected by the federal restrictions.

Other states offer fewer alternatives, leaving some people who lose comprehensive Medicaid with Emergency Medicaid, community health centers, charity programs or unsubsidized private coverage as their principal options.

Critics of the policy argue that its effects extend beyond illegal immigration because refugees, asylees, trafficking victims and other people lawfully admitted into the United States are among those losing eligibility before they obtain green cards.

Immigrant-assistance organizations have also warned that people undergoing treatment for serious or chronic medical conditions may have difficulty replacing Medicaid quickly, particularly when they lack employer-sponsored insurance or cannot afford unsubsidized private plans.

The administration and supporters of the legislation have emphasized a different concern: reducing federal expenditures, enforcing eligibility standards and reserving taxpayer-supported benefits for the populations Congress has designated as eligible.

The Medicaid change is part of a much larger restructuring of the program. CBO estimates that the Medicaid provisions of the enacted 2025 reconciliation law will reduce federal deficits by hundreds of billions of dollars through 2034 while increasing the number of uninsured people by approximately 7.5 million overall when immigration restrictions, work requirements, eligibility reviews and other provisions are considered together.

The immigration provisions are among the earliest of those changes to take effect nationwide. Work and community-engagement requirements for certain Medicaid adults are scheduled on a separate implementation timeline.

For the immigrants directly affected this month, the immediate question is whether another form of coverage is available once federal Medicaid eligibility ends.

For states, the decision is increasingly financial: accept the narrower federal eligibility rules and terminate coverage, or use state tax dollars to replace some or all of the federal assistance that disappeared Oct. 1.