Hundreds of thousands of immigrants lose Medicaid starting October 1

Starting October 1, hundreds of thousands of lawfully present immigrants will begin losing Medicaid and CHIP coverage under eligibility changes passed in last year’s federal budget reconciliation law, according to a KFF analysis.

The law, H.R. 1, was signed in July 2025 and narrows Medicaid, CHIP, Medicare and Affordable Care Act marketplace eligibility to four categories of immigrants: lawful permanent residents, Cuban and Haitian entrants, people residing in the country under Compacts of Free Association with Pacific island nations, and, at state option, lawfully residing children and pregnant people. Refugees, asylees, people paroled into the country for at least a year, survivors of trafficking holding T visas, people with Temporary Protected Status, and other lawfully present immigrants fall outside those categories and lose eligibility.

The Congressional Budget Office estimates the changes will leave 1.4 million lawfully present immigrants uninsured by 2034: 100,000 losing Medicaid or CHIP coverage, 1.2 million losing marketplace coverage, and 100,000 losing Medicare. Marketplace subsidies for immigrants earning below the federal poverty line ended January 1, and subsidized marketplace coverage will be limited to the same four permitted categories starting January 1, 2027. People currently enrolled in Medicare or Medicaid outside the permitted categories keep coverage for up to 18 months after the law’s enactment, losing it no later than January 4, 2027.

A separate policy is compounding the effect on citizen children in mixed-status families. The Department of Homeland Security has proposed a public charge rule change that it said would remove about 4 million people from Medicaid rolls. Georgetown University’s Center for Children and Families found that figure includes households where only some members are noncitizens, and that many of the people losing coverage are US citizens or otherwise eligible for benefits who are being deterred by fear of the policy rather than made ineligible by it. The center’s research professor, Leonardo Cuello, found 1.8 million US citizen children stand to lose health coverage as a result, which would raise the national rate of uninsured children by more than 25%. DHS’s own proposed regulation acknowledged that coverage losses would occur among people “not subject to the public charge test.”

The Commonwealth Fund and Justice in Aging have both published separate analyses tracking the same eligibility changes, and the National Immigration Law Center has begun cataloging state-level responses as the October 1 deadline approaches. Washington state has said children and pregnant people can continue to apply for coverage through its Apple Health program regardless of immigration status, using state rather than federal funds.

Rosa María Carranza, a 67-year-old Oakland, California, resident who has held Temporary Protected Status since 2001, is among those who will lose Medicare under the law, according to KFF Health News. Carranza arrived in the US from El Salvador in 1991 and has paid into Medicare and Social Security for 24 years, contributing tens of thousands of dollars according to her Social Security Administration earnings record. “It’s like getting slapped on the face after more than 30 years working for the system here,” she said.