The immigrant-eligibility restrictions in H.R. 1 — the One Big Beautiful Bill Act, signed by President Trump on July 4, 2025 — took effect on October 1, 2026. From that date, refugees, asylees without a green card, humanitarian parolees, survivors of human trafficking and domestic violence, and Iraqi and Afghan special immigrant visa holders are no longer eligible for federally funded Medicaid or the Children's Health Insurance Program (CHIP), as long as they do not yet hold a green card. Undocumented immigrants were already barred from federal coverage; this time the cutoff hits people with legal status.
The groups that stay eligible are a short list: U.S. citizens, lawful permanent residents (most still subject to the five-year waiting period under the 1996 welfare reform law, which H.R. 1 does not change), Cuban and Haitian entrants, migrants from Micronesia, the Marshall Islands and Palau under the Compacts of Free Association (COFA), and lawfully residing children and pregnant people in states that elected the CHIPRA 214 option. Emergency Medicaid remains available. Georgetown University's Edwin Park notes the groups being removed have been eligible since 1996 — the first wholesale removal in three decades.
Data compiled by KFF Health News across nine states and the District of Columbia shows more than 281,000 people at risk of losing coverage this month: nearly 177,000 in Florida, about 29,000 in North Carolina, roughly 28,000 in Arizona, 11,000 in Washington state, 15,000 to 25,000 in New Jersey, and about 5,550 in Minnesota. The Denver Post estimates about 5,900 documented immigrants in Colorado are affected, including refugees, asylees, some domestic violence and trafficking survivors, and even Native Americans born in Canada. In Maryland, up to 4,500 residents could lose coverage — Leidi Garcia of the immigrant advocacy group We Are CASA says a woman recently diagnosed with colon cancer came to them for help, and her biggest worry is: "Where are we going to send these individuals to actually be seen?"
The Congressional Budget Office's national estimate is more conservative: about 100,000 more people uninsured by 2034, saving the federal government $6.2 billion over that period. Set against the whole law — H.R. 1 cuts Medicaid by roughly $900 billion to $1 trillion over ten years — the savings from this provision are a fraction.
Many of those losing coverage are already on the path to permanent status: refugees can apply for a green card after a year in the country, and many applied on time. But U.S. Citizenship and Immigration Services now has nearly 150,000 refugee green card applications pending, and processing times have more than doubled since the end of 2024. "When a family loses coverage, there's no reliable health care equivalent of a food bank," said Krish O'Mara Vignarajah, president and CEO of Global Refuge. "These new restrictions only increase the likelihood that children and families are going to ration essential medication or put off care until a manageable problem becomes an emergency room visit."
States were required to redetermine potentially affected enrollees by October 1 — first using existing data and automated matches, including the Department of Homeland Security's SAVE system and Social Security Administration databases, before asking people for documents. KFF cautions that SAVE is a point-in-time system that may not reflect a later change in someone's status, making errors likely. Immigrant advocates report some states did not start sending notices until September, leaving recipients little time to respond or challenge mistakes.
In the same week, a second front is tightening: a Department of Homeland Security rule tightening the "public charge" test for visas and green cards takes effect October 2, and 21 states plus a coalition of cities have already sued to block it.
This is only the first wave. H.R. 1 extends the same restrictions to Affordable Care Act marketplace subsidies and Medicare coverage beginning in 2027. The Congressional Budget Office estimates about 1 million lawfully present immigrants will lose eligibility for government subsidies to buy individual coverage on ACA marketplaces by 2034. The Medicare Rights Center's summary is blunt: as of October 1, 2026, "most lawfully present immigrants in the U.S." are no longer eligible for Medicaid.