A major change to Medicaid eligibility took effect in the US this month, putting hundreds of thousands of legally present immigrants at risk of losing their health coverage, including refugees, asylum seekers and survivors of sex trafficking.

The change stems from the 2025 reconciliation law signed by President Donald Trump. Starting 1 October, Medicaid eligibility for immigrants receiving federally funded coverage was narrowed largely to lawful permanent residents, certain Cuban and Haitian entrants, people from countries covered by the Compacts of Free Association and, in participating states, some lawfully residing children and pregnant people.

Unlike undocumented immigrants, many of the people affected had previously been legally eligible for Medicaid. The new rules mean that a person can have lawful permission to remain in the US yet no longer qualify for the programme because of their immigration category.

State data compiled by KFF Health News found that more than 281,000 immigrants in nine states and Washington, DC, were identified as potentially losing Medicaid coverage in October. The Congressional Budget Office has estimated that the changes eliminating Medicaid eligibility for certain noncitizen adults will leave about 100,000 additional immigrants uninsured by 2034.

Who Could Lose Medicaid Under the New Rules?

The affected groups include refugees and asylees who have not obtained green cards, as well as certain people granted humanitarian protection. Survivors of domestic violence and human trafficking with qualifying immigration statuses can also lose eligibility under the new rules.

The distinction matters because these people are not necessarily newly arrived or undocumented. Some have lived in the US for years and previously qualified for Medicaid after meeting income and other eligibility requirements.

Lawful permanent residents, or green card holders, remain eligible under the new federal rules if they meet the programme's other requirements, although some may still face existing waiting-period rules.

States can choose to use their own funds to maintain coverage for some affected immigrants, meaning the impact will not be identical across the country. Children and pregnant people who qualify under a separate Medicaid option for lawfully residing immigrants can also retain coverage in states that have adopted it.

Losing Insurance Can Mean Losing More Than a Doctor's Appointment

For people with chronic conditions, health insurance is often what makes ongoing treatment possible.

Medicaid can cover prescription medicines, specialist appointments, laboratory testing, preventive care and treatment for long-term illnesses. Losing coverage can therefore interrupt care even when someone is not experiencing an immediate medical emergency.

Research from the Commonwealth Fund has found that immigrants are more likely than US-born adults to be uninsured and to report delays in receiving medical care. Having a usual source of care is associated with greater use of preventive services and better health outcomes.

Without comprehensive coverage, people may postpone routine appointments or medications because of cost. A manageable health problem can then become more difficult and expensive to treat.

The effects can be particularly important for people who require regular monitoring, such as those with diabetes, hypertension, asthma or other chronic conditions.

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Emergency Care Is Not the Same as Full Coverage

The new rules do not mean that every affected immigrant will be unable to receive medical treatment.

Emergency Medicaid can remain available to people who meet the programme's other eligibility requirements but are ineligible for full Medicaid because of their immigration status, when they need treatment for an emergency medical condition.

But emergency coverage is fundamentally different from comprehensive health insurance.

It is designed for acute medical conditions rather than routine management of chronic disease, preventive appointments or ongoing specialist care. Someone who loses full Medicaid coverage may therefore still be able to receive emergency treatment while having fewer options for preventing that emergency in the first place.

That distinction can be particularly significant for people who already face barriers to healthcare because of language, transportation, cost or unfamiliarity with the US healthcare system.

The Health Impact Could Extend Beyond Those Losing Coverage

The coverage change could also put pressure on clinics and hospitals that care for uninsured patients.

When people delay routine care because they cannot afford it, they may eventually seek treatment when symptoms become severe enough to require emergency attention. Uninsured patients can also increase the amount of uncompensated care providers must absorb.

The Commonwealth Fund has warned that rising numbers of uninsured patients could place additional financial pressure on community health centres and hospitals, potentially affecting access to care more broadly.

For affected immigrants, however, the most immediate concern is continuity.

A refugee receiving treatment, a trafficking survivor managing a chronic illness or an asylum seeker relying on regular medication may suddenly have to determine whether they still qualify for coverage, whether their state offers an alternative and how to pay for care if they do not.

The new Medicaid rules are therefore more than an eligibility change on paper. For some legally present immigrants, 1 October therefore marked a change in eligibility that means access to federally funded Medicaid now depends not only on income and other programme requirements, but also on immigration category.

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