Refugees and legal immigrants lose Medicaid under 2025 budget law

Overview

Updated Yesterday

On October 1, refugees, asylum seekers, and other legal immigrants began losing Medicaid coverage nationwide. The cutoff comes from H.R. 1, the Republican budget bill passed in July 2025, which limits the program to green card holders and a few other groups. State tallies are emerging: Arizona reported 29,000 people cut, Florida close to 177,000, and KFF estimates more than 281,000 people in nine states and the District of Columbia have lost coverage.

More cuts arrive in January, when roughly 1 million immigrants lose eligibility for Affordable Care Act subsidies and about 100,000 lose Medicare access. H.R. 1 also sets six-month eligibility redeterminations and work requirements starting then. The Congressional Budget Office projects 7.5 million fewer people with health insurance overall.

Why it matters

Refugees are more likely than other groups to have serious health conditions; losing coverage cuts off access to doctors, prescription drugs, and ongoing treatment.

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Key Indicators

281,000+

People losing Medicaid in October

KFF estimate based on state data from nine states and the District of Columbia.

1 million

Immigrants losing ACA subsidies

Congressional Budget Office projection for the January 2027 change.

100,000

Immigrants losing Medicare access

Congressional Budget Office forecast for the same January change.

Voices

Curated perspectives — historical figures and your fellow readers.

Ever wondered what historical figures would say about today's headlines?

People Involved

Mustafa Rfat

Professor of social work, University of Nebraska at Omaha

Former refugee from Iraq, now a U.S. citizen

Drishti Pillai

Director of immigrant health policy, KFF

Documenting the impact of the H.R. 1 changes

Mark Schaefer

Vice president of system innovation and financing, Connecticut Hospital Association

Warned about rising uncompensated care costs

Organizations Involved

KFF (Kaiser Family Foundation)

Nonpartisan health policy research organization

Tracking the impact of the Medicaid eligibility changes

KFF (formerly the Kaiser Family Foundation) researches health policy and produces the KFF Health News analysis cited in coverage of the October 2026 coverage loss.

Connecticut Department of Social Services

State agency

Administering the coverage loss in Connecticut

The Connecticut agency estimated that about 3,200 noncitizens in the state would lose Medicaid coverage on October 1.

Timeline

July 2025 January 2027

5 events Latest: 5 days ago

Tap a bar to jump to that date

January 2027
ACA subsidies and Medicare changes take effect
Upcoming Policy change

Roughly 1 million immigrants lose Affordable Care Act subsidy eligibility; about 100,000 lose Medicare access.
January 1st, 2027
October 2026
CMS asks to add codes for reporting immigrant coverage terminations
Latest Administrative

A Federal Register notice requests OMB approval of new T-MSIS codes identifying disenrollment related to immigration status or verification failure. Comments are due November 6.
5 days ago
Refugees and legal immigrants lose Medicaid coverage
Policy change

An estimated 280,000 people lose coverage as the new eligibility rules take effect nationwide.
October 1st, 2026
States report initial Medicaid coverage losses
Implementation

Arizona reported 29,000 legal immigrants cut from Medicaid; Florida put the number near 177,000. Virginia reported reaching out to about 5,800 affected people.
October 1st, 2026
July 2025
Republicans pass H.R. 1, the One Big Beautiful Bill Act
Legislation

The budget bill changes 'Alien Medicaid Eligibility,' restricting coverage to green card holders and a few other groups.
July 2025

Scenarios

Congress restores Medicaid for refugees

Unlikely Resolves by Q2 2027

Discussed by: Mustafa Rfat, who hopes Congress reverses course

Advocates and refugee organizations push for legislation restoring Medicaid eligibility for refugees and asylum seekers. A bill would need to pass both chambers and be signed into law, a steep climb given the current Congress passed the restriction.

States build their own coverage programs

Possible Resolves by End of 2027

Discussed by: Drishti Pillai of KFF; Connecticut and Washington are already creating options

A few states are creating state-funded coverage for affected immigrants. Most states face tight budgets and larger Medicaid cuts in January, which may limit how many follow.

Changes stand; immigrants remain uninsured until green card status

Likely Resolves by Jan 1, 2027

Discussed by: KFF Health News and the Congressional Budget Office

Without federal or state action, affected immigrants remain without comprehensive coverage until they obtain green cards. The CBO projects about 100,000 more uninsured immigrants by 2034.

Historical Context

2 moments from history that rhyme with this story — and how they unfolded.

August 1996

Welfare Reform Act (1996)

Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act, which barred most legal immigrants from Medicaid and food stamps for their first five years in the country. The law also created the modern Temporary Assistance for Needy Families program.

Then

Many states created their own programs to fill the gap for immigrants.

Now

Some restrictions were later rolled back for children and pregnant women, but the five-year bar shaped immigrant benefit policy for decades.

Why this matters now

The 1996 law was the last major restriction of immigrant benefit eligibility before H.R. 1.

August 2019

Public Charge Rule (2019)

The Trump administration expanded the public charge test, making it harder for immigrants who used Medicaid, food stamps, or housing assistance to get green cards. The rule was challenged in court.

Then

The rule was blocked in several courts and created widespread fear among immigrants about using public benefits.

Now

The Biden administration rescinded the rule in 2022, but the chilling effect on benefit use persisted.

Why this matters now

It shows how benefit eligibility rules shape immigrant decisions about seeking care, a dynamic now repeating under H.R. 1.