This change takes effect October 1, 2026, under federal law (H.R. 1, Section 71109), with implementation guidance issued by CMS in April 2026. State Medicaid agencies are actively mailing notices to affected households now. Do not tell a client they have lost Medicaid coverage based on this article alone; confirm current status with the client's state Medicaid agency.
What Is Changing
Beginning October 1, 2026, federal law narrows which non-citizens can receive federally funded Medicaid and Children's Health Insurance Program (CHIP) coverage. This change is based on immigration status only. It does not affect U.S. citizens, and it does not change Medicaid eligibility based on income. A client can still lose Medicaid for other reasons, such as income, separately from this change. This applies to both new applicants and people currently enrolled — clients in an affected category will be disenrolled from full Medicaid coverage.
Non-Citizen Categories Losing Medicaid and CHIP Coverage
Starting October 1, 2026, the following categories of non-citizens will no longer qualify for federally funded Medicaid or CHIP coverage:
Individuals granted asylum, and refugees
Individuals granted conditional entry
Humanitarian parolees
Individuals with Temporary Protected Status (TPS)
Victims of human trafficking, and certain qualifying family members
Individuals granted withholding of deportation or removal
Individuals with Amerasian immigrant status
American Indians born in Canada or outside the U.S. who are not U.S. citizens, including federally recognized tribal members who are not U.S. citizens
Non-citizens with immigration protection due to domestic abuse by a family member, including a spouse, parent, or child (including pending or approved VAWA applications)
Non-citizen veterans or active-duty service members, and certain of their family members
Non-citizens with an Iraqi or Afghan Special Immigrant Visa, and certain of their family members
Hmong, Mien, or Highland Laotian non-citizens, and certain of their family members
Applicants for a green card, asylum, or Temporary Protected Status whose application has not yet been approved
Other non-citizens lawfully living in the U.S. who do not fall into one of the remaining eligible categories below
Who Remains Eligible
The following groups keep their Medicaid eligibility after October 1, 2026:
U.S. citizens and U.S. nationals
Lawful permanent residents (green card holders) who have completed the required waiting period
Cuban and Haitian entrants
Compact of Free Association (COFA) migrants: citizens of the Federated States of Micronesia, the Marshall Islands, or the Republic of Palau
In addition, states that have adopted the federal "lawfully residing" coverage option may continue covering lawfully present children and pregnant individuals under Medicaid or CHIP even if they fall in an affected category above. Whether this applies depends on the client's state — confirm with the state Medicaid agency.
Note on the waiting period: if a client in an affected category (such as a refugee or asylee) later adjusts to lawful permanent resident status, CMS guidance confirms the five-year waiting period does not apply to them — they can regain full Medicaid eligibility upon becoming an LPR, subject to normal income and eligibility rules.
If a Client Loses Medicaid Coverage Due to This Change
A client who loses full Medicaid coverage under this change may still qualify for Emergency Medicaid. Emergency Medicaid is limited to acute, sudden medical conditions that require immediate treatment to prevent death or serious impairment. It does not cover urgent care, ongoing care, or preventive care, and the client must still meet income and other Medicaid eligibility rules to qualify.
Alternative Coverage Options — Act Quickly
A client who loses Medicaid eligibility due to this change may be able to get coverage through the ACA Marketplace at HealthCare.gov. Losing Medicaid coverage triggers a Special Enrollment Period.
Important timing: Marketplace subsidy eligibility for these same immigration categories also narrows under federal law, effective January 1, 2027. This creates a limited window — October 1, 2026 through December 31, 2026 — during which a client who loses Medicaid under this change may still qualify for Premium Tax Credits and cost-sharing reductions on a Marketplace plan. Beginning January 1, 2027, most of the affected categories will no longer qualify for Marketplace subsidies either. Do not assume the Marketplace remains a subsidized fallback into 2027; see ACA Marketplace Coverage for Immigrant Families for details.
Federally Qualified Health Centers and other community health centers also provide services at reduced cost regardless of immigration status.
What Agents Should Advise Clients To Do
Confirm the client's current address is on file with their state Medicaid agency, and check mail carefully — states are mailing eligibility notices to affected households now
Respond promptly to any letter from the state Medicaid agency asking about immigration status
If the client has met the requirements for a green card but has not yet applied, apply as soon as possible; living in the U.S. for the required period alone does not preserve Medicaid eligibility without an approved green card
If the client's immigration status changes to lawful permanent resident, notify the state Medicaid agency right away
Do not wait until coverage ends to explore ACA Marketplace options — the subsidy window for affected clients closes December 31, 2026
Where to Get Help
Direct clients to their state Medicaid agency, found through medicaid.gov, for questions about a specific eligibility notice or their immigration status verification. For general Medicaid eligibility and application guidance, see Medicaid Eligibility and How to Apply.
Need Help?
For questions about how this change affects a specific client, contact Producer Support at [email protected] or by phone at (866) 568-9649.