Here's the short answer. Starting October 1, 2026, federal Medicaid and CHIP money for full benefits is limited to U.S. citizens and nationals, green card holders (lawful permanent residents), Cuban and Haitian entrants, and people from the Compacts of Free Association (COFA). This means many refugees, asylees, and others lose federal Medicaid funding. Federal funding for emergency Medicaid continues. The same law limits Medicare for noncitizens to the same groups, starting 18 months after it became law on July 4, 2025. That is about January 2027.
Medicaid and CHIP: what changed on October 1, 2026
Section 71109 of Public Law 119-21 limits federal funding (called "federal financial participation") for Medicaid and CHIP. From October 1, 2026, the federal government will pay its share only for these groups:
- U.S. citizens and U.S. nationals
- Lawful permanent residents (green card holders)
- Cuban and Haitian entrants
- People who live in the U.S. under a Compact of Free Association (COFA migrants)
Before this, many other "qualified noncitizens" could get full Medicaid or CHIP. This included refugees and asylees. They were already exempt from the 5-year waiting period. CMS says federal funding will no longer be available for full benefits for asylees, refugees, parolees, and victims of trafficking, unless they also have a status or category on the list above.
What is not changed
The funding limit does not apply to:
- Emergency Medicaid. Care to treat an emergency medical condition. See Emergency Medicaid.
- Lawfully residing children and pregnant women in states that choose that option (the "CHIPRA 214 option").
- Certain CHIP health services initiatives run by states.
The law does not change the 5-year waiting period that many green card holders still face. It also does not stop a state from using its own money to cover someone. CMS will not require states to do so. CMS also says coverage a state pays for with only state money is not counted as Medicaid.
What happens to people who have Medicaid now
The new limits apply to people already enrolled on October 1, 2026, not only to new applicants. Before ending coverage, a state must give advance notice and the right to a fair hearing. The state must also check whether you qualify some other way. For example, a refugee child or pregnant woman may still qualify under the state's CHIPRA 214 option.
CMS uses the term "full Medicaid and CHIP benefits" to include partial benefits, such as Medicare Savings Programs. It does not include emergency Medicaid. If you get help from a Medicare Savings Program, ask your state how this applies to you. See Medicare Savings Programs.
Medicare: what changes around January 2027
Section 71201 of the same law adds a new rule for Medicare. It limits Medicare eligibility for noncitizens to the same groups that can get federally funded full Medicaid: green card holders, Cuban and Haitian entrants, and COFA migrants. It begins 18 months after the date the law was signed. The law was signed July 4, 2025, so that is January 2027.
CMS says it will give more information on this part in later guidance. Until then, the full details are not settled. For how Medicare works for immigrants today, including work history and the 5-year rule, read Medicare for Immigrants and Green Card Holders.
Other coverage that may change
- Marketplace tax credits. CMS notes that the law also limits premium tax credits to noncitizens who are "eligible aliens" (green card holders, Cuban and Haitian entrants, and COFA migrants). This starts in 2027. See Marketplace Coverage for Mixed-Status Families.
- Older immigrants. Some states cover older immigrants with their own money. See State Health Coverage for Older Immigrants.
- Sponsor rules. Some Medicaid rules count a sponsor's income. See Medicaid Sponsor Deeming.
What you can do now
- Keep your papers. Keep proof of your immigration status or category, and every Medicaid notice.
- Read your state's letters. They will say if your coverage is changing and how to ask for a hearing.
- Do not skip care in an emergency. Emergency Medicaid remains available to people who meet other state rules.
- Get free help. Try your state Medicaid agency, your SHIP, or a legal aid group.
For a running list of federal changes, see Policy & Rule Changes.
Common Questions
Can refugees and asylees still get Medicaid?
From October 1, 2026, federal funding for full Medicaid is not available for refugees and asylees unless they also have a status on the list, such as a green card. Children and pregnant women may still qualify in states that use the CHIPRA 214 option. Emergency Medicaid remains.
Do green card holders lose Medicaid?
No. Lawful permanent residents stay on the list. The usual 5-year waiting period still applies to many of them.
Is emergency care still covered?
Yes. Federal funding continues for care to treat an emergency medical condition.
When does the Medicare change start?
The law's Medicare rule begins 18 months after July 4, 2025, which is about January 2027. CMS plans more guidance.
Will applying for benefits hurt my immigration case?
Rules on that are separate from this page. Talk to an immigration legal aid group before you decide.