Medicaid Cutoff Hits Immigrants as Big Beautiful Bill Rules Take Effect

Federal Medicaid rules that took effect Thursday are ending coverage for hundreds of thousands of lawfully present immigrants who do not hold green cards, the first large eligibility cut from President Trump’s One Big Beautiful Bill Act to reach enrollees.

The law, signed July 4, 2025, limits full federal Medicaid and Children’s Health Insurance Program coverage to U.S. citizens, lawful permanent residents, certain Cuban and Haitian entrants, and nationals of Compact of Free Association countries. States that already cover lawfully residing children and pregnant women may keep that option. People in the country without authorization were already barred from regular federally funded Medicaid. Emergency Medicaid for qualifying emergency care remains.

Groups that lose eligibility include refugees and asylees who have not obtained green cards, people granted humanitarian parole for at least a year, including many Afghan and Ukrainian parolees, survivors of human trafficking, and certain survivors of domestic violence. Those statuses previously allowed Medicaid if income and other rules were met.

State data compiled by KFF Health News put the October losses at more than 281,000 people in nine states and the District of Columbia. Florida alone identified nearly 177,000 enrollees who would no longer qualify, according to the state Department of Children and Families, which checked immigration status in government databases and sent notices giving people a chance to show they still qualify. Arizona projected nearly 28,000. North Carolina about 29,000. Washington state about 11,000. New Jersey estimated 15,000 to 25,000. Final termination counts will not be available until later this fall.

The Centers for Medicare and Medicaid Services told states to redetermine eligibility for potentially affected enrollees by Oct. 1 and to apply the new rules to new applications from that date. Advocates said some states did not mail notices until September.

The Congressional Budget Office estimates the Medicaid and CHIP restrictions will cut federal spending by about $6.2 billion and leave an additional 100,000 people uninsured by 2034. KFF, citing CBO, puts the broader package of immigrant restrictions — Medicaid, CHIP, Affordable Care Act marketplace subsidies, and Medicare — at about 1.4 million lawfully present immigrants uninsured by 2034. Marketplace subsidy limits, scheduled for 2027, account for most of that figure, about 1.2 million. Medicare eligibility changes account for about 100,000 more. Those are projections, not a count of people already dropped.

The White House has said Medicaid should prioritize eligible Americans, including children, pregnant women, seniors, people with disabilities, and other low-income citizens, and that the wider law is meant to cut waste and require work and self-sufficiency. The same statute is scored to reduce Medicaid spending by more than $900 billion through 2034. Work requirements for many able-bodied expansion adults, at least 80 hours a month, are set for Jan. 1, 2027. CBO has estimated those rules alone will add about 5 million uninsured by 2034.

A related SNAP provision is already in motion. Ballotpedia reported that as of June 1, 2026, all 50 states had applied expanded work rules for able-bodied adults without dependents, and 29 states had implemented the law’s narrower noncitizen food-stamp eligibility. Medicaid work rules and the 2027 marketplace and Medicare limits are the next scheduled steps. The October notices are the first large group of people losing a benefit the 2025 law rewrote.