Refugees Lose Medicaid While Green Cards Sit in Line

Refugees and asylees lost federally funded Medicaid on Oct. 1 under a 2025 budget law that still leaves their care inside U.S. hospitals. H.R. 1, signed July 4, 2025, now limits full federal Medicaid and CHIP to citizens, green-card holders, Cuban and Haitian entrants, and Compact of Free Association migrants from Palau, Micronesia, and the Marshall Islands.

The people being cut are not exiting the health system. Most can apply for a green card after a year, then re-qualify, which means untreated illness shows up later in emergency rooms and, after adjustment, back on Medicaid.

Federal Medicaid Stops for Refugees Without Green Cards

Section 71109 of H.R. 1 rewrote which noncitizens can draw a federal match for full benefits. Public Law 119-21, which CMS also calls the Working Families Tax Cut legislation, took that slice of the statute live on Oct. 1, 2026. Undocumented immigrants were already barred from full federal Medicaid. The new line hits people the United States admitted on humanitarian grounds and had, for decades, treated like citizens for this benefit until they received a green card.

KFF, the health policy research group, says the Congressional Budget Office scores this Medicaid and CHIP eligibility slice as a reduce federal spending by $6.2 billion through 2034, with 100,000 more people uninsured by that year. That 100,000 figure is a ten-year net, not a headcount of who lost a card this month. The same research group puts the wider immigrant coverage limits, including marketplace subsidies and Medicare, at about 1.4 million uninsured and $131 billion less federal spending by 2034, plus $4.8 billion in extra federal revenue. The whole Medicaid rewrite in the law is a separate $911 billion over 2025 to 2034.

THE OCTOBER SLICE, IN BRIEF

• The date: Full federal Medicaid and CHIP matching for the newly excluded groups ended Oct. 1, 2026.
• The score: CBO puts this eligibility change at $6.2 billion in federal savings and 100,000 more uninsured by 2034.
• The check window: Enrollees who declare a qualifying status get a 90-day chance to prove it, with coverage kept on during that stretch.
• The next cliff: Subsidized ACA marketplace plans for the same groups end Jan. 1, 2027.

Mustafa Rfat, a social work professor at the University of Nebraska at Omaha who arrived from Iraq as a refugee in 2011 and is now a citizen, said he had spent two weeks on the phone with families before the date hit.

I spent this past two weeks just talking with so many of them, terrorized by the reality that their children with disabilities are losing coverage.

Mustafa Rfat, professor of social work, University of Nebraska at Omaha

CMS said it was carrying out rules set by Congress and did not answer a question about refugees with disabilities. Congress gave the agency $15 million for fiscal 2026 to run the eligibility change.

Who Still Qualifies After the October Cutoff

The loud public argument treats Oct. 1 as a sweep of noncitizens off taxpayer insurance. The statute is a status filter. People with green cards stay on the program, subject to the old five-year wait unless they first entered in an exempt class such as refugee or asylee. Afghan and Iraqi special immigrant visa holders, who are admitted as lawful permanent residents, can qualify under the green-card rules. Cuban and Haitian entrants and COFA migrants keep their long-standing exemption.

WHO LOSES FULL FEDERAL BENEFITS

• Refugees and asylees: Those without a green card lose federally funded full Medicaid and CHIP.
• Parolees: People granted humanitarian parole expected to last a year or longer, including many Afghan and Ukrainian parolees, are out.
• Trafficking survivors: Certain T visa holders and family members lose the federal match.
• Domestic violence survivors: VAWA self-petitioners and people granted withholding of removal lose it too.

States that already use the federal option to cover lawfully residing children and pregnant people can keep that coverage with a federal match. Prenatal care from conception through the end of pregnancy remains available under a separate CHIP option. Emergency Medicaid still pays for qualifying emergency treatment, including childbirth, for people who meet other state rules. Community health centers still see patients on sliding fees. Full-price ACA plans remain for sale, and employer coverage remains if a job offers it.

Drishti Pillai, director of immigrant health policy at KFF, said marketplace plans at full price are often unaffordable, and many immigrants work in construction, agriculture, and food service jobs that do not offer employer coverage. CMS guidance to state Medicaid agencies tells states to redetermine “potentially affected” enrollees, try automated SAVE and Social Security matches first, then ask people for papers. If someone declares a qualifying status and the database still cannot confirm it, the state must keep covering them for 90 days. Medicaid terminations still need at least ten days’ advance notice and a path to a hearing. Because SAVE is a point-in-time check, a new green card may not show up in time, which can knock eligible people off by mistake.

Florida Alone Flagged Nearly 177,000 Enrollees

State agencies in nine states and the District of Columbia flagged more than 281,000 current enrollees as at risk of losing Medicaid in October, according to figures those agencies gave KFF Health News. That snapshot is a caseload count, not CBO’s 100,000 ten-year uninsured estimate. Final termination numbers will not land until later this fall, and the 90-day proof window means some of those people were still covered after Oct. 1.

STATE COUNTS OF ENROLLEES AT RISK

California’s about 148,000 sits outside the 281,000 sample. Anna Holaday, a spokesperson for the Florida Department of Children and Families, said the agency matched enrollees against government databases and sent notices asking people to prove they still qualify. Pennsylvania officials have put the in-state figure at an estimated 8,000. Massachusetts estimated 7,300 people would lose MassHealth Standard. New York and Pennsylvania are using state money to cover many of the same adults. Those state figures are not a national total; other states have not published comparable counts.

Washington’s 11,000 includes roughly 1,000 people on long-term care or developmental disability services. The state stood up a Limited Benefit Community Access Program on Oct. 1 for certain clients who were receiving those services as of July 31, 2026, and who live in residential care or meet set acuity rules. Others go on a waitlist. The Washington State Health Care Authority told Apple Health enrollees that adult refugees, asylum seekers, and victims of domestic violence or trafficking no longer qualify for full coverage.

New Apple Health (Medicaid) rules are coming.
In October 2026, these groups of adult noncitizens will no longer qualify for Apple Health coverage:
• Refugees and asylum seekers
• Victims of domestic violence or human trafficking
Coverage options: https://t.co/Q558Ooq4CS pic.twitter.com/HpRtDHxjIK

— Washington State Health Care Authority (@WA_Health_Care) October 1, 2026

Emergency Rooms Keep the Patients and Lose the Match

Hospitals still have to treat emergencies. Emergency Medicaid reimburses that work for people who meet income and other rules but lack a qualifying immigration status, and the Oct. 1 eligibility rewrite leaves that backstop in place. The same law, in Section 71110, also caps the federal share of those emergency bills at each state’s regular match rate, which runs from 50 percent to 83 percent, instead of the 90 percent expansion rate some states had used. Washington will keep paying for the visit. It will send a smaller check.

Ben D’Avanzo of the National Immigration Law Center said the people being cut will, in time, become green-card holders who can enroll again. The gap is the point of pressure.

So these are people who are going to put off preventative care, who are not going to treat their chronic conditions, who are going to forego important medication.

Ben D’Avanzo, National Immigration Law Center

On Oct. 1 he wrote that the restrictions make it harder to get preventive care, manage chronic conditions, and obtain treatment, and that hospitals will see more uninsured emergency visits. Delayed care is not free care. It is later care, often in the most expensive setting, billed to a match rate that just got smaller.

The Green Card Line Is Longer Than the Coverage Gap

Refugees can apply for a green card after one year in the country. Global Refuge, a resettlement agency, says nearly 150,000 refugee green-card applications are pending at U.S. Citizenship and Immigration Services, and that processing times have more than doubled since the end of 2024. People who hold green cards keep Medicaid. People still waiting do not, as of Oct. 1, unless a state pays or they fall under the child or pregnancy option.

Rfat put the old rule in personal terms. Medicaid, he said, was the factor that let him get a chronic inflammatory condition under control while he learned English and dealt with the war he had left.

I had to climb this big mountain of acclimating into the culture here, learning English, dealing with the traumas of the war, the loss of family members. I was determined, and Medicaid was the big factor that made my dreams come true.

Mustafa Rfat, professor of social work, University of Nebraska at Omaha

The U.S. Committee for Refugees and Immigrants notes that immediate health coverage was built into resettlement because self-sufficiency was the goal. H.R. 1 does not revoke refugee status, asylum, or the right to seek a green card. It inserts an uninsured stretch into a process that already runs longer than a year. International Rescue Committee legal guides have also described a 2026 pause on decisions for certain refugee green-card filings from arrivals between Jan. 21, 2021, and Feb. 20, 2025, which lengthens that stretch for a defined cohort even when the form is on file.

Twelve Months of Refugee Medical Assistance Is Not a Substitute

The Office of Refugee Resettlement runs a separate program, Refugee Medical Assistance, for ORR-eligible newcomers who do not qualify for Medicaid. H.R. 1 does not touch RMA. On the same day federal Medicaid ended for these groups, ORR stretched RMA.

HOW REFUGEE MEDICAL ASSISTANCE CHANGED

1. March 31, 2025: ORR cuts the RMA and cash-assistance period from 12 months to 4 months, citing limited funds.
2. July 14, 2026: ORR raises the period from 4 months to 8 months for people whose ORR eligibility date is on or after Jan. 1, 2026.
3. October 1, 2026: A correction sets the period at 12 months for that same Jan. 1, 2026, cohort, and states get 30 days to retool systems.

Acting ORR Director Angie Salazar, in a Dear Colleague letter revised that day, said available funding and lower-than-expected arrivals gave the office room to go longer, while reduced access to other benefits increased reliance on ORR aid. Eligible people may receive up to 12 months of medical assistance. The Federal Register correction on October 1 is 91 FR 62534. The catch inside the rules is blunt: RMA is for people who are not eligible for Medicaid, and the 12-month clock runs from an ORR eligibility date on or after Jan. 1, 2026. A refugee who has already been on Medicaid for years, and whose first-year window closed long ago, does not get a fresh 12 months because the federal match vanished. New arrivals get a bridge. The existing caseload gets a notice.

California Is Writing a Check Other Capitals Will Not

Tony Cava, a spokesperson for the California Department of Health Care Services, said the state is spending $365 million on a separate program to keep about 148,000 immigrants covered through July 2027. CMS has told states to wall off any state-only spending so it is not billed to Washington. That is the legal opening: the federal dollar stopped; a state dollar did not have to.

Most states in the published sample did not take it. Florida, North Carolina, Arizona, and New Jersey flagged large caseloads and did not announce a replacement adult program. Krish O’Mara Vignarajah, president and CEO of Global Refuge, put the hole in household terms.

When a family loses coverage, there’s no reliable health care equivalent of a food bank.

Krish O’Mara Vignarajah, president and CEO, Global Refuge

The next federal turn is already dated. On Jan. 1, 2027, subsidized marketplace coverage narrows to the same short list: green-card holders, Cuban and Haitian entrants, and COFA migrants. Adults still waiting on a card will be looking at full-price ACA plans, a job that offers insurance, a state-funded program if they live in one of the few that built one, or the emergency department. The green card, when it finally prints, puts them back on Medicaid. The months without a card are the part the federal score treats as savings.

Disclaimer: This article is news reporting and analysis of a federal Medicaid and CHIP eligibility change. It is informational only and is not medical, insurance, immigration, or legal advice. People who may be affected should contact their state Medicaid agency, a benefits counselor, or a qualified immigration attorney before they drop a plan, ignore a notice, or file new paperwork. Caseload figures, processing times, and program rules come from the agency letters, research briefs, and state statements cited above and can change as states finish redeterminations and as USCIS works pending green-card files.