About 4,500 immigrants living legally in Maryland lost full Medicaid coverage on October 1, the first wave of cuts under last year’s federal budget law to reach the state. They are refugees, asylees, humanitarian parolees including Afghans and Ukrainians, and abuse and trafficking survivors, all of whom received notices in August that their coverage would end, the Maryland Department of Health told Capital News Service. The state cannot yet say which counties they live in.
Montgomery County’s chief of public health services, Nina Ashford, called the situation terrible and cruel, to put it lightly, and said it would fall hardest on the county’s low-income and immigrant residents. In Prince George’s County, where people have been bringing their termination notices to the health department for review, the department’s public health policy chief, Andrew Ballard, said some residents dropped their coverage before the deadline rather than wait for it, and that when Medicaid ends, care shifts or stops: prescriptions go unfilled, chronic conditions and mental health needs go untreated, and routine problems surface later in emergency departments.
Who Was Cut and Who Was Not
Green card holders who have passed the five-year waiting period or are exempt from it, Cuban and Haitian entrants and Compact of Free Association migrants keep coverage. Children and pregnant women keep coverage regardless of status, and emergency Medicaid is unchanged. The site’s state-by-state guide explains the federal rule.
Health Secretary Meena Seshamani put the state’s position plainly: the law passed and Maryland has to comply. She said the department is deeply concerned about what happens when people cannot see a doctor when they get sick, and that the state is doing what it can to keep them connected to care. What it can do is limited. Maryland has no state-funded health program for immigrants who lose federal eligibility, unlike California, New York, Oregon and Pennsylvania, each of which is covering some or all of its affected residents with state money. Maryland’s response is a $25 million fund for community health centers.
For the rest of 2026, some of the 4,500 can buy a subsidized plan through Maryland Health Connection, the state marketplace. That window closes January 1, 2027, when the same budget law cuts marketplace subsidies to the same three groups that kept Medicaid: green card holders, Cuban and Haitian entrants and COFA migrants.
January Is Bigger
The 4,500 are the smallest of three cuts. On January 1, 2027, about 320,000 Maryland adults aged 19 to 64 who get Medicaid through the Affordable Care Act expansion face new work requirements and twice-yearly renewals. They will need to show $580 a month in earnings, 80 hours a month of work, training or volunteering, or half-time school enrollment, unless exempt for pregnancy, caring for a young child or a disabled person, or being medically frail. The state projects 152,000 will lose coverage by June 2028, up from an earlier estimate of 115,000 after federal regulators tightened the rules in June. The Urban Institute’s range is 102,000 to 207,000.
Ashford expects many of those losses to come from paperwork, not ineligibility: people who still qualify but cannot navigate the checks. A 2019 study of Arkansas’s work requirement found the same pattern, with large coverage losses and no measurable increase in employment. Attorney General Anthony Brown has joined a multistate lawsuit over the federal rule’s narrowing of the medically frail exemption.
Also on January 1, Medicaid’s retroactive coverage of medical bills shrinks from three months before enrollment to one month for expansion adults, which Ashford said could leave eligible people with large debts from the gap.
Vincent DeMarco of the Maryland Health Care for All Coalition said the losses will push uncompensated care onto hospitals and raise premiums for everyone else, and is pressing lawmakers for new revenue, including a 10-cent-per-drink alcohol tax he estimates at $220 million a year.
What This Means for Marylanders Who Lost Coverage
If you received an August notice and your coverage ended October 1, check first whether the state has your status right. Anyone who has adjusted status or passed the five-year bar since enrolling is still eligible; send proof to the Department of Health and ask for a redetermination.
If your status is correctly recorded, enroll in Maryland Health Connection now if your income is above the poverty line; losing Medicaid qualifies you for a special enrollment period. Below the poverty line, subsidies are not available, which is the case for most people coming off Medicaid.
For care without insurance, the $25 million the state set aside goes to federally qualified health centers, which must see you regardless of status on a sliding fee. In Montgomery County, Montgomery Cares and Care for Kids are expanding to take more patients; in Prince George’s, the health department points to its clinics for reproductive health, HIV and STI testing and behavioral health. Ballard’s warning applies everywhere: these are patchwork programs with capacity limits, not a replacement for coverage.
If you have a refugee or asylee green card application pending, or are eligible to file one, do it now. Adjusting to permanent residence restores Medicaid eligibility. Refugees and asylees can apply one year after arrival or grant, and most of the 4,500 passed that point long ago.
Do not stop medication because the prescription is no longer covered. Pharmacists and clinics can often find a low-cost alternative or a manufacturer program, and stopping abruptly is what turns a routine condition into the emergency room visit Ballard is predicting.