On October 1, 2026, the first major Medicaid cuts in last year’s federal budget law took effect, and the first people to feel them are lawful immigrants who do not yet have a green card. Refugees, asylees, humanitarian parolees, trafficking survivors and others who had been covered by Medicaid for years lost their eligibility overnight, NPR reports. The Congressional Budget Office estimated roughly 100,000 people would become uninsured from this change alone; advocates say the real number is higher because the government has slowed green card processing, leaving many people stuck in a status that no longer qualifies.
What happens to those families now depends almost entirely on where they live. This guide explains who lost coverage, who kept it, and what the picture looks like in every state and the District of Columbia.
Two more cuts follow. On January 1, 2027, the same groups lose eligibility for subsidized Affordable Care Act marketplace plans and for Medicare.
Who Lost Federal Medicaid and Who Kept It
Undocumented immigrants were never eligible for regular Medicaid. The change hits people who are here legally. Under Section 71109 of H.R. 1, the federal government now pays for Medicaid and CHIP only for four groups of noncitizens:
- Lawful permanent residents (green card holders), still subject to the existing five-year waiting period in most cases
- Cuban and Haitian entrants
- People from the Marshall Islands, Micronesia and Palau living in the U.S. under the Compacts of Free Association
- Lawfully residing children and pregnant women, but only in states that have chosen to cover them
Everyone else with lawful status lost full Medicaid on October 1. That includes refugees who have not yet adjusted to a green card, asylees, people granted withholding of removal, humanitarian parolees including Ukrainians and Afghans admitted under special programs, Afghan and Iraqi Special Immigrant Visa applicants who have not yet received green cards, survivors of trafficking with T visas, abused spouses and children with approved VAWA petitions, and conditional entrants. TPS holders and DACA recipients were already ineligible and are not affected.
The law required every state to re-check the immigration status of anyone who might be affected before October 1. Most states did this through automated matches with DHS and Social Security records. If the state could not confirm a qualifying status, it had to send a notice, allow time to respond, and give at least ten days’ warning before ending coverage.
Two exceptions survive. Emergency Medicaid still pays for emergency care regardless of status, and states may keep covering lawfully residing children and pregnant women under the ICHIA option. That option is where the state-by-state differences begin.
The States That Are Stepping In
The federal law does not stop a state from covering these immigrants with its own money. It just stops the federal government from paying its usual share, which is roughly two thirds of the cost. Only a few states have decided to absorb that bill.
California identified about 148,000 Medi-Cal enrollees who lost federal eligibility and is spending 365 million dollars to keep them covered through a separate state program until July 2027, KFF Health News reports. What happens after that depends on the next governor and the next budget.
Oregon moved about 7,000 refugees, asylees and parolees into Healthier Oregon, its state-funded Oregon Health Plan category, on October 1 with no gap in benefits. The state’s notice says plainly that unlike in other states, nobody loses coverage.
New York is bound by a decades-old court ruling that requires the state to cover lawfully present immigrants who would qualify for Medicaid if not for their status, so affected New Yorkers move to state-funded coverage automatically. The state is also using its own funds to keep eligible immigrants in the Essential Plan when federal subsidies end in January.
Pennsylvania has state-funded coverage for many of the people affected, according to KFF Health News. New Mexico has moved to cover lawfully present immigrants losing Medicaid and marketplace subsidies with state funds, along with DACA recipients; details of the rollout should be confirmed with the state Health Care Authority.
Washington is the cautionary case. It has a state-funded Apple Health Expansion, but enrollment is capped and closed, so the roughly 14,000 residents losing Medicaid are expected to become uninsured. Massachusetts is moving about 7,300 affected MassHealth members to MassHealth Limited, which covers emergencies only, and advocates say neither the governor nor the legislature has offered a bridge. Illinois ended its state program for adults 42 to 64 in 2025 and has frozen enrollment for seniors, though its state-funded programs for asylum applicants, torture survivors and VAWA petitioners continue. Colorado, Minnesota and the District of Columbia have all cut back their immigrant coverage programs in the past year because of budget pressure.
State by State: What Happens After October 1
The table covers all 50 states and DC. The second column shows whether the state kept Medicaid or CHIP for lawfully residing children and pregnant women under the ICHIA option, based on KFF data as of January 2026. The third column shows state-funded coverage that exists regardless of immigration status, from KFF’s April 2026 survey. The last column is what an affected adult refugee, asylee or parolee faces now. Figures for people losing coverage come from state agencies as reported by KFF Health News and local outlets.
| State | Children and pregnant women kept | State-funded coverage | Affected adults after Oct 1 |
|---|---|---|---|
| Alabama | Neither | None | Lose Medicaid |
| Alaska | Neither | None | Lose Medicaid |
| Arizona | Neither | None | Lose Medicaid; state expects nearly 28,000 |
| Arkansas | Both | None | Lose Medicaid |
| California | Both | Children; adults enrolled before 2026 | Moved to state-funded program through July 2027; about 148,000 |
| Colorado | Both | Children and pregnant women; OmniSalud plans capped | Lose Medicaid; state program enrollment closed |
| Connecticut | Both | Children under 16 at enrollment | Lose Medicaid |
| Delaware | Both | None | Lose Medicaid |
| District of Columbia | Both | Children; Healthcare Alliance adults 21 to 25 only | Lose Medicaid unless 21 to 25 |
| Florida | Children only | None | Lose Medicaid; state flagged nearly 177,000 |
| Georgia | Both | None | Lose Medicaid |
| Hawaii | Both | None | Lose Medicaid |
| Idaho | Neither | None | Lose Medicaid |
| Illinois | Children only | Children; seniors 65 and over, enrollment frozen; asylum applicants, torture survivors and VAWA petitioners | Lose Medicaid |
| Indiana | Neither | None | Lose Medicaid |
| Iowa | Children only | None | Lose Medicaid |
| Kansas | Neither | None | Lose Medicaid |
| Kentucky | Both | None | Lose Medicaid |
| Louisiana | Children only | None | Lose Medicaid |
| Maine | Both | Children | Lose Medicaid |
| Maryland | Both | None | Lose Medicaid |
| Massachusetts | Both | Children; Health Safety Net for hospital and clinic care | Moved to MassHealth Limited, emergency only; about 7,300 |
| Michigan | Both | None | Lose Medicaid |
| Minnesota | Both | Children; adult program ended January 2026 | Lose Medicaid |
| Mississippi | Neither | None | Lose Medicaid |
| Missouri | Neither | None | Lose Medicaid |
| Montana | Children only | None | Lose Medicaid |
| Nebraska | Both | None | Lose Medicaid |
| Nevada | Both | None | Lose Medicaid |
| New Hampshire | Both | None | Lose Medicaid |
| New Jersey | Both | Children and pregnant women | Lose Medicaid; state expects 15,000 to 25,000 |
| New Mexico | Both | State plans to cover lawfully present immigrants losing federal coverage | State-funded coverage planned; confirm with the state |
| New York | Both | Children; seniors 65 and over; court-ordered coverage for lawfully present | Moved to state-funded coverage |
| North Carolina | Both, but state law may end this | None | Lose Medicaid; about 29,000 |
| North Dakota | Pregnant women only | None | Lose Medicaid |
| Ohio | Both | None | Lose Medicaid |
| Oklahoma | Neither | None | Lose Medicaid |
| Oregon | Children only | Children and adults through Healthier Oregon | Moved to Healthier Oregon; about 7,000 |
| Pennsylvania | Both | State-funded coverage for many affected | Many keep state-funded coverage |
| Rhode Island | Both | Children | Lose Medicaid |
| South Carolina | Both | None | Lose Medicaid |
| South Dakota | Neither | None | Lose Medicaid |
| Tennessee | Neither | None | Lose Medicaid |
| Texas | Children only | None | Lose Medicaid |
| Utah | Children only | Children, open enrollment periods only | Lose Medicaid |
| Vermont | Both | Children and pregnant women | Lose Medicaid |
| Virginia | Both | None | Lose Medicaid; about 6,000 |
| Washington | Both | Children; Apple Health Expansion adults, enrollment closed | Lose Medicaid; about 14,000 |
| West Virginia | Both | None | Lose Medicaid |
| Wisconsin | Both | None | Lose Medicaid |
| Wyoming | Pregnant women only | None | Lose Medicaid |
A few notes on reading the table. In the 38 states that kept the ICHIA option for children, a refugee or asylee child under 19 stays on Medicaid or CHIP even though the parents lose it. In the 32 that kept it for pregnant women, a pregnant asylee keeps coverage through the pregnancy and the postpartum period. North Carolina’s legislature passed a budget bill in April that would strip that option as of October 1; the governor has asked lawmakers to reverse it and several said the cut was a drafting mistake, so North Carolina families should check with NC Medicaid before assuming children are covered.
The counts are preliminary. Final termination numbers will not be available until later this fall.
What to Do If You Lost Coverage
First, make sure you actually lost eligibility. If you have received a green card since you enrolled, or if you are a Cuban or Haitian entrant, you still qualify, and the state may simply have old information. Send a copy of your green card or I-94 to your state Medicaid agency and ask for a redetermination. You have the right to a fair hearing if coverage was ended by mistake, and coverage must continue during a 90-day reasonable opportunity period while you prove your status. If you had unpaid medical bills from before October, you can still apply through December 31, 2026 for up to three months of retroactive coverage for months when you were eligible.
If you are a newly arrived refugee or recently granted asylee, ask your resettlement agency about Refugee Medical Assistance. It is a separate federal program run by the Office of Refugee Resettlement that is not affected by the Medicaid change, but it currently lasts only four months from arrival or grant of status.
Emergency Medicaid still exists everywhere. If you have an emergency and meet the income rules, the hospital can bill Medicaid for that visit regardless of your status. It does not cover follow-up appointments, prescriptions or managing a chronic condition.
For everything else, federally funded community health centers must see you regardless of status or ability to pay, on a sliding fee scale. You can find the nearest one through HRSA. Many also help with low-cost prescriptions.
The marketplace is a bridge, not a solution. Losing Medicaid triggers a special enrollment period, and lawfully present immigrants with income above the poverty line can still buy a subsidized 2026 plan through the end of the year; those below it lost subsidy eligibility in January 2026. Once the subsidies end in January, a full-price plan is out of reach for most people who were on Medicaid.
The lasting fix is a green card. A refugee can apply after a year in the country, and an asylee a year after asylum is granted. Anyone eligible to adjust status should file now. Once the green card arrives, Medicaid eligibility comes back, and advocates recommend contacting a legal aid organization or the EOIR pro bono list for free help with the application.