Federal Medicaid and Children’s Health Insurance Program funding ended Oct. 1 for refugees, asylees and several other groups of lawfully present immigrants who do not hold green cards, according to the KFF analysis of the 2025 reconciliation law. States now decide whether to keep paying for their coverage.
Which Immigrants Lose Medicaid Eligibility on Oct. 1
The change affects refugees and asylees without a green card, “among others,” KFF wrote. Mississippi Today, in a report distributed by States Newsroom, listed the groups: refugees and asylees, survivors of domestic violence with approved or pending applications under the Violence Against Women Act, trafficking victims with approved or pending T visas, immigrants granted humanitarian parole for at least a year, immigrants granted withholding of deportation, Canadian-born members of federally recognized tribes and people granted conditional entry before 1980.
Federal funding continues for U.S. citizens and nationals, green card holders, Cuban and Haitian entrants and migrants from the Compact of Free Association nations, according to the Centers for Medicare and Medicaid Services in a letter to state health officials. Dan Brillman, a deputy administrator who directs the agency’s Center for Medicaid and CHIP Services, signed the letter April 8.
How the Law Works: A Funding Cutoff, Not a Coverage Ban
The law does not say states must drop these immigrants. The CMS letter says that starting Oct. 1, section 71109 of the legislation limits what the letter calls federal financial participation, which is the federal share of Medicaid and CHIP spending, to citizens, nationals, green card holders, Cuban and Haitian entrants and Compact of Free Association migrants, with limited exceptions. The groups left out include asylees, refugees, parolees and trafficking victims, unless they hold another qualifying status.
State Health and Value Strategies, a policy group, summarized the CMS guidance this way: states may use their own dollars to cover these immigrants but are not required to. The guidance also leaves open several state-run options for children and pregnant people and says people who would qualify except for their immigration status stay eligible for emergency Medicaid.
The CMS letter adds that emergency Medicaid spending for those people is now matched at each state’s regular federal rate. The law carries different names in different documents. CMS calls it the Working Families Tax Cut legislation, Public Law 119-21. KFF calls it the 2025 reconciliation law. Mississippi Today and other outlets call it the One Big Beautiful Bill Act.
How Many People Lose Coverage: Washington Versus the National Estimate
KFF reported that the Congressional Budget Office estimates the immigrant eligibility restrictions in Medicaid and CHIP will reduce federal spending by $6.2 billion and lead to 100,000 more people becoming uninsured by 2034.
State counts show how the change lands locally. About 14,000 Washington residents lose Apple Health, the state’s Medicaid program, on Oct. 1, OPB reported in a story by KUOW. Those 14,000 people equal 14% of the national estimate of 100,000 new uninsured people, and Washington is one state of 50.
The two numbers measure different things. KFF’s figure counts people who end up uninsured over time, and OPB’s counts people who lose Medicaid on one day, some of whom may find other coverage. The comparison shows how concentrated the effect could be, and it is not a forecast for any state.
Ryan Moran, director of the Washington State Health Care Authority, told OPB, “We worry about the strain and stress on the hospital system.” He said many people without coverage may use emergency departments as their only access to care. The law also bars these immigrants from buying subsidized marketplace plans for 2027, and OPB reported that the state expects most of them to become uninsured because full-price plans will likely be unaffordable.
States That Keep Covering Children and Pregnant People
Mississippi Today reported that 38 states continue Medicaid coverage for lawfully present immigrant children and 32 states do so for pregnant people. Mississippi has chosen neither option. The states cover those groups under options that predate this law, according to the CMS guidance summary, so their children and pregnant residents are less exposed than adults.
In Mississippi, Khaylah Scott of the Mississippi Health Advocacy Program said people may learn about the change from a letter. Drishti Pillai, director of immigrant health policy at KFF, told Mississippi Today these immigrants “will be left with very few affordable coverage options.”
Florida Notices and the Missing Paperwork Risk
Florida’s Department of Children and Families began removing immigrants from Medicaid and CHIP on Oct. 1, Central Florida Public Media reported. The department sent verification letters in August, and people who did not respond by Sept. 30 lost coverage, the station reported.
Scott Darius of Florida Voices for Health said the biggest effect is that “people are confused.” Katie Roders Turner of the Family Healthcare Foundation said someone could miss a letter and lose coverage while still eligible. The station reported that in Florida’s 2023 Medicaid review, 58% of terminations were procedural errors such as address and phone number changes.
The CMS guidance summary from State Health and Value Strategies says states must give advance notice and a reasonable opportunity to respond, including a 90-day period before adverse action. The Florida report did not say how the department’s timeline fits that standard.
What Happens Next for Medicaid and Marketplace Coverage
The next change is already scheduled. KFF reported that the restrictions on subsidized marketplace coverage for these immigrants begin Jan. 1, 2027. In the meantime, each state’s choice about using its own money will determine who keeps Medicaid. People who lose coverage can contact their state Medicaid agency to ask whether they qualify under another status or under a state-funded program.
