Hundreds of Thousands of Legal Immigrants to Lose Medicaid Coverage Under Trump’s One Big Beautiful Bill Act
State-level data reveals the scope of Medicaid terminations for lawfully present immigrants — including refugees, asylees, and trafficking survivors — may far exceed initial federal projections.
New data collected from states across the country shows that the Medicaid coverage losses triggered by the One Big Beautiful Bill Act — President Donald Trump’s landmark 2025 legislation — are poised to affect lawfully present immigrants on a scale that was not anticipated when Congress first passed the law. Beginning October 1, 2026, the law eliminates federal Medicaid eligibility for a broad range of noncitizens who were, until now, fully authorized to reside in the United States. Among those losing their health benefits are refugees who fled armed conflict, asylees who escaped persecution, survivors of sex trafficking, and military interpreters who assisted American forces in Afghanistan — groups that entered the country with the express permission of the federal government.
State Data Exposes the True Scope of Medicaid Terminations for Legal Immigrants
When KFF Health News reached out to individual states to assess how many Medicaid enrollees had been flagged as losing eligibility under the new law, the results were striking. More than 281,000 immigrants across nine states and the District of Columbia were identified as likely to lose their Medicaid coverage in October 2026 alone. Florida accounts for the largest single-state total: nearly 177,000 individuals were identified by the state as no longer qualifying for the program, according to Anna Holaday, a spokesperson for the Florida Department of Children and Families. The agency verified immigration status through government databases and sent notices to enrollees, giving them a window to supply additional documentation proving continued eligibility.
Other states add substantially to that national tally. North Carolina identified roughly 29,000 enrollees at risk, Arizona projected nearly 28,000, New Jersey anticipated between 15,000 and 25,000 of its noncitizen residents losing coverage, and Washington state placed its expected figure at approximately 11,000. Final termination counts from each state will not be confirmed until later in the fall of 2026. Still, these preliminary figures suggest the actual human toll is considerably greater than what the Congressional Budget Office originally projected.
How CBO Estimates Compare to Real-World Uninsured Numbers for Noncitizen Enrollees
The Congressional Budget Office, the nonpartisan agency responsible for scoring legislation’s fiscal impact, had estimated that the law’s Medicaid eligibility changes for noncitizen adults with legal status would produce roughly 100,000 additional uninsured immigrants by 2034. But the state-level figures that are already emerging suggest that number could be far exceeded in the near term alone. The CBO declined to comment when asked about the discrepancy between its estimate and the preliminary state data. Critically, the agency did not release its estimate of the law’s impact on noncitizen Medicaid enrollees until a full month after Congress had already passed the bill and the president had signed it into law — a sequence that left lawmakers without a complete fiscal picture at the time of the vote.
Much of the public and political attention surrounding the legislation’s Medicaid provisions has focused on a separate element: work requirements that will take effect in January as a new condition of eligibility for many enrollees. The CBO forecasts those requirements will leave an additional five million Americans uninsured by 2034. The immigrant eligibility cuts, while receiving less public attention, are unfolding immediately and affecting people with no violation of immigration law on their records.
Under long-standing federal law, individuals in the country without authorization were already ineligible for the general Medicaid program funded jointly by states and the federal government. The One Big Beautiful Bill Act does not change that baseline. What it does change is eligibility for many categories of lawfully present immigrants — people who hold documented, government-sanctioned status. The law now limits federally funded Medicaid and CHIP to lawful permanent residents (green card holders), certain Cuban and Haitian entrants, people residing in the U.S. under Compacts of Free Association, and a narrow set of additional groups. People under age 19 and immigrants from Cuba, Haiti, or certain Pacific Island nations retain coverage under existing protections. States may also continue using existing options to cover lawfully residing children and pregnant women using federal matching funds.
For Refugees and Asylum Seekers, Losing Coverage Is a Life-or-Death Healthcare Reality
Without Medicaid, the immigrants losing coverage will effectively lose access to doctors, prescription drugs, and the overwhelming majority of medical services. The sole remaining federal safety net for most will be Emergency Medicaid, a separate program that covers emergency care only. Advocacy groups have been scrambling to direct affected immigrants toward government-funded or free health clinics, but those resources are stretched well beyond their capacity to absorb the coming wave of newly uninsured patients.
Among those facing these changes is Ahin, a 25-year-old refugee who left war-torn Syria for Turkey in 2011 and arrived in the United States in October 2024. She spoke with KFF Health News on the condition that she be identified only by her first name, citing concerns for her privacy and safety. Shortly after arriving, she developed severe abdominal pain that required intestinal surgery, with all related costs — including follow-up visits with specialists — covered by Medicaid. Her mother, who lives with her in a small apartment in New Jersey and has asthma, has also relied heavily on the program.
“I came here to live a better life. I’m really worried about this. It’s truly a terrible situation.”
Ahin applied for permanent residency soon after arriving in the United States two years ago — a process that, under normal timelines, should have delivered a green card by now. That card would have shielded her from losing coverage under the GOP law. Andrea Mendez Perez, director at Interfaith-RISE, a refugee resettlement organization in southern New Jersey, described the situation plainly: the Trump administration has stretched the timeline for green card processing while simultaneously stripping health coverage from those still waiting. Before 2025, the process typically took about six months; today, according to Mendez Perez, the wait extends well beyond a year. According to U.S. Citizenship and Immigration Services, it now takes an average of 30 months to process a permanent residency application from a refugee who was admitted more than a year ago.
For many of the immigrants now losing Medicaid, Mendez Perez said, being cut off from prescribed medications represents “a life-or-death situation.” Colleen McCauley, policy and advocacy director at the Camden Coalition — a nonprofit in southern New Jersey focused on connecting vulnerable people to health services — was equally direct in her assessment: “None of them did anything wrong, and they are losing coverage.”
“We’ve just been scrambling trying to find free medical care. To not be a welcoming place is the most un-American thing I’ve ever experienced.”
Medicaid Cuts Are One Part of a Wider Strategy to Restrict Immigrant Access to Federal Benefits
President Trump has consistently argued that taxpayer-funded government programs should be reserved exclusively for American citizens. As Congress debated the legislation in May 2025, the White House issued a news release making the misleading claim that the One Big Beautiful Bill Act would remove Medicaid coverage from individuals in the country without authorization — a group that was already barred from the program under long-standing law. The October 2026 Medicaid terminations, by contrast, affect individuals who entered the United States legally and remain in the country with federal permission.
Ben D’Avanzo, senior strategist for federal advocacy at the National Immigration Law Center, characterized the health coverage cuts as one thread in a broader effort to signal that immigrants are unwelcome. The Trump administration has also moved to remove people with legal status from the Supplemental Nutrition Assistance Program, or SNAP, and attempted to apply similar restrictions to Head Start, the federal early childhood program, before a federal judge intervened. The law’s reach extends further: beginning in January 2027, the CBO estimates approximately one million lawfully present immigrants will lose eligibility for government subsidies to purchase individual health plans on Affordable Care Act marketplaces by 2034. An additional 100,000 immigrants are projected to lose access to Medicare under the same law.
Beyond the October 2026 Medicaid cuts, the One Big Beautiful Bill Act is projected to strip approximately one million more lawfully present immigrants of ACA marketplace subsidies, and roughly 100,000 of Medicare coverage, starting in January 2027 — extending the coverage crisis well into next year.
Some States Step In With Their Own Funding to Protect Immigrant Health Coverage
A handful of states are choosing to spend their own money to prevent coverage gaps for immigrants who lose federal Medicaid eligibility. California, which expects roughly 148,000 immigrants to be stripped of federally supported Medicaid, has allocated approximately $365 million for a separate state-financed program to keep those individuals covered through July 2027, according to Tony Cava, a spokesperson for the California Department of Health Care Services. New York and Pennsylvania have also established state-funded health coverage for many of the immigrants affected by the federal changes.
Carlos Alarcón, health and public benefits policy manager with the California Immigrant Policy Center, has warned that stripping immigrants of healthcare access harms the broader population — pointing to the COVID-19 pandemic as evidence that reduced coverage for any segment of the population facilitates the spread of contagious disease. Alarcón expressed hope that the state-funded program would be extended under California’s next governor. Polling released in September showed Democrat Xavier Becerra, the former secretary of Health and Human Services under President Joe Biden, leading Republican Steve Hilton in California’s gubernatorial race. Becerra has publicly pledged to issue an executive order to preserve health coverage for every Californian affected by the federal cuts. “I believe there’s folks in the legislature that will really want to fight to make sure that we restore things as much as we can,” Alarcón said.
Late Notification Leaves Affected Immigrants With Little Time to Respond or Appeal
Federal rules required states to notify immigrants who were set to lose their Medicaid eligibility, but immigrant rights advocates reported that several states did not begin sending those letters until September 2026 — leaving affected individuals with extremely limited time to gather documentation, appeal errors, or explore alternative options. That compressed timeline meant that even enrollees whose coverage was being terminated in error had little opportunity to challenge those determinations. Refugee assistance organizations said they had been working intensively to inform community members about the changes and direct them toward free or government-funded health clinics, though the sudden surge in need has far outpaced available resources.
The Uninsured Wave Yet to Come for Legal Immigrants Under the Big Beautiful Bill
The Medicaid terminations that began October 1, 2026, represent only the first wave of a rolling coverage crisis for lawfully present immigrants under the One Big Beautiful Bill Act. For people like Ahin — a 25-year-old Syrian refugee caught in the gap between the government’s own processing delays and the law’s new eligibility wall — the policy cuts are neither abstract nor political; they are a direct threat to access to surgery, medication, and specialist care she cannot pay for out of pocket. With additional eligibility restrictions for ACA subsidies and Medicare set to take hold in 2027, and with green card processing times now stretching well past two years on average, hundreds of thousands of immigrants who have done everything legally required of them face years trapped without any federal health safety net — at a moment when the communities and advocacy organizations meant to help them are already stretched beyond their limits.
