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Federal Medicaid and CHIP funding restrictions that took effect October 1, 2026, have ended federally matched full coverage for some lawfully present immigrants who previously qualified. Early reporting describes losses affecting thousands of people, but a broader tally of more than 281,000 people in nine states and Washington, D.C., is an estimate of people considered at risk—not a confirmed count of completed terminations. The change does not apply to every immigrant with legal status, and state-funded coverage may remain available.
What changed on October 1, 2026?
Section 71109 of H.R. 1, signed by President Trump on July 4, 2025, narrowed which noncitizen categories can receive federal matching funds for full Medicaid and the Children’s Health Insurance Program (CHIP). The restrictions took effect October 1, 2026. States had to review current cases by that date and apply the new funding rules to new eligibility decisions, according to the Centers for Medicare & Medicaid Services (CMS) and KFF.
This is principally a change to federal funding eligibility for specified groups who were lawfully present—not a new rule making all immigrants ineligible. People without qualifying immigration status were already generally ineligible for ordinary federally funded Medicaid. They may still qualify for emergency Medicaid if they meet the program’s other requirements.
Who may lose federally matched Medicaid or CHIP?
Some people in immigration categories that qualified under earlier rules are no longer eligible for federally matched full benefits based on status. Affected groups include refugees and asylees who do not have green cards, as well as other categories covered under prior rules. Eligibility also depends on income, age, pregnancy, state rules, and other Medicaid requirements; immigration category alone does not establish eligibility or ineligibility.
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Several categories remain eligible for federal matching for full Medicaid and CHIP, subject to the programs’ other rules:
| Immigration category or circumstance | Federal funding treatment under the October 2026 change |
|---|---|
| Lawful permanent residents (green-card holders) | Remain among the categories eligible for federal matching, subject to other eligibility rules. Existing five-year waiting-period rules still apply to many lawful permanent residents, with exceptions. |
| Cuban and Haitian entrants | Remain among the categories eligible for federal matching, subject to other eligibility rules. |
| Citizens of Compact of Free Association (COFA) nations | Remain among the categories eligible for federal matching, subject to other eligibility rules. |
| Lawfully residing children or pregnant people | Federal law preserves a state option to cover these groups. Availability depends on whether the state has adopted the option and on other eligibility rules. |
| Some refugees, asylees, and other previously covered categories without a green card | May lose eligibility for federally matched full benefits under the new categories, depending on their exact status and circumstances. |
These are funding categories, not a complete individual eligibility determination. The CMS guidance and KFF’s policy explanation describe the federal rules; a state agency must apply them to the person’s case.
How many people have lost coverage?
KFF Health News reported early coverage losses in the thousands. Separately, it found state estimates identifying more than 281,000 people across nine states and Washington, D.C., as expected to lose Medicaid in October. Those figures count people flagged as at risk before or around implementation; they are not a finalized tally of people actually disenrolled. As of the reporting, post-October termination totals, including any cases later corrected or reinstated, were not available.
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| State | People identified as at risk | Attribution and qualification |
|---|---|---|
| Florida | Nearly 177,000 | Florida Department of Children and Families estimate, as reported by KFF Health News in 2026; at risk, not confirmed terminations. |
| Arizona | Nearly 28,000 | State estimate, as reported by KFF Health News in 2026; at risk, not confirmed terminations. |
| New Jersey | 15,000–25,000 | State estimate range, as reported by KFF Health News in 2026; at risk, not confirmed terminations. |
| North Carolina | About 29,000 | State estimate, as reported by KFF Health News in 2026; at risk, not confirmed terminations. |
| Washington | 11,000 | State estimate, as reported by KFF Health News in 2026; at risk, not confirmed terminations. |
The figures above are examples, not an exhaustive state-by-state breakdown. California separately expects about 148,000 immigrants to lose federal Medicaid coverage. KFF Health News reported that California set aside $365 million to maintain separate coverage through July 2027; state-funded coverage is distinct from federally matched Medicaid.
What should you do if you get a Medicaid termination notice?
Use the instructions and deadlines on the notice from your state. Notices and procedures vary, so do not assume that another person’s deadline or state process applies to your case.
- Check the stated reason and effective date. Compare the immigration category and other information in the notice with your records. Contact the number listed if something appears inaccurate or unclear.
- Respond by the deadline. Send the documents or information requested if you may remain eligible—for example, because your immigration category is listed as eligible or the agency’s records are wrong. Keep copies and proof of submission.
- Ask about a hearing if you disagree. Medicaid enrollees have a right to advance notice and a fair hearing before coverage is terminated or reduced. CMS requires at least ten days’ advance notice for Medicaid; the notice explains how to request a hearing and the applicable deadline.
- Get qualified help if needed. A benefits assister or legal aid organization may help you understand the notice or correct a status-record problem. This is practical support, not a substitute for advice from a qualified professional about your specific case.
States are required to check existing records and automated data sources before asking enrollees for documents. If an enrollee declares citizenship or a satisfactory immigration status but the SAVE system has not resolved verification, CMS describes a 90-day reasonable-opportunity period with continued coverage in the relevant case. That protection is not a general 90-day extension for every notice: its application depends on the circumstances, and the state notice remains important.
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What coverage or care may remain?
Losing federally matched full Medicaid does not always mean that every source of help ends. The options differ in scope, eligibility, cost, and availability:
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|---|---|---|
| State-funded coverage | A state may use its own funds to continue or offer coverage outside federally matched Medicaid. | Programs vary by state and may have separate eligibility rules, limited services, or enrollment limits. Confirm whether coverage is comprehensive and when it starts. |
| Emergency Medicaid | Federal funding can support qualifying emergency services for people who meet other Medicaid conditions but do not qualify for full Medicaid because of immigration status. | It is not comprehensive insurance and does not replace ordinary Medicaid. Beginning October 1, 2026, federal matching for certain Emergency Medicaid services is limited to the state’s regular matching rate. |
| State option for lawfully residing children or pregnant people | In states that have adopted the option, qualifying children or pregnant people may remain eligible for federally matched coverage. | State adoption and other program rules determine availability; ask the state agency about the specific case. |
| Community health center | Some centers provide services free or on a sliding-fee scale. | Services, fees, eligibility procedures, and appointment availability differ locally. Contact the center to confirm current offerings; a clinic visit is not the same as comprehensive insurance. |
KFF’s analysis of community health centers notes that federal policy and litigation have affected access rules. A local center can confirm what it currently offers and what documents or costs to expect.
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How does this differ from later marketplace and Medicare changes?
The October 2026 Medicaid and CHIP restrictions are one part of a broader law, not a single combined coverage cutoff. KFF’s policy brief says marketplace subsidy eligibility for many affected immigration categories narrows starting January 1, 2027; the scope depends on the category. Medicare changes described in reporting are also separate provisions with different timing and affected populations. Neither should be added to October’s Medicaid at-risk figures.
KFF reports that the Congressional Budget Office estimates about 100,000 additional immigrants will be uninsured by 2034 because of the Medicaid and CHIP eligibility restrictions, with $6.2 billion less federal Medicaid and CHIP spending by that year. Those are long-term estimates, not counts of people who lost coverage in October. KFF Health News separately reported that the broader law reduces Medicaid spending by more than $900 billion through 2034; that figure covers the law’s wider Medicaid impact, not just this immigration provision.
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