The United States is implementing changes to Medicaid eligibility that will remove coverage from hundreds of thousands of immigrants with legal status, according to state data compiled ahead of implementation beginning October 1. The changes stem from the One Big Beautiful Bill Act, legislation passed in 2025 that aims to reduce Medicaid spending by more than $900 billion through 2034. The affected population includes individuals who entered the country through established legal pathways, such as refugees fleeing conflict, asylees escaping persecution, victims of human trafficking, and interpreters who assisted U.S. military operations in Afghanistan.
Among nine states and the District of Columbia surveyed, more than 281,000 immigrants have been identified as at risk of losing Medicaid coverage in October. Florida accounts for nearly 177,000 of these cases, with Arizona expecting approximately 28,000 losses, North Carolina around 29,000, Washington state 11,000, and New Jersey between 15,000 and 25,000. States conducted verification of immigration status through government databases and initiated notification processes to inform affected enrollees, though immigrant advocates report some states did not begin sending notices until September, providing limited time for recipients to respond or challenge potential errors.
The Congressional Budget Office estimates the Medicaid eligibility changes will result in approximately 100,000 additional uninsured immigrants by 2034. Additional provisions beginning in January are projected to remove about 1 million from subsidized Affordable Care Act marketplace coverage and approximately 100,000 from Medicare. Those losing Medicaid coverage will retain access to Emergency Medicaid for urgent medical needs. Green card holders and individuals under age 19, along with immigrants from Cuba, Haiti, and certain Pacific Island nations, are exempt from these eligibility changes.
Individuals facing coverage loss report significant concerns about access to ongoing medical care. The loss of Medicaid coverage eliminates access to routine doctor visits, prescription medications, and most medical services for affected immigrants. Some states are attempting to mitigate coverage losses through state-funded alternatives, while broader policy debates continue regarding the scope and intent of the legislation.
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