U.S. poised to boot legal immigrants from Medicaid, including refugees and sex-trafficking victims

Hundreds of thousands of immigrants with legal status are at risk of losing government health coverage starting Oct. 1, state data shows, signaling that the Medicaid changes in President Donald Trump's signature 2025 legislation may have a greater impact than anticipated. Many lawfully present immigrants will be among the first to lose Medicaid under congressional Republicans' One Big Beautiful Bill Act, which is expected to cut more than $900 billion in spending through 2034 for the state-federal health program serving low-income people and people with disabilities. The law will also strip many more immigrants of Affordable Care Act plan subsidies and Medicare coverage next year.

Those losing benefits they were previously eligible for include refugees of war, asylees who fled persecution, victims of sex trafficking, and interpreters who risked their lives assisting U.S. service members in Afghanistan — all of whom are in the country with the federal government's permission. The law does not affect coverage for a few groups, including green card holders.

The Congressional Budget Office estimated that the law's changes eliminating Medicaid eligibility for many noncitizen adults with legal status would lead to about 100,000 more immigrants being uninsured by 2034. KFF Health News asked several states how many Medicaid enrollees they had identified as at risk under the provision: more than 281,000 immigrants from nine states and the District of Columbia are expected to lose Medicaid in October. Florida alone identified nearly 177,000 immigrants who would no longer qualify starting in October, according to Anna Holaday, a spokesperson for the Florida Department of Children and Families, which verified enrollees' immigration status through government databases and sent notices giving people an opportunity to provide more information proving they remain eligible. Arizona predicts nearly 28,000 could lose eligibility, North Carolina about 29,000, New Jersey 15,000 to 25,000, and Washington state 11,000. Final state numbers on how many enrollees have actually been terminated won't be available until later this fall.

While some of those losing coverage may be able to obtain it elsewhere, the state figures suggest hundreds of thousands of immigrants nationally are at imminent risk of becoming uninsured. Lawmakers rely on the CBO to understand the budgetary and economic impacts of proposed legislation, yet the agency did not publish estimates on the One Big Beautiful Bill Act's impact on noncitizens enrolled in Medicaid until a month after Congress passed the bill and Trump signed it into law; the CBO declined to comment. Much of the attention around the law's Medicaid changes has centered on implementation of work requirements.