Federal Medicaid Funds Only 3 Immigrant Groups From October
Starting October 1, 2026, the federal government pays for Medicaid and CHIP for only three groups of noncitizens: green card holders, Cuban and Haitian entrants, and people living in the US under a Compact of Free Association (COFA). For statuses outside that list, such as refugees and asylees who do not yet have green cards, people on parole, work visa holders and students, federal money no longer pays for full Medicaid, only for emergency care (including emergency labor and delivery); lawfully residing children and pregnant women in states that chose to cover them are another exception.
This comes from section 71109 of Public Law 119-21, passed in 2025, and it changes whether the federal government pays states. Whether a state uses its own money to fill the gap varies, and this article did not check state by state.
By status, from 2026-10-01
| Status | Does federal money pay for full Medicaid and CHIP? | Source |
|---|---|---|
| US citizens and US nationals | Yes | Public Law 119-21 §71109 |
| Green card holders | Yes; there is generally a 5-year waiting period, but former refugees and asylees do not wait | Same, HealthCare.gov |
| Cuban or Haitian entrants | Yes | Same |
| COFA migrants (Micronesia, Marshall Islands, Palau) | Yes | Same |
| Everyone else (for example refugees and asylees without green cards, parole, work visas, students) | No; emergency care is still paid | Same |
| Lawfully residing children (under 21) and pregnant women in states that chose to cover them | An exception; can be paid | 42 U.S.C. 1396b(v)(4) |
What the law says
Section 71109 adds paragraph (5) to section 1903(v) of the Social Security Act: starting October 1, 2026, except as provided in paragraphs (2) and (4), no federal payment goes to a state for Medicaid for anyone not on the list. The list is people living in the 50 states, DC or a US territory who are US citizens or nationals, lawful permanent residents, Cuban or Haitian entrants, or people lawfully residing under COFA (text of Public Law 119-21). The same section applies this limit to CHIP.
- Green card defined: the law means people lawfully admitted for permanent residence as immigrants, not visitors, tourists, diplomats or students who come to the US temporarily.
- The last table row is an inference: the law lists only the statuses that can be paid for; refugees, asylees, parole and others are not on the list, so federal money does not pay.
Two exceptions emergency care and children and pregnant women by state choice
Both exceptions are in paragraphs (2) and (4) of 42 U.S.C. 1396b(v) (text of the US Code):
- Emergency care: federal money still pays for treating an emergency medical condition, including emergency labor and delivery, but not organ transplants. The person must meet the other Medicaid requirements.
- Children and pregnant women by state choice: a state can choose to cover children under 21 and pregnant women (through 60 days after the pregnancy ends) who are lawfully residing in the US. To find out whether your state chose this, HealthCare.gov asks you to check your state’s information (HealthCare.gov).
Green card holders the 5-year wait still applies
HealthCare.gov says you are generally eligible for Medicaid and CHIP 5 years after getting “qualified non-citizen” status; green card holders who used to be refugees, asylees or certain other statuses do not have the 5-year wait. States can remove the 5 years for lawfully residing pregnant women and children (HealthCare.gov).
Marketplace savings the same three groups from 2027
Lawfully present immigrants can still buy Marketplace coverage. HealthCare.gov says that starting January 1, 2027, income-based savings on premiums and out-of-pocket costs go to green card holders, Cuban or Haitian entrants and COFA migrants (HealthCare.gov). For how to enroll after arriving, see health insurance for new immigrants within 60 days of moving.
What this article did not read
- CMS guidance to states: the State Health Official letter (SHO #26-001) and the implementation tool on Medicaid.gov could not be opened when we checked on 2026-10-28, so this article did not read them and does not cover implementation details.
- Whether states fill the gap: the law changes federal payment; what each state does on its own was not checked state by state. When you apply or renew, go by your state Medicaid agency’s notice.
Frequently asked questions
I have a green card. Can I still apply for Medicaid after October 2026?
Green card holders are on the list, so federal money still pays. You generally wait 5 years after getting the status; former refugees and asylees do not wait.
I am a refugee or asylee without a green card yet. Do I still have Medicaid?
The law’s list does not include refugees or asylees, so federal money no longer pays for full Medicaid; emergency care is still paid. What your state does on its own depends on the state’s notice.
My child is on H-4 or F-2. Can the child get Medicaid or CHIP?
It depends on whether your state chose to cover lawfully residing children and how the state applies it. In states that did, federal money can pay; in states that did not, it does not.
If my status is not on the list, does Medicaid still pay for emergency care?
The Medicaid emergency exception remains: if you meet the other requirements, federal money pays for treating an emergency medical condition, including emergency labor and delivery.
Can work visa holders buy Marketplace coverage?
Yes. Starting January 1, 2027, premium savings go only to green card holders, Cuban or Haitian entrants and COFA migrants.
This item on the checklist
“Explore whether you qualify for local government benefits or assistance” is in the full version of the My USA Plan checklist . The first 30 items are free, and the full 91 items cost US$9.90 once, not a subscription. For every first-year deadline, see the first-year deadline table for new immigrants.
Sources and dates checked
All checked on 2026-10-27. This article is not legal, immigration or insurance advice; for your own case, ask your state Medicaid agency or a lawyer.
- Public Law 119-21 §71109 (govinfo): https://www.govinfo.gov/content/pkg/PLAW-119publ21/html/PLAW-119publ21.htm
- 42 U.S.C. 1396b(v) (govinfo, 2023 edition of the Code):https://www.govinfo.gov/content/pkg/USCODE-2023-title42/html/USCODE-2023-title42-chap7-subchapXIX-sec1396b.htm
- HealthCare.gov lawfully present immigrants:https://www.healthcare.gov/immigrants/lawfully-present-immigrants/