Medicaid Restrictions for Noncitizens Take Effect Oct. 1

New Medicaid restrictions noncitizens rules took effect on October 1, ending Medicaid and Children’s Health Insurance Program eligibility for many legally present immigrants who do not hold green cards, under H.R.1, the One Big Beautiful Bill Act passed by Congress last July.

State agencies from Missouri to Washington began applying the change this week. The Missouri Department of Social Services says non-citizens who do not meet the new citizenship or immigration status requirements may lose eligibility on that date, and affected members will receive notices before coverage ends.

Who Is Affected by the Medicaid Restrictions Noncitizens Change

Under the new rules, eligibility for federally funded Medicaid is limited to U.S. citizens and nationals, Cuban and Haitian entrants, Compact of Free Association migrants, and lawful permanent residents who have met or are exempt from the five-year waiting period, according to state guidance from Nebraska, Rhode Island and Washington.

Statuses no longer listed as eligible include refugees, asylees, Amerasians, trafficking victims, immigration parolees, people granted withholding of removal, non-citizen U.S. veterans and their family members, and American Indians born in Canada, according to Missouri’s H.R.1 FAQ.

• Effective date: October 1, 2026
• Law: H.R.1, One Big Beautiful Bill Act
• CBO estimate: about 100,000 more people uninsured
• KFF analysis: 281,000+ at risk in nine states plus D.C.

Lawfully present pregnant women and children under 19 in the affected groups will continue to qualify if they meet other eligibility requirements, Nebraska DHHS notes.

What Advocates and States Are Saying

Global Refuge, a resettlement organization, warned in an October 1 statement that refugees, Afghan allies, Ukrainian parolees and survivors of torture and trafficking living legally in the United States are no longer eligible for Medicaid or CHIP, coverage refugees have accessed for decades under administrations of both parties.

Krish O’Mara Vignarajah, president and CEO of Global Refuge, said in the statement that when a family loses coverage there is no reliable health care equivalent of a food bank, and warned families may ration medication or delay care until problems become emergencies.

The organization also noted a backlog: refugees can apply for green cards after a year in the country, and many applied on time, but nearly 150,000 refugee green card applications are pending with U.S. Citizenship and Immigration Services, with processing times more than doubled since the end of 2024.

In Maryland, state data cited by Maryland Matters suggest up to 4,500 residents could lose Medicaid under the rule, including people in treatment for cancer and diabetes. Leidi Garcia, director of health and human services at We Are CASA, told the outlet her biggest concern is where people with chronic disease will be seen when coverage ends.

What Affected Members Should Do

State agencies urge members to keep mailing addresses and phone numbers current, open any notices promptly and respond to requests for information. Nebraska says it will review eligibility using available information, send notices explaining needed documents, and send an official notice to anyone who is no longer eligible because of immigration status.

Officials also advise scheduling medical, dental and behavioral health appointments and refilling prescriptions promptly if coverage may be affected. People who lose Medicaid may still buy a plan through a state marketplace such as HealthSourceRI, through an employer, or directly from an insurer, though federal financial help may be limited under the new law.

Health care remains available regardless of insurance or immigration status at community health centers and hospital emergency departments, state guidance notes.

A Phased Rollout With More Changes Ahead

The October 1 change is one of several H.R.1 provisions phasing in since the budget reconciliation bill passed in July 2025, with more scheduled for 2027. Another provision taking effect this week changes how states are charged for operating SNAP, the food assistance program, which Maryland officials estimate could cost the state up to $57 million.

For now, the immediate question for thousands of families is practical: whether a pending green card, a pregnancy or a child’s age keeps them covered, and where to turn if it does not. State Medicaid agencies say notices, appeal rights and marketplace options are the first places to check.

As the Medicaid restrictions noncitizens rules move from law to lived experience, health providers and advocates say the coming weeks will show how many people actually lose coverage and how quickly they find alternatives.

States are handling the transition differently. Washington’s Health Care Authority says full-scope Apple Health will be limited to the federally eligible groups from October 1, while Rhode Island will send notices through HealthyRhode accounts and by mail, including appeal information and marketplace alternatives. Missouri says its Family Support Division will send notices before ending coverage. Advocates urge anyone who receives a termination notice to check the stated reason carefully, since a pending green card application, pregnancy or a child under 19 may preserve eligibility under the new rules.