Starting October 1, 2026, Medicaid is no longer available to people without a green card or U.S. citizenship, but some states kept their own coverage programs, and refugees can still get Refugee Medical Assistance for their first months after arrival.
In short
- Starting October 1, 2026, Medicaid stays available only to U.S. citizens, green card holders, and a narrow list of immigration statuses — refugees and asylum seekers are not among them.
- Already having Medicaid doesn’t protect you: authorities are required to verify every recipient’s status and cancel coverage for anyone who isn’t an exception.
- RMA provides free coverage for 8 months — counted from arrival if an application is pending, or from the asylum approval date if it’s already granted.
- 41 states, including Florida and Texas, kept no coverage program of their own — medical care there becomes entirely paid.
- An asylum case needs to hold up as of the interview or court date, not the filing date — outdated circumstances need to be updated.
Who loses Medicaid on October 1, 2026
Starting October 1, 2026, Medicaid will be limited to U.S. citizens, green card holders, and a narrow set of special immigration statuses — Cuban-Haitian entrants, migrants from Compact of Free Association (COFA) countries, and certain Afghan and Ukrainian parolees. Pregnancy or age alone do not preserve Medicaid eligibility. The restriction applies to specific immigration statuses — refugees, asylum seekers, certain categories of parolees, and people with withholding of removal — regardless of where someone is in the process: waiting for an interview, in court, on appeal, or already approved but not yet holding a green card.
Pregnancy or age alone do not preserve Medicaid eligibility.
The cutoff doesn’t only affect people who were planning to apply. If Medicaid is already active and in use, it gets pulled on October 1 as well: authorities are required to verify every recipient’s status and cancel free coverage for anyone who doesn’t fall under an exception.
In states that never set up their own coverage programs — Florida and Texas among them — there is no free medical coverage left at all for people without a green card or citizenship.
If Medicaid is already active and in use, authorities are required starting October 1, 2026 to verify every recipient’s status and cancel coverage for anyone who doesn’t fall under an exception.
Refugee Medical Assistance (RMA): free coverage for 8 months
One option for people who lose Medicaid is Refugee Medical Assistance (RMA), a long-standing program unrelated to the October 1, 2026 changes — it existed independently of Medicaid long before this.
RMA works in two ways. If you’ve filed an asylum application, coverage runs for the first 8 months after arriving in the U.S. If asylum has already been granted but the green card hasn’t arrived yet, RMA is also available for 8 months — counted from the date of approval instead.
How long Refugee Medical Assistance lasts
RMA covers 8 months, but the clock starts differently depending on the stage of the case.
- Asylum application filed, no decision yet8 months from arrival in the U.S.
- Asylum approved, green card not yet issued8 months from the approval date
The starting point depends on the stage: if an asylum application has only been filed, it’s 8 months from arrival in the U.S.; if asylum has already been granted, it’s 8 months from the approval date.
ACA marketplace coverage as a paid alternative to Medicaid
Another option is Marketplace coverage under the Affordable Care Act (ACA), commonly known as ObamaCare. Unlike RMA, it isn’t free, but it comes with income-based subsidies.
At low income levels, the monthly premium can run as little as 5 to 10 dollars. It’s not a replacement for free programs, but an added option for people who’ve already used up their RMA window or don’t qualify for a state program.
Which states kept their own coverage programs
Beyond RMA and ACA marketplace plans, a number of states fund their own health coverage programs — they operate outside the federal rule because they’re governed by state budgets, not federal law.
| State | Program | Conditions |
|---|---|---|
| California | Full Medi-Cal | Runs in full through July 1, 2027; renewal depends on whether the budget gets approved. Covers people whose income previously met Medicaid requirements |
| Oregon | Health Oregon | Available to anyone previously enrolled in Medicaid — benefits stay the same |
| New York | Essential Plan | Secured by a court ruling; any immigrant residing in the state can apply, regardless of prior Medicaid enrollment |
| New Mexico | State program | Fully covers health insurance |
| Minnesota | State program | Fully covers health insurance |
| Massachusetts | MassHealth Family Assistance | Full coverage for people over 65 and people with disabilities; only emergency coverage for working-age adults 21–64 |
For California, one caveat matters: the July 1, 2027 cutoff isn’t a guaranteed extension — it’s the date after which the program only continues if the budget gets approved. If funding isn’t approved, the program ends on that date.
Full Medi-Cal for immigrants without status runs through July 1, 2027, and that’s not a guarantee — it’s the date after which the program only continues if the state budget is approved.
Pennsylvania and Washington, D.C.: partial coverage and planned changes
In Pennsylvania, a limited Medicaid category covers people with lawful status, while everyone else only has access to emergency medical care. A bill to preserve broader coverage in the state has stalled, but separate programs keep running — for asylum seekers, and for survivors of trafficking and torture (AATV, VTTC). One key limit: these programs only accept people who were already enrolled — new sign-ups aren’t possible.
these programs only accept people who were already enrolled — new sign-ups aren’t possible
In Washington, D.C., the local program is closed to new adults aged 26 and older. A separate program for the 21–26 age group is planned to launch by October 2027 — but for now that’s only a plan, not an option you can use.
States with no coverage programs: what to do if yours is on the list
If a state isn’t listed among the territories with full or partial coverage, there’s no state-level program there: asylum seekers — regardless of whether they’re waiting on a court decision, still in the administrative stage, or already approved but without a green card yet — can no longer count on free health insurance.
States with no coverage program include Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
For people living in these states, medical care becomes paid directly — out of pocket or through an insurance company. It’s worth budgeting 300 to 1,000 dollars or more for these costs.
Moving to a state that kept its program is a workable option: state-level coverage and reimbursement for medical services are offered in the states listed above as having full or partial coverage.
If a state isn’t on the coverage list, medical care there becomes entirely out of pocket — budget 300 to 1,000 dollars or more for costs.
Why a strong asylum case matters more than ever right now
The Medicaid cutoff turns an asylum grant from a goal into a practical necessity: once a green card is issued, programs like DCA — closed to applicants without status — become available. But moving to a state with better approval statistics isn’t enough on its own — winning a case in any state requires a strong, convincing claim.
There’s a detail that’s often missed: a case needs to hold up not as of the filing date, but as of the date it’s actually reviewed — meaning the interview or court hearing date. If a case was filed in 2022–2023 but the hearing is scheduled for 2026, conditions in the home country and the applicant’s own circumstances may have changed in the meantime. An outdated case needs to be updated, not left as it was filed years earlier.
a case needs to hold up not as of the filing date, but as of the date it’s actually reviewed — meaning the interview or court hearing date
Frequently asked questions
What happens if Medicaid is already cut off but an asylum case is still pending — or was denied in court?
The Medicaid cutoff is tied to immigration status, not case stage: without a green card, free Medicaid isn’t available regardless of the outcome. If a case is denied and no status is granted, the remaining options are RMA (if the 8-month window hasn’t run out), subsidized ACA marketplace coverage, or a state program, if one is still available.
What if the 8 months of RMA have already run out and the green card still hasn’t arrived?
Once the 8 months of RMA end, the program isn’t extended or reissued. The remaining paths are ACA marketplace coverage — where premiums can run 5 to 10 dollars a month at low income — or a state program, if one is still available where you live.
Can you move to a state with a coverage program if you already live in a state without one?
Yes, moving to a state that kept its program is a workable option: the benefits are available to residents of those states, not just to people who originally filed there. But moving on its own doesn’t strengthen an asylum case — winning in any state still requires a strong, convincing claim.
Can Medicaid be restored after getting a green card, if it was cut off before that?
Once a green card is issued, a person is no longer in the category covered by the October 1, 2026 restriction, and gains access to programs that are closed to applicants without status — including the ability to qualify for Medicaid on the same basis as anyone else.
How do you know if an asylum case is outdated and needs updating?
A case is outdated if conditions in the home country or the applicant’s own circumstances changed between the filing date and the interview or court hearing date. What matters is the date the case is actually reviewed, not the filing date — if there are several years between them, the materials need to be updated rather than left as originally filed.
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