A Deadline That Will Change Everything: October 1, 2026

Mark it on your calendar. Write it on your refrigerator. Tell your neighbors who haven’t heard.

October 1, 2026 is the date when a provision buried inside H.R. 1—the sweeping federal budget reconciliation law also known as the “One Big Beautiful Bill”—begins to strip health insurance from hundreds of thousands of immigrant families who did everything right. Who came here legally. Who enrolled in the programs they were told they qualified for. Who have, in many cases, paid into these systems for years.

The Congressional Budget Office estimates that H.R. 1’s changes to Medicaid, CHIP, and Marketplace subsidies for non-citizens will cause approximately 1.3 million more people to become uninsured. That number represents real families—parents whose children need checkups, older adults managing chronic conditions, pregnant women who depend on prenatal care, workers who live one accident away from financial catastrophe.

This guide is designed to help you understand exactly what is changing, when, and what your options are—before the cliff arrives.

What H.R. 1 Actually Does: The Timeline of Cuts

The healthcare changes in H.R. 1 do not arrive all at once. They are staged across a two-year window, which means different people face different deadlines. Here is the full picture.

January 1, 2026 — Already in Effect

The first cut has already happened. Before H.R. 1, lawfully present immigrants whose income fell below 100% of the Federal Poverty Level (FPL) had access to a special exception that allowed them to receive Premium Tax Credits (PTCs) to help pay for Marketplace health plans, even though U.S. citizens at that income level would normally be directed to Medicaid rather than the Marketplace. This exception existed because immigrants in the five-year waiting period for Medicaid would otherwise have no affordable coverage option.

H.R. 1 eliminated this exception effective January 1, 2026. If your household income is below 100% FPL and you are a lawfully present immigrant who is not yet eligible for Medicaid, you have already lost access to subsidized Marketplace coverage. The CBO estimates this change alone will cause 300,000 people to lose coverage.

October 1, 2026 — The Main Event

This is the date that will affect the largest number of people. Beginning October 1, 2026, the federal government will restrict Medicaid and CHIP funding to a very narrow category of immigrants:

  • Lawful Permanent Residents (LPRs) — Green Card holders, but only after completing the five-year waiting period
  • Cuban and Haitian entrants — a specific legal category with a distinct history
  • COFA migrants — citizens of the Marshall Islands, Micronesia, and Palau living in the U.S. under Compact of Free Association agreements
  • Lawfully residing children and pregnant people in states that have adopted the ICHIA option (more on this below)

Who is not in that list? Everyone else who is currently enrolled. That includes refugees. Asylees. People with Temporary Protected Status. Special Immigrant Visa holders from Iraq and Afghanistan. Victims of trafficking and domestic violence. Native American tribal members born in Canada. Parolees admitted for humanitarian reasons, including many Ukrainians.

Many of these people have been covered by Medicaid for years—lawfully, because they qualified under the previous rules. H.R. 1 does not provide a transition period. When October 1 arrives, those currently enrolled lose coverage on that date alongside new applicants.

January 1, 2027 — The Marketplace Closes Too

For immigrants who lose Medicaid on October 1, 2026, there will be a brief window during which they can turn to the Marketplace. That window closes on January 1, 2027, when H.R. 1 also restricts Premium Tax Credit eligibility for Marketplace plans to the same narrow group of immigrants eligible for federal Medicaid. Refugees, asylees, TPS holders, and others who lost Medicaid in October will also lose their ability to receive subsidized Marketplace coverage in January.

The combination of these cuts means that a refugee who has been legally enrolled in Medicaid for years will, within a three-month span, lose their Medicaid coverage and then their access to affordable Marketplace coverage. As Justice in Aging notes in its analysis of H.R. 1’s impact on older immigrants: for those who also have Medicare, the overlapping losses are compounding and severe.

The Five-Year Bar: The Rule That Trips Up Even Green Card Holders

One of the most misunderstood aspects of immigrant health coverage is the five-year waiting period—and H.R. 1 makes understanding it more urgent than ever.

Under longstanding law, most Lawful Permanent Residents (LPRs) must wait five years from the date they received their Green Card before they become eligible for federally funded Medicaid or CHIP. This rule predates H.R. 1; it has been part of federal immigration and benefits law since the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA).

Here is why it matters right now: H.R. 1 restricts Medicaid eligibility to LPRs—but the five-year bar still applies. That means a green card holder who received their permanent residence two years ago has three years left to wait before federal Medicaid kicks in. During that waiting period, they have essentially no federally subsidized coverage option, because H.R. 1 has now also eliminated the PTC exception for those below 100% FPL.

This creates what health policy analysts are calling a “coverage desert” for recently arrived LPRs with low incomes: ineligible for Medicaid (because of the five-year bar), ineligible for subsidized Marketplace coverage below 100% FPL (because of the H.R. 1 PTC change), and ineligible for unsubsidized Marketplace plans (because premiums at full cost are simply unaffordable on low incomes).

If you received your Green Card fewer than five years ago, check your date carefully. Your five-year clock started on the date that status was granted—not the date you applied or the date you entered the country. If you are approaching your five-year anniversary, that date represents genuine access to federal coverage and is worth knowing precisely.

Who Keeps Coverage Under H.R. 1

Not everyone is affected equally. Here is who continues to have access to federal health coverage under the new rules:

Naturalized U.S. citizens are fully unaffected. If you have become a citizen, your coverage rights are identical to those of any U.S.-born citizen.

LPRs who have passed the five-year bar remain eligible for Medicaid and CHIP, assuming they meet income requirements, and they retain PTC eligibility for Marketplace plans above 100% FPL.

Children have more protection than adults in most states, because 38 states have adopted the ICHIA (Immigrant Children’s Health Improvement Act) option under CHIPRA 214, which allows states to provide federally funded Medicaid and CHIP to lawfully residing children regardless of how long they have been in the country. H.R. 1 explicitly preserves this option. If your state has adopted ICHIA, your lawfully residing children may continue to be covered even if you, as an adult, lose coverage.

Pregnant people in states that have adopted the ICHIA pregnancy option have additional federal protection as well, including through the CHIP From-Conception-to-End-of-Pregnancy (FCEP) option, which 24 states have adopted.

Emergency Medicaid remains available under federal law. EMTALA (the Emergency Medical Treatment and Labor Act) requires Medicare-participating hospitals to provide stabilizing care to anyone who arrives at an emergency room regardless of insurance or immigration status. Federal Emergency Medicaid reimburses hospitals for some of that cost, even for patients who cannot qualify for regular Medicaid due to immigration status. However, H.R. 1 reduces the federal match for Emergency Medicaid in expansion states from the enhanced 90% rate to the regular state rate—meaning states will bear more of this cost and some may limit services accordingly.

The State-Only Lifeline: Where to Look If You’re Losing Federal Coverage

Here is the most important piece of practical information in this guide: federal law does not stop states from using their own money to cover immigrants. H.R. 1 restricts federal funding—but states can still design and fund their own programs to cover immigrants who are excluded from federally funded coverage.

Several states have done exactly that. But the landscape is shifting, and some states are pulling back due to budget pressure. Here is the current picture, state by state, as of April 2026:

California

California has the most comprehensive state-funded immigrant health coverage in the country. The state expanded Medi-Cal (its Medicaid program) to all income-eligible adults regardless of immigration status in January 2024, making it the first state to achieve that level of coverage. However, due to a significant state budget deficit, California announced in late 2025 that it would pause new enrollment for immigrant adults ages 19 and older starting January 2026. Existing enrollees retain their coverage, but new applicants will be placed on a waiting list. Starting July 2027, currently enrolled adults ages 19–59 will be charged a $30 monthly premium.

Bottom line for California: If you are already enrolled in Medi-Cal, you should retain your coverage for now. If you are not yet enrolled and need coverage, contact your county social services office immediately to understand your options and get on any available waiting list.

New York

New York provides state-funded Medicaid-equivalent coverage to residents ages 65 and older regardless of immigration status through its Essential Plan and related programs. Children in New York have broad coverage through Child Health Plus (CHP), which covers children under 19 at any income level regardless of immigration status—with no waiting period and no immigration status requirement.

Bottom line for New York: Children and seniors have relatively strong state-level protections. Working-age adults without qualifying immigration status face more limited options; contact the NY State of Health marketplace (nystateofhealth.ny.gov) to assess what is available based on your specific situation.

Illinois

Illinois has been contracting its state-funded immigrant coverage programs due to budget constraints. The Health Benefits for Immigrant Adults (HBIA) program, which covered low-income immigrants ages 42–64 regardless of status, ended in July 2025. The Health Benefits for Immigrant Seniors (HBIS) program, covering those 65 and older, has paused new enrollment since 2023.

Bottom line for Illinois: State-funded adult coverage options in Illinois have narrowed significantly. Children continue to have ICHIA protections. If you are a senior or working-age adult who previously relied on Illinois state-funded programs, contact the Illinois Department of Healthcare and Family Services (HFS) to understand your current status and explore alternatives through the federal Marketplace or community health centers.

Colorado

Colorado offers state-funded health coverage through its state-run Marketplace and other programs. Notably, residents earning up to 300% of the federal poverty level may be eligible for state-based financial assistance—a higher ceiling than most states. Colorado requires insurers selling through the state marketplace to also offer plans on a separate platform for people ineligible for ACA marketplace plans due to immigration status.

Bottom line for Colorado: Coverage options may be broader here than in other states, including for people in the five-year waiting period. Contact Connect for Health Colorado (connectforhealthco.com) to explore your options.

Oregon, Washington, Minnesota

These states have also expanded state-funded coverage to immigrants in various forms, though Minnesota paused enrollment for undocumented adults in mid-2025. Washington is using a Section 1332 waiver to allow immigrants ineligible for the federal Marketplace to enroll in state-subsidized coverage.

Bottom line: If you live in one of these states, contact your state Medicaid or marketplace office directly to understand current eligibility. The situation is dynamic and has shifted multiple times in the past year.

States Without State-Only Programs

If you live in a state that has not established state-funded immigrant health coverage—which is the majority of states, particularly in the South and parts of the Midwest—your options after October 1, 2026 are more limited. You may still be able to enroll in an unsubsidized Marketplace plan (without PTC assistance), and Emergency Medicaid remains available for acute situations. Community health centers and Federally Qualified Health Centers (FQHCs) provide care on a sliding-scale basis regardless of insurance status, and will be a critical resource as coverage gaps widen.

The Premium Tax Credit Cliff in Detail

For people who are not losing Medicaid coverage directly, but who depend on Marketplace subsidies, H.R. 1 creates a different but equally serious problem.

As noted, the PTC exception for immigrants below 100% FPL was already eliminated as of January 2026. But the impact does not stop there. Starting January 1, 2027, PTC eligibility for all Marketplace plans—not just those below 100% FPL—will be restricted to LPRs (after five years), Cuban/Haitian entrants, and COFA migrants.

This means a refugee or asylee earning, say, 150% of FPL—an income level that should qualify for a meaningful PTC—will lose that subsidy when shopping for 2027 coverage during the fall 2026 open enrollment period. Without the PTC, the full premium cost of a Marketplace plan at that income level may consume a prohibitive portion of monthly earnings.

The Commonwealth Fund estimates that 900,000 people will lose Marketplace coverage by 2034 as a result of these PTC restrictions, in addition to those losing Medicaid and CHIP directly.

One often-overlooked implication: as healthier, younger immigrants—who tend to purchase Marketplace plans at subsidized rates—exit the insurance pool, the remaining pool becomes older and sicker. This is expected to push premium costs higher for everyone on the Marketplace, including U.S. citizens, as a smaller, less healthy pool shares the cost of care.

What To Do Right Now: A Checklist

The most powerful thing you can do between now and October 1, 2026, is act with information. Here is a step-by-step action plan:

Step 1: Know your immigration status precisely. The question of who keeps coverage is determined at the level of specific legal categories. “Lawfully present” is not sufficient. You need to know your exact immigration classification—and if you are unsure, an immigration attorney or accredited representative can clarify it.

Step 2: Identify your Green Card date, if applicable. If you are an LPR, calculate your five-year anniversary from the date your permanent residence was granted (found on your Green Card). That date is your entry point to federal Medicaid eligibility—assuming you also meet income requirements.

Step 3: Check your state’s programs. Before October 1, contact your state Medicaid agency or state health marketplace to ask specifically about state-funded coverage for immigrants who are losing federal eligibility. The landscape is changing rapidly; the answer you got six months ago may not be current.

Step 4: Explore Community Health Centers. Federally Qualified Health Centers (FQHCs) and community health centers provide primary and preventive care on a sliding-fee scale regardless of insurance status or immigration status. Find one near you at findahealthcenter.hrsa.gov. These will be an essential resource for the newly uninsured.

Step 5: Check if your children remain covered. Even if you lose coverage as an adult, your lawfully residing children may remain eligible for Medicaid or CHIP in your state through the ICHIA option. Do not assume that because you lose coverage, your children do too—but verify this with your state Medicaid office.

Step 6: Watch the open enrollment window. If you are a refugee or asylee who loses Medicaid on October 1, 2026 but retains PTC eligibility for Marketplace plans through December 31, 2026, the fall 2026 open enrollment period becomes critically important. You will need to enroll in a Marketplace plan for 2027 before your PTC eligibility ends—and you will want to understand exactly what you qualify for before that window closes. Note: Starting with fall 2026 enrollment, the open enrollment period will end December 15 rather than January 15 in most states.

Step 7: Prepare for the Special Enrollment Period (SEP). Losing coverage that you did not choose to lose—like losing Medicaid due to a law change—typically triggers a Special Enrollment Period, allowing you to enroll in a Marketplace plan outside of the normal open enrollment window. Document your coverage termination notice when it arrives.

The Human Cost Behind the Numbers

Policy analysis can make these changes feel abstract. They are not.

A refugee from Sudan who spent years in a camp, arrived legally with resettlement assistance, and enrolled in Medicaid will lose that coverage on October 1 because H.R. 1 does not carve out an exception for refugees who have been in the country for less than five years—or, beginning January 1, 2027, at all. The irony is particularly sharp: refugees and asylees, who are here precisely because the U.S. government determined they faced persecution, are losing their health coverage under the same legal system that granted them protection.

An older immigrant from Mexico who received a Green Card through a family petition four years ago and has been managing diabetes through Medicaid is three years away from her five-year anniversary. She is now uninsured for those three years, with the PTC option below 100% FPL gone and the full Marketplace premium far beyond her budget.

A Haitian family whose members hold TPS—a status granted because the U.S. government determined Haiti was unsafe to return to—faces losing Medicaid and eventually Marketplace subsidies too.

These are not edge cases. These are the people H.R. 1 is designed to remove from federally funded coverage.

Why This Matters Beyond Immigrant Communities

It is worth stating plainly: the consequences of H.R. 1’s health coverage cuts will not be contained to immigrant communities.

When people lose insurance and avoid preventive care—as research consistently shows happens—illnesses go undiagnosed and untreated longer. When conditions become emergencies, people show up in emergency rooms, which are the most expensive setting for care and which cannot turn patients away under EMTALA. Those costs do not disappear; they are absorbed by hospitals, passed on as higher costs to other patients, and shifted to state and local governments.

The Commonwealth Fund has noted that the loss of younger, healthier immigrants from Marketplace risk pools will push premiums higher for everyone else enrolled. This is not a political argument; it is how insurance pricing works. Smaller, sicker risk pools cost more to cover.

Community health centers—the safety net providers that will absorb much of the demand from the newly uninsured—are simultaneously facing funding cuts from other H.R. 1 provisions. The pressure on an already-strained system will intensify precisely when demand for its services peaks.

Where to Find Help

If you believe you or your family will be affected by H.R. 1’s coverage changes, these are your most reliable resources for accurate, up-to-date information:

Your state Medicaid agency is the authoritative source on what state-funded programs may be available and whether your children retain coverage. Find your state’s contact at Medicaid.gov.

Healthcare.gov and your state marketplace can show you what Marketplace plans are available to you and whether you qualify for PTCs based on your current immigration status and income.

Find a Health Center (HRSA): Community health centers provide sliding-scale care regardless of insurance status. Find the nearest one at findahealthcenter.hrsa.gov.

National Immigration Law Center (NILC): NILC maintains up-to-date resources on immigrant eligibility for health programs by state, including their Medical Assistance Programs for Immigrants table, updated regularly at nilc.org/resources.

KFF (Kaiser Family Foundation): KFF has published extensive analysis of H.R. 1’s impact on immigrant coverage, with state-by-state breakdowns. Their research is the most comprehensive publicly available analysis of these changes and is accessible at kff.org.

Community-Based Organizations: Many immigrant-serving nonprofits—legal aid organizations, health navigators, community health workers—provide in-person assistance with enrollment and can help you navigate what is available in your specific situation. Ask at your local community center, library, or faith community.

Conclusion: The Cliff Is Real. The Window Is Closing.

H.R. 1 represents the most significant restriction of immigrant access to federal health coverage in three decades. For the 1.3 million people the CBO estimates will become uninsured as a result, the stakes are not abstract. They are a cancer screening that does not happen. A chronic condition that goes unmanaged. A child who misses a vaccine. A mother who avoids prenatal care.

The deadline of October 1, 2026, is close. The action steps above—checking your status, understanding your state’s programs, preparing for the enrollment periods—are things you can do now, before the cliff arrives.

The healthcare cliff is real. But it is not a surprise. And preparation, in this case, is the most powerful act of protection available to you and your family.

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