1.4 million legally present immigrants should lose health coverage due to the 2025 tax and budget law

The Republicans of Congress and President Trump adopted the bill on tax and budgetary reconciliation in July 2025. The new law includes significant reductions in the Medicaid program as well as eligibility restrictions for many legally present immigrants, in particular refugees and asylees, to access Medicaid and the health insurance program (CHIP) Affordable care (ACA) and health insurance-health insurance. Under longtime federal policy, undocumented immigrants are already not eligible for health coverage funded by the federal government. This policy ensures that the groups of immigrants present legally which will lose access to health coverage funded by the federal government due to the 2025 tax and budget law and estimates of the Congressional Budget Office (CBO) of the increase in the number of changes in savings and federal and federal income due to these provisions.

The CBO estimates that the restrictions of the law on admissibility to health coverage financed by the federal government for immigrants legally present will lead to around 1.4 million legally current immigrants who do not become assured, will reduce federal spending by approximately $ 131 billion and increase federal income by $ 4.8 billion from 2034. In addition, under the regulatory changes in the Trump administration, more than 530,000 beneficiaries of delayed action for children arrivals (DACA) are not eligible for coverage options funded by the federal government.

Immigrant admissibility changes under legally legally under the tax on tax and the 2025 budget

Medicaid and chip

Under the previous law, to be eligible for Medicaid and Chip, immigrants must have “qualified” immigration status in addition to responding to other eligibility conditions such as income. Qualified immigrants, as defined by the 1996 law on personal responsibility and work opportunities and subsequent additions, include legal permanent residents (LPRS or “green card” holders); refugees; People granted parole for at least a year; Individuals have granted asylum or related rescue and some mistreated spouses and their children or parents; Some victims of trafficking; Cuban and Haitian participants; And the citizens of freely associated nations (COFA) of the Marshall Islands, Micronesia and Palaos residing in American States and Territories. In addition, many had to wait five years after obtaining qualified status before they could register in Medicaid even if they met other eligibility conditions. States have an option to extend the coverage of Medicaid and / or chips to all children and / or pregnant that reside legally and renounce the expectations of five years for these groups, which 39 more DC states had taken into account from January 2025. April 2025.

The 2025 tax and budget law will limit the eligibility for Medicaid or the LPR chip, to the Cuban and Haitian participants, people residing in the United States under COFA, and legally residing in children and pregnant immigrants in states that cover them under the Medicaid and / or Chip option (Table 1). States will also have the possibility of extending prenatal benefits and linked to pregnancy to children with low -targeted income from design until the end of pregnancy thanks to the FCEP option. These restrictions will eliminate eligibility for many other groups of legally present immigrants, including refugees and asyera without a green card, among others (Table 1). This provision will come into force on October 1, 2026 and CBO estimates that it will reduce federal expenses by $ 6.2 billion and will drive an additional 100,000 people not insured by 2034.

ACA markets

Under the previous law, the legally present immigrants were eligible to register for the coverage of the ACA market and receive subsidies to premiums and cost sharing reductions, including people with temporary protection status (TPS), those who have a deferred departure and people on working visas. In general, market coverage is limited to people with income or greater than 100% of the federal poverty level (FPL), as most people with lower income would be eligible for Medicaid. However, some immigrants legally present with lower income remain ineligible for Medicaid (for example, due to the five -year waiting period and eligibility limits for qualified immigrants). To fill this gap, the market eligibility has also been extended to legally present immigrants with income under 100% FPL which are not eligible for Medicaid because of their immigration status, including those of the five -year waiting period for the coverage of Medicaid. In the years which followed the adoption of the ACA, the beneficiaries of the DACA were excluded from the eligibility for the markets although they are legally present. Under the regulations published by the Biden Administration in May 2024, the DACA beneficiaries were made newly eligible for the markets and to receive grants to compensate for costs from November 2024. However, this coverage was blocked in certain states due to legal challenges, and on June 25, 2025, the Trump administration finalized a rule which once again did the United States. Finish the coverage of the registered beneficiaries of the DACA on September 30, 2025.

The law will also limit eligibility for the coverage of the Subsidized ACA market to legally present immigrants who are LPRs, Cuban and Haitian participants, and people residing in the United States under COFA. (Table 1). A wider group of legally present immigrants will lose access to the coverage of the subsidized market within the framework of this change, including refugees and asyères without green cards, people with TPS and individuals on work visas, among others, from January 1, 2027. The CBO estimates that this provision will lead to an additional million of uninsured people and will reduce federal expenses by 91.4 billions of dollars over the period 2026 for 2035. In addition, the provision should increase federal income by $ 4.8 billion from 2034. The law also eliminates access to the coverage of the subsidized market for legally present immigrants, including those of the five -year waiting period for coverage, from Medicaid. Listed with a market plan, which are probably mainly legally present immigrants who are not eligible for Medicaid due to immigration status. The CBO estimates that this provision will lead to 200,000 additional people who are not guaranteed and will reduce federal expenses of $ 27.3 billion over the period from 2026 to 2035. In addition, the provision should increase federal revenues by $ 176 million in 2034.

Medicine

Immigrants legally present have been eligible for Medicare if they have the required work districts and meet the disability or age requirements. People with no work history required could also buy Medicare after residing legally in the United States for five years continuously.

Under the new law, eligibility for health insurance will also be limited to immigrants who are legally present who are LPRS, Cuban and Haitian participants, and people residing in the United States under the COFA, eliminating the eligibility for refugees and asyères without green card, people with TPS and people with work visas, among others (Table 1). Current beneficiaries subject to new restrictions will lose coverage no later than 18 months after the promulgation of legislation (January 4, 2027). The CBO estimates that this provision will result in coverage of an additional 100,000 people, with a reduction in federal expenses of $ 5.1 billion and a drop in federal income of $ 123 million in 2034.