Roughly 1 in 7 of all older adults within the U.S. is an immigrant.[1] The U.S. has a wealthy and lengthy historical past of immigrants arriving from a wide range of international locations and ethnic backgrounds. Older immigrants might have immigrated to the U.S. at an older age or arrived as youthful people and lived and labored within the U.S. for many years.[2] Immigrants come to the U.S. via a wide range of immigration pathways, typically for humanitarian causes like asylum or refugee, employment or education-based choices, or underneath household unification processes.
Immigrant eligibility for federally funded well being applications has at all times been advanced, with some lawfully current immigrants having to attend a sure variety of years earlier than being eligible for Medicaid or Medicare, and different teams bypassing this ready interval.
Nonetheless, many immigrants with authorized standing have traditionally been eligible for Medicare, Medicaid, and tax credit for Inexpensive Care Act (ACA) insurance policy. This modified in July 2025 when the federal finances reconciliation invoice (H.R.1) was signed into legislation and upended immigrant eligibility, considerably narrowing which immigrant teams can qualify for Medicare, Medicaid, and ACA tax credit.
Immigrants shedding eligibility are individuals whose lawfully current standing has not modified and, for many years, might entry these well being applications. They’ve fled violence, famine, endured trafficking, and, as older adults, have typically lived and labored within the U.S. for years, all of the whereas supporting their households, paying taxes, contributing billions of {dollars} into the Medicare Belief Fund,[3] and strengthening the U.S. financial system. They play an necessary function in households, communities, and society at giant, offering assist in multigenerational households and serving as cultural hyperlinks for youthful generations.
What Modified Underneath H.R.1?
Eligibility for Medicare, Medicaid, and ACA tax credit might be solely restricted to 4 classes:
- U.S. residents,
- Authorized everlasting residents (“inexperienced card holders”),
- Sure Cuban/Haitian entrants, and
- Individuals residing within the U.S. underneath the Compact of Free Affiliation (COFA).[4]
All different immigrant statuses are excluded, despite the fact that these teams stay lawfully current.
Immigrants newly ineligible and shedding protection embrace:
- Refugees and folks granted asylum,
- Individuals granted withholding of elimination,
- Trafficking and home violence survivors,
- Individuals granted humanitarian parole, comparable to sure Afghans who aided U.S. army operations in Afghanistan or individuals fleeing violence in Ukraine,
- Individuals granted Non permanent Protected Standing (TPS).[5]
When Do These Adjustments Take Impact?
A few of these adjustments have already taken impact and others might be phased in over the approaching yr.
Medicare
Individuals who change into newly eligible for Medicare on or after July 4, 2025 should be residents, inexperienced card holders, Cuban/Haitian entrants, or COFA migrants to enroll. Present Medicare enrollees who aren’t in one among these 4 classes may have their protection terminated on January 4, 2027. [6]
Medicaid
On October 1, 2026, Medicaid eligibility and enrollment for older adults who aren’t in one of many 4 named classes will finish in most states.[7]
ACA Tax Credit
As of January 1, 2026, lawfully current immigrants who’re ineligible for Medicaid and have earnings under 100% FPL are not eligible for tax credit. Starting January 1, 2027, tax credit score eligibility is restricted to the 4 named classes. [8]
What’s the Affect on Older Immigrants?
Mixed, the result’s that a whole bunch of hundreds of immigrants are vulnerable to being uninsured, significantly if they’re low-income. Some older immigrants who’re dually eligible for Medicare and Medicaid will lose each sources of protection. These adjustments are vital to older immigrants as a result of H.R.1 cuts off all pathways to reasonably priced well being care protection for individuals with TPS, refugees, asylees, and different humanitarian immigrants.
Multiplying Harms
The overlapping harms of H.R.1 are substantial. By reducing off entry to Medicare, Medicaid, and ACA tax credit, few sensible choices stay. Employer-based medical insurance requires a return to employment at an older age, and older immigrants might face obstacles to discovering employment and employer protection, on account of discrimination on the premise of age and restricted English proficiency. Non-public medical insurance could also be accessible however solely at full value.
For older immigrants who’ve each Medicare and Medicaid, a inhabitants who already has larger charges of advanced medical situations,[9] the lack of each Medicaid after which Medicare in a three-month span will hit laborious. Not solely will they lose entry to constant medical care, Medicaid supplies essential advantages that assist older adults stay safely at house as they age like private care providers to assist with each day actions, transportation, and different house and community-based providers (HCBS).
If left uninsured, older immigrants will go with out preventative or ongoing care, medicines, and incur medical debt after they do search care.[10] Monetary insecurity may even rise due to rising medical debt and since older immigrants might be weighing tough decisions, comparable to whether or not to pay for personal medical insurance or requirements like housing and meals.
States is not going to see financial savings in the long term, as individuals with out medical insurance will finally search care at hospitals and emergency rooms throughout medical crises, resulting in elevated uncompensated care prices. General, these harms don’t exist in a vacuum however somewhat happen within the context of bigger assaults on immigrant communities that damage each older immigrants and their households.
Restricted Various Protection Sources
Different pathways to reasonably priced and complete protection for older immigrants might be restricted and extremely depending on the state and area through which an individual lives. Emergency well being care, together with emergency Medicaid, stays however is restricted to remedy for emergency situations to stop dying, critical hurt or incapacity.[11]
A couple of states use state funds to offer some type of Medicaid protection for immigrants no matter standing, [12] however protection isn’t uniformly supplied and large H.R. 1 funding cuts and different finances pressures are main states to drag again.[13] Neighborhood well being clinics and indigent well being care applications, which can be an choice for older immigrants, are additionally going through funding cuts and can probably see elevated demand as hundreds of thousands of individuals within the U.S. change into newly uninsured.[14]
Conclusion
Entry to reasonably priced and high quality well being care is a vital want for everybody—together with older immigrants—and the lack of security web applications like Medicare and Medicaid might be irreparable. The true value of H.R.1’s restrictions towards immigrants is worsening well being, medical debt, and can trigger a sudden want to seek out various well being care in a panorama of restricted choices at ages when individuals want extra well being and medical care.
Impacted individuals will quickly obtain notices of impending termination of Medicare and Medicaid advantages in 2026. Justice in Growing older is obtainable to assist advocates as they encounter well being protection points for his or her older immigrant shoppers. Contact information@justiceinaging.org.
Assets
Endnotes
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Migration Coverage Institute, State Immigration Information Profiles, accessible at https://www.migrationpolicy.org/knowledge/state-profiles/state/demographics/US. ↑
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Denny Chan and Sahar Takshi, Understanding Essential Connections Between Immigration and Older Adults, Justice in Growing older, April 2025. ↑
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Together with their employers, immigrants paid $58.7 billion {dollars} into the Medicare Belief Fund in 2023. American Immigration Council, Immigrants in the USA. ↑
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Public Regulation 119-21 Sec. 71109, Sec. 71201, and Sec. 71301. ↑
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Individuals with Non permanent Protected Standing have by no means been eligible for federal Medicaid however certified for Medicare and ACA tax credit. Many Non permanent Protected Standing holders are going through threats to their U.S. residency and Medicare protection because of the federal authorities ending TPS designations for a lot of international locations. See, U.S. Citizenship and Immigration Providers, Non permanent Protected Standing. ↑
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H.R.1 Sec. 71201 (codified at 42 U.S.C. 1395mmm). ↑
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H.R.1 Sec. 71109 (codified at 42 U.S.C. 1396b(v)(5)). ↑
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H.R.1 Sec. 71301 (codified at 26 U.S.C. 36B(e); 26 U.S.C. 36B(c)(1)(B) repealed). ↑
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Maria T. Pena, et al., A Profile of Medicare-Medicaid Enrollees (Twin Eligibles), Kaiser Household Basis (KFF), January 2023. ↑
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36% of adults report they skipped or postponed wanted well being care due to the prices. Grace Sparks et al., People’ Challenges with Well being Care Prices, KFF, January 2026. ↑
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42 U.S.C. §1396b(v) and eight U.S.C. §1611(b)(1)(A). ↑
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Seven states and D.C. present Medicaid protection to in any other case ineligible immigrants, topic to sure limitations by state. For instance, New York limits enrollment by age and California will remove dental advantages and impose month-to-month premiums in its state funded program. States finance these efforts utilizing state funds solely and don’t get federal reimbursement, apart from emergency providers. See, Akash Pillai et al., State Well being Protection for Immigrants and Implications for Well being Protection and Care, KFF, Might 2025. ↑
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Rhiannon Euhus et al., Allocating CBO’s Estimates of Federal Medicaid Spending Reductions Throughout the States: Enacted Reconciliation Package deal, KFF, July 2025. See additionally, Celli Horstman, States Are Planning Their Responses to H.R. 1 Cuts in Medicaid Funding — Will Enrollees Lose Advantages?, The Commonwealth Fund, October 2025. ↑
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Christine Mai-Duc et al., On the Hook for Uninsured Residents, Counties Now Surprise How They’ll Pay, KFF, January 2026. As well as, the administration’s reinterpretation of the Private Accountability and Work Alternative Reconciliation Act of 1996 (PRWORA) to introduce immigration verification processes for providers at neighborhood well being facilities and others might additional chill entry amongst older immigrants in search of care. ↑
