Understanding the Affect of H.R.1 on Older Immigrants’ Entry to Well being Care in California

Roughly 1 in 7 of all older adults within the U.S. is an immigrant, and California is residence to greater than 10.9 million immigrants of all ages.^[1] California has the biggest inhabitants of immigrants than another state, with the bulk coming from Latin America or Asia.^[2] 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 could 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.^[3] Immigrants come to the U.S. by a wide range of immigration pathways, usually for humanitarian causes like asylum or refugee, employment or education-based choices, or below household unification processes.

Immigrant eligibility for federally funded well being applications has all the time been complicated, with some lawfully current immigrants having to attend a sure variety of years earlier than being eligible for Medicaid (Medi-Cal in California) 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 coverage. 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 usually 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,^[4] and strengthening the U.S. economic system. They play an necessary position in households, communities, and broader society at giant, offering assist in multigenerational households and serving as cultural hyperlinks for youthful generations.

For years, California has supplied state-funded full Medi-Cal protection to all immigrants, no matter standing^[5]. Immigrants with authorized standing, and people with out authorized standing, are entitled to Medi-Cal protection in the event that they in any other case meet monetary eligibility guidelines. This protection is eroding nonetheless as a consequence of current state finances deficits. H.R.1 compounds these protection limitations and can go away extra older immigrants uninsured.

What Modified Beneath H.R.1?

Eligibility for Medicare, federal Medicaid, and ACA tax credit will probably be completely restricted to 4 classes:

1. U.S. residents,
2. Authorized everlasting residents (“inexperienced card holders”),
3. Sure Cuban/Haitian entrants, and
4. Individuals dwelling within the U.S. below the Compact of Free Affiliation (COFA).^[6]

All different immigrant statuses are excluded, regardless that these teams stay lawfully current.

Immigrants newly ineligible and shedding protection embody:

• Refugees and other people granted asylum,
• Folks granted withholding of elimination,
• Trafficking and home violence survivors,
• Folks granted humanitarian parole, equivalent to sure Afghans who aided U.S. navy operations in Afghanistan or individuals fleeing violence in Ukraine,
• Folks granted Short-term Protected Standing (TPS).^[7]

When Do These Modifications Take Impact?

A few of these adjustments have already taken impact and others are phased in over the approaching 12 months.

Medicare

Individuals who develop 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 usually are not in certainly one of these 4 classes could have their protection terminated on January 4, 2027. ^[8]

Medicaid

On October 1, 2026, federal Medicaid eligibility and enrollment for older adults who usually are not in one of many 4 named classes will finish in most states.^[9]

ACA Tax Credit

As of January 1, 2026, lawfully current immigrants who’re ineligible for Medicaid and have earnings beneath 100% FPL are not eligible for tax credit. Starting January 1, 2027, tax credit score eligibility is restricted to the 4 named classes. ^[10]

California might proceed to supply well being care below state-funded Medi-Cal, however the Governor’s proposed 2026-2027 state finances proposes shifting these populations to emergency Medi-Cal.^[11] This isn’t a ultimate coverage resolution. If finalized, roughly 200,000 lawfully current immigrants will lose full scope Medi-Cal. Asylees and refugees are the 2 largest teams shedding protection if this coverage is finalized.^[12]

If the Governor’s proposal is rejected, different current coverage adjustments to the state-funded Medi-Cal program will apply for sure immigrants, together with the lack of dental advantages^[13] and a month-to-month premium for protection.^[14] All different Medi-Cal advantages will stay intact, together with main and specialty care, and long-term care together with In-home supportive providers (IHSS) and different home- and community-based providers (HCBS). California has additionally stopped new enrollment into state-funded Medi-Cal for immigrants with out authorized standing.^[15]

What’s the Affect on Older Immigrants?

Mixed, the result’s that tons of of 1000’s of immigrants are susceptible to being uninsured, notably 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 inexpensive 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 slicing off entry to Medicare, Medicaid, and ACA tax credit, few sensible choices stay. Employer-based medical health insurance requires a return to employment at an older age, and older immigrants could face obstacles to discovering employment and employer protection, as a consequence of discrimination on the premise of age and restricted English proficiency. Personal medical health insurance could also be accessible however solely at full price.

For older immigrants who’ve each Medicare and Medicaid, a inhabitants who already has larger charges of complicated medical situations,^[16] the lack of each Medicaid after which Medicare in a three-month span will hit exhausting. Not solely will they lose entry to constant medical care, Medicaid offers essential advantages that assist older adults stay safely at residence as they age like private care providers to assist with day by day actions, transportation, and different residence and community-based providers (HCBS).

If left uninsured, older immigrants will go with out preventative or ongoing care, drugs, and incur medical debt after they do search care.^[17] Monetary insecurity can even rise due to rising medical debt and since older immigrants will probably be weighing tough selections, equivalent to whether or not to pay for personal medical health insurance or requirements like housing and meals.

States is not going to see financial savings in the long term, as individuals with out medical health insurance will finally search care at hospitals and emergency rooms throughout medical crises, resulting in elevated uncompensated care prices. Total, these harms don’t exist in a vacuum however fairly happen within the context of bigger assaults on immigrant communities that damage each older immigrants and their households.

Restricted Different Protection Sources

Different pathways to inexpensive and complete protection for older immigrants will probably be restricted and extremely depending on the state and area wherein an individual lives. Emergency well being care, together with emergency Medicaid, stays however is restricted to remedy for emergency situations to stop dying, severe hurt or incapacity.^[18]

California makes use of state funds to supply Medi-Cal protection for immigrants no matter standing, however protection shouldn’t be uniformly supplied and finances pressures are resulting in pullbacks as talked about above.^[19] States are additionally dealing with hundreds of thousands of {dollars} of federal funding cuts from H.R.1^[20] with California anticipated to lose 30 billion yearly.^[21]

Neighborhood well being clinics and California’s county indigent well being care applications^[22], which can be an possibility for older immigrants, are additionally dealing with funding cuts and can possible see elevated demand because of the rise within the uninsured fee.^[23]

Conclusion

Entry to inexpensive 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 will probably be irreparable. The true price of H.R.1’s restrictions towards immigrants is worsening well being, medical debt, and can trigger a sudden want to search out different 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 out there to assist advocates as they encounter well being protection points for his or her older immigrant shoppers. Contact information@justiceinaging.org.

Sources

Endnotes

1. Migration Coverage Institute, State Immigration Information Profiles, accessible at https://www.migrationpolicy.org/knowledge/state-profiles/state/demographics/US. ↑

2. Marisol Cuellar Mejia et al., Immigrants in California, Public Coverage Institute of California, January 2026. ↑

3. Denny Chan and Sahar Takshi, Understanding Vital Connections Between Immigration and Older Adults, Justice in Growing older, April 2025. ↑

4. Together with their employers, immigrants paid $58.7 billion {dollars} into the Medicare Belief Fund in 2023. American Immigration Council, Immigrants in the US. ↑

5. Welf. and Inst. Code §14007.8. ↑

6. Public Regulation 119-21 Sec. 71109, Sec. 71201, and Sec. 71301. ↑

7. Folks with Short-term Protected Standing have by no means been eligible for federal Medicaid however certified for Medicare and ACA tax credit. Many Short-term Protected Standing holders are dealing with 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, Short-term Protected Standing. ↑

8. H.R.1 Sec. 71201 (codified at 42 U.S.C. 1395mmm). ↑

9. H.R.1 Sec. 71109 (codified at 42 U.S.C. 1396b(v)(5)). ↑

10. H.R.1 Sec. 71301 (codified at 26 U.S.C. 36B(e); 26 U.S.C. 36B(c)(1)(B) repealed). ↑

11. Division of Well being Care Providers, 2026-2027 Governor’s Price range, January 2026. See additionally, CalHealth and Human Providers, How Federal Coverage Modifications are Impacting a Wholesome California for All, at slide 38. ↑

12. Inner knowledge obtained from the California Division of Well being Care Providers. ↑

13. Beginning July 2026, Medi-Cal enrollees on state funded Medi-Cal age 19 or older and who usually are not pregnant will lose dental protection. Welf. & Inst. Code §14007.5(c) and §14007.8(ok); see additionally Medi-Cal Immigrant Eligibility FAQs. ↑

14. Starting July 2027, immigrants on state-funded Medi-Cal age 19-59 and who usually are not pregnant should pay a $30 month-to-month premium to maintain protection. Welf. & Inst. Code §14007.5(e)(1) and §14007.8(j)(1); see additionally Medi-Cal Immigrant Eligibility FAQs. ↑

15. Immigrants with out authorized standing, or on scholar, work or vacationer visas, or who can’t confirm their standing who’re aged 19 and older, and never pregnant, solely qualify for emergency Medi-Cal in the event that they apply after January 1, 2026. Welf. & Inst. Code § 14007.8(b)(1); see additionally Medi-Cal Immigrant Eligibility FAQs. ↑

16. Maria T. Pena, et al., A Profile of Medicare-Medicaid Enrollees (Twin Eligibles), Kaiser Household Basis (KFF), January 2023. ↑

17. 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. ↑

18. 42 U.S.C. §1396b(v) and eight U.S.C. §1611(b)(1)(A). ↑

19. 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. ↑

20. Rhiannon Euhus et al., Allocating CBO’s Estimates of Federal Medicaid Spending Reductions Throughout the States: Enacted Reconciliation Bundle, 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. ↑

21. Adriana Ramos-Yamamoto, How Federal Funding Cuts Threaten the Well being of Californians, California Price range and Coverage Heart, September 2025. ↑

22. California counties are required by state legislation to supply care to low-income and uninsured residents however applications fluctuate extensively by county. Welf. and Inst. Code §17000; see additionally Well being Entry, County Well being Care Entry for Uninsured Californians, August 2024. ↑

23. Christine Mai-Duc et al., On the Hook for Uninsured Residents, Counties Now Marvel How They’ll Pay, KFF, January 2026. As well as, the federal 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 could additional chill entry amongst older immigrants looking for care. ↑