Understanding the Impact of H.R.1 on Older Immigrants’ Access to Health Care

Approximately 1 in 7 of all older adults in the U.S. is an immigrant.^[1] The U.S. has a rich and long history of immigrants arriving from a variety of countries and ethnic backgrounds. Older immigrants may have immigrated to the U.S. at an older age or arrived as younger individuals and lived and worked in the U.S. for decades.^[2] Immigrants come to the U.S. through a variety of immigration pathways, often for humanitarian reasons like asylum or refugee, employment or education-based options, or under family unification processes.

Immigrant eligibility for federally funded health programs has always been complex, with some lawfully present immigrants having to wait a certain number of years before being eligible for Medicaid or Medicare, and other groups bypassing this waiting period.

Nonetheless, many immigrants with legal status have historically been eligible for Medicare, Medicaid, and tax credits for Affordable Care Act (ACA) insurance plans. This changed in July 2025 when the federal budget reconciliation bill (H.R.1) was signed into law and upended immigrant eligibility, significantly narrowing which immigrant groups can qualify for Medicare, Medicaid, and ACA tax credits.

Immigrants losing eligibility are people whose lawfully present status has not changed and, for decades, could access these health programs. They have fled violence, famine, endured trafficking, and, as older adults, have often lived and worked in the U.S. for years, all the while supporting their families, paying taxes, contributing billions of dollars into the Medicare Trust Fund,^[3] and strengthening the U.S. economy. They play an important role in families, communities, and society at large, providing support in multigenerational households and serving as cultural links for younger generations.

What Changed Under H.R.1?

Eligibility for Medicare, Medicaid, and ACA tax credits will be exclusively limited to four categories:

1. U.S. citizens,
2. Legal permanent residents (“green card holders”),
3. Certain Cuban/Haitian entrants, and
4. Persons living in the U.S. under the Compact of Free Association (COFA).^[4]

All other immigrant statuses are excluded, even though these groups remain lawfully present.

Immigrants newly ineligible and losing coverage include:

• Refugees and people granted asylum,
• People granted withholding of removal,
• Trafficking and domestic violence survivors,
• People granted humanitarian parole, such as certain Afghans who aided U.S. military operations in Afghanistan or people fleeing violence in Ukraine,
• People granted Temporary Protected Status (TPS).^[5]

When Do These Changes Take Effect?

Some of these changes have already taken effect and others will be phased in over the coming year.

Medicare

People who become newly eligible for Medicare on or after July 4, 2025 must be citizens, green card holders, Cuban/Haitian entrants, or COFA migrants to enroll. Current Medicare enrollees who are not in one of these four categories will have their coverage terminated on January 4, 2027. ^[6]

Medicaid

On October 1, 2026, Medicaid eligibility and enrollment for older adults who are not in one of the four named categories will end in most states.^[7]

ACA Tax Credits

As of January 1, 2026, lawfully present immigrants who are ineligible for Medicaid and have income below 100% FPL are no longer eligible for tax credits. Beginning January 1, 2027, tax credit eligibility is limited to the four named categories. ^[8]

What is the Impact on Older Immigrants?

Combined, the result is that hundreds of thousands of immigrants are at risk of being uninsured, particularly if they are low-income. Some older immigrants who are dually eligible for Medicare and Medicaid will lose both sources of coverage. These changes are significant to older immigrants because H.R.1 cuts off all pathways to affordable health care coverage for people with TPS, refugees, asylees, and other humanitarian immigrants.

Multiplying Harms

The overlapping harms of H.R.1 are substantial. By cutting off access to Medicare, Medicaid, and ACA tax credits, few practical options remain. Employer-based health insurance requires a return to employment at an older age, and older immigrants may face barriers to finding employment and employer coverage, due to discrimination on the basis of age and limited English proficiency. Private health insurance may be available but only at full cost.

For older immigrants who have both Medicare and Medicaid, a population who already has higher rates of complex medical conditions,^[9] the loss of both Medicaid and then Medicare in a three-month span will hit hard. Not only will they lose access to consistent medical care, Medicaid provides critical benefits that help older adults live safely at home as they age like personal care services to help with daily activities, transportation, and other home and community-based services (HCBS).

If left uninsured, older immigrants will go without preventative or ongoing care, medications, and incur medical debt when they do seek care.^[10] Financial insecurity will also rise because of increasing medical debt and because older immigrants will be weighing difficult choices, such as whether to pay for private health insurance or necessities like housing and food.

States will not see savings in the long run, as people without health insurance will eventually seek care at hospitals and emergency rooms during medical crises, leading to increased uncompensated care costs. Overall, these harms do not exist in a vacuum but rather occur in the context of larger attacks on immigrant communities that hurt both older immigrants and their families.

Limited Alternative Coverage Sources

Other pathways to affordable and comprehensive coverage for older immigrants will be limited and highly dependent on the state and region in which a person lives. Emergency health care, including emergency Medicaid, remains but is limited to treatment for emergency conditions to prevent death, serious harm or disability.^[11]

A few states use state funds to provide some form of Medicaid coverage for immigrants regardless of status, ^[12] but coverage is not uniformly offered and massive H.R. 1 funding cuts and other budget pressures are leading states to pull back.^[13] Community health clinics and indigent health care programs, which may be an option for older immigrants, are also facing funding cuts and will likely see increased demand as millions of people in the U.S. become newly uninsured.^[14]

Conclusion

Access to affordable and quality health care is an essential need for everyone—including older immigrants—and the loss of safety net programs like Medicare and Medicaid will be irreparable. The true cost of H.R.1’s restrictions against immigrants is worsening health, medical debt, and will cause a sudden need to find alternative health care in a landscape of limited options at ages when people need more health and medical care.

Impacted people will soon receive notices of impending termination of Medicare and Medicaid benefits in 2026. Justice in Aging is available to support advocates as they encounter health coverage issues for their older immigrant clients. Contact info@justiceinaging.org.

Resources

Endnotes

1. Migration Policy Institute, State Immigration Data Profiles, available at https://www.migrationpolicy.org/data/state-profiles/state/demographics/US. ↑

2. Denny Chan and Sahar Takshi, Understanding Critical Connections Between Immigration and Older Adults, Justice in Aging, April 2025. ↑

3. Along with their employers, immigrants paid $58.7 billion dollars into the Medicare Trust Fund in 2023. American Immigration Council, Immigrants in the United States. ↑

4. Public Law 119-21 Sec. 71109, Sec. 71201, and Sec. 71301. ↑

5. People with Temporary Protected Status have never been eligible for federal Medicaid but qualified for Medicare and ACA tax credits. Many Temporary Protected Status holders are facing threats to their U.S. residency and Medicare coverage due to the federal government ending TPS designations for many countries. See, U.S. Citizenship and Immigration Services, Temporary Protected Status. ↑

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

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

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

9. Maria T. Pena, et al., A Profile of Medicare-Medicaid Enrollees (Dual Eligibles), Kaiser Family Foundation (KFF), January 2023. ↑

10. 36% of adults report they skipped or postponed needed health care because of the costs. Grace Sparks et al., Americans’ Challenges with Health Care Costs, KFF, January 2026. ↑

11. 42 U.S.C. §1396b(v) and 8 U.S.C. §1611(b)(1)(A). ↑

12. Seven states and D.C. provide Medicaid coverage to otherwise ineligible immigrants, subject to certain limitations by state. For example, New York limits enrollment by age and California will eliminate dental benefits and impose monthly premiums in its state funded program. States finance these efforts using state funds only and do not get federal reimbursement, except for emergency services. See, Akash Pillai et al., State Health Coverage for Immigrants and Implications for Health Coverage and Care, KFF, May 2025. ↑

13. Rhiannon Euhus et al., Allocating CBO’s Estimates of Federal Medicaid Spending Reductions Across the States: Enacted Reconciliation Package, KFF, July 2025. See also, Celli Horstman, States Are Planning Their Responses to H.R. 1 Cuts in Medicaid Funding — Will Enrollees Lose Benefits?, The Commonwealth Fund, October 2025. ↑

14. Christine Mai-Duc et al., On the Hook for Uninsured Residents, Counties Now Wonder How They’ll Pay, KFF, January 2026. In addition, the administration’s reinterpretation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) to introduce immigration verification processes for services at community health centers and others may further chill access among older immigrants seeking care. ↑