Approximately 1 in 7 of all older adults in the U.S. is an immigrant, and California is home to more than 10.9 million immigrants of all ages.[1] California has the largest population of immigrants than any other state, with the majority coming from Latin America or Asia.[2] 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.[3] 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 (Medi-Cal in California) 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,[4] and strengthening the U.S. economy. They play an important role in families, communities, and broader society at large, providing support in multigenerational households and serving as cultural links for younger generations.
For years, California has provided state-funded full Medi-Cal coverage to all immigrants, regardless of status[5]. Immigrants with legal status, and those without legal status, are entitled to Medi-Cal coverage if they otherwise meet financial eligibility rules. This coverage is eroding however due to recent state budget deficits. H.R.1 compounds these coverage limitations and will leave more older immigrants uninsured.
What Changed Under H.R.1?
Eligibility for Medicare, federal Medicaid, and ACA tax credits will be exclusively limited to four categories:
- U.S. citizens,
- Legal permanent residents (“green card holders”),
- Certain Cuban/Haitian entrants, and
- Persons living in the U.S. under the Compact of Free Association (COFA).[6]
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).[7]
When Do These Changes Take Effect?
Some of these changes have already taken effect and others are 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. [8]
Medicaid
On October 1, 2026, federal Medicaid eligibility and enrollment for older adults who are not in one of the four named categories will end in most states.[9]
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. [10]
California could continue to provide health care under state-funded Medi-Cal, but the Governor’s proposed 2026-2027 state budget proposes moving these populations to emergency Medi-Cal.[11] This is not a final policy decision. If finalized, approximately 200,000 lawfully present immigrants will lose full scope Medi-Cal. Asylees and refugees are the two biggest groups losing coverage if this policy is finalized.[12]
If the Governor’s proposal is rejected, other recent policy changes to the state-funded Medi-Cal program will apply for certain immigrants, including the loss of dental benefits[13] and a monthly premium for coverage.[14] All other Medi-Cal benefits will remain intact, including primary and specialty care, and long-term care including In-home supportive services (IHSS) and other home- and community-based services (HCBS). California has also stopped new enrollment into state-funded Medi-Cal for immigrants without legal status.[15]
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,[16] 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.[17] 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.[18]
California uses state funds to provide Medi-Cal coverage for immigrants regardless of status, but coverage is not uniformly offered and budget pressures are leading to pullbacks as mentioned above.[19] States are also facing millions of dollars of federal funding cuts from H.R.1[20] with California expected to lose 30 billion annually.[21]
Community health clinics and California’s county indigent health care programs[22], which may be an option for older immigrants, are also facing funding cuts and will likely see increased demand due to the rise in the uninsured rate.[23]
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
Migration Policy Institute, State Immigration Data Profiles, available at https://www.migrationpolicy.org/data/state-profiles/state/demographics/US. ↑
Marisol Cuellar Mejia et al., Immigrants in California, Public Policy Institute of California, January 2026. ↑
Denny Chan and Sahar Takshi, Understanding Critical Connections Between Immigration and Older Adults, Justice in Aging, April 2025. ↑
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. ↑
Welf. and Inst. Code §14007.8. ↑
Public Law 119-21 Sec. 71109, Sec. 71201, and Sec. 71301. ↑
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. ↑
H.R.1 Sec. 71201 (codified at 42 U.S.C. 1395mmm). ↑
H.R.1 Sec. 71109 (codified at 42 U.S.C. 1396b(v)(5)). ↑
H.R.1 Sec. 71301 (codified at 26 U.S.C. 36B(e); 26 U.S.C. 36B(c)(1)(B) repealed). ↑
Department of Health Care Services, 2026-2027 Governor’s Budget, January 2026. See also, CalHealth and Human Services, How Federal Policy Changes are Impacting a Healthy California for All, at slide 38. ↑
Internal data obtained from the California Department of Health Care Services. ↑
Starting July 2026, Medi-Cal enrollees on state funded Medi-Cal age 19 or older and who are not pregnant will lose dental coverage. Welf. & Inst. Code §14007.5(c) and §14007.8(k); see also Medi-Cal Immigrant Eligibility FAQs. ↑
Beginning July 2027, immigrants on state-funded Medi-Cal age 19-59 and who are not pregnant must pay a $30 monthly premium to keep coverage. Welf. & Inst. Code §14007.5(e)(1) and §14007.8(j)(1); see also Medi-Cal Immigrant Eligibility FAQs. ↑
Immigrants without legal status, or on student, work or tourist visas, or who cannot verify their status who are aged 19 and older, and not pregnant, only qualify for emergency Medi-Cal if they apply after January 1, 2026. Welf. & Inst. Code § 14007.8(b)(1); see also Medi-Cal Immigrant Eligibility FAQs. ↑
Maria T. Pena, et al., A Profile of Medicare-Medicaid Enrollees (Dual Eligibles), Kaiser Family Foundation (KFF), January 2023. ↑
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. ↑
42 U.S.C. §1396b(v) and 8 U.S.C. §1611(b)(1)(A). ↑
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. ↑
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. ↑
Adriana Ramos-Yamamoto, How Federal Funding Cuts Threaten the Health of Californians, California Budget and Policy Center, September 2025. ↑
California counties are required by state law to provide care to low-income and uninsured residents but programs vary widely by county. Welf. and Inst. Code §17000; see also Health Access, County Health Care Access for Uninsured Californians, August 2024. ↑
Christine Mai-Duc et al., On the Hook for Uninsured Residents, Counties Now Wonder How They’ll Pay, KFF, January 2026. In addition, the federal 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. ↑
