What changed
On July 4, 2025, the President signed Public Law 119-21. Section 71109 of that law, titled “Alien Medicaid Eligibility,” adds a new paragraph to the Social Security Act. It says that “beginning on October 1, 2026,” the federal government will not pay a state for Medicaid medical assistance unless the person is a resident of a state, the District of Columbia or a U.S. territory and is one of four things: a U.S. citizen or national; a lawful permanent resident (a green card holder); a person granted the status of Cuban and Haitian entrant; or a person who lawfully resides in the United States under a Compact of Free Association. The same limit is applied to CHIP, the children’s health insurance program.
On April 8, 2026, the Centers for Medicare & Medicaid Services (CMS) sent every state a letter, SHO #26-001, explaining how to carry this out. CMS writes that, with limited exceptions, federal matching funds “will no longer be available for full Medicaid or CHIP benefits furnished to qualified noncitizens who are not also FFP-eligible noncitizens (e.g., asylees, refugees, parolees, or victims of trafficking) unless they have another immigration status or category” on the list. Before this date, refugees and asylees were eligible for full Medicaid and were exempt from the usual five-year waiting period.
CMS’s letter lists the groups that go from “yes” to “no” for federal funding of full benefits on October 1, 2026: refugees; asylees; people paroled into the United States for at least one year; people granted withholding of deportation; people granted conditional entry before April 1, 1980; people covered under the Violence Against Women Act as victims of battery or extreme cruelty; victims of trafficking and certain family members; Amerasian immigrants; lawfully residing veterans and active-duty service members and certain family members; American Indians born in Canada who are not U.S. citizens; and certain Afghan and Ukrainian parolees. CMS told states they must identify these beneficiaries, first try to re-verify their status electronically through DHS’s SAVE system, and contact the person only if that fails. Oklahoma’s Medicaid agency, the Oklahoma Health Care Authority, has posted a matching policy change for SoonerCare: “Most other non-citizens will no longer qualify for full-scope coverage” and “will be limited to Emergency Medical Assistance.”
Who this is about
This is about people who are not U.S. citizens, who had full Medicaid or CHIP through one of the statuses above, and who are not also a green card holder, a Cuban/Haitian entrant or a COFA citizen. CMS’s letter says the limit does not reach a person in one of the affected groups who also has “another immigration status or category” on the list, which is how it treats, for example, a former refugee who now holds a green card. It does not say how many people are affected, and we did not find an official count, so the figures circulating for Florida, Arizona or any other state are not in the sources linked here.
The law and the letter are about federal funding. CMS writes that it “will not require states to provide state-only funded health coverage” to these groups, and that coverage a state chooses to keep paying for with its own money would not be considered Medicaid. Whether a particular state does that is a decision of that state, and the sources here do not list which states have.
What it does not mean
- It does not change emergency Medicaid. The law keeps the exception for “care and services necessary for the treatment of an emergency medical condition,” and CMS confirms federal funding for emergency Medicaid remains available to these groups on and after October 1, 2026.
- It does not remove green card holders. Lawful permanent residents are named in the law as eligible. CMS says the five-year waiting period that already applied to many permanent residents continues to apply, with its existing exceptions.
- It does not override the children’s option. In states that elected the CHIPRA 214 option, lawfully residing children (up to age 21 in Medicaid, 19 in CHIP) and pregnant women can still get full benefits, and CMS says a refugee child or pregnant woman in such a state can be covered that way. As of April 2, 2026, Medicaid.gov’s list of states with that option does not include Oklahoma or Arizona; it does include Florida and Texas for children.
- It does not mean a case is closed without notice. CMS’s letter says states must give the person a reasonable time to respond before taking adverse action, a 90-day reasonable opportunity period if a new declaration of status cannot be verified, and, for Medicaid, at least ten days’ advance written notice of a proposed termination and the chance to ask for a fair hearing.
What to do with this
The quotes and dates above come from the text of the law on govinfo.gov, from CMS’s April 8, 2026 letter to the states, and from the Oklahoma Health Care Authority’s posted policy change, all linked at the top of this page. What any of it means for one family’s coverage or immigration status is a question for a licensed immigration attorney or a DOJ-accredited representative, and the organizations below are a place to start. Advocasí helps prepare paperwork once a qualified advisor has said which path applies.
Advocasí is not a law firm. We explain what a policy says and help people prepare their own paperwork once a qualified advisor has told them which path applies.