An Afghan refugee caresses her 9-day-old infant in the pediatric unit of a medical facility in 2021 at Joint Base McGuire-Dix-Lakehurst, New Jersey. Refugees are among those legally residing in the country who face the loss of federally funded health care. (Photo: Barbara Davidson/Pool/Getty Images)
An estimated 1.4 million immigrants who are in the country legally but not citizens could lose government-subsidized health care under the drastic tax and spending bill that President Donald Trump signed into law this summer. estimates from the nonpartisan Congressional Budget Office.
The One Big Beautiful Bill Act cuts federal spending on Medicaid, the state’s joint health insurance program for low-income people. It also imposes modern eligibility restrictions on lawfully present immigrants, including refugees and asylees, who are enrolled in various government-subsidized health programs: Medicaid, the Children’s Health Insurance Program (CHIP), Medicare, and the Affordable Care Act marketplaces.
Immigrants who are in the country illegally has long been ineligible for federally funded health insurance.
However, seven states – California, Colorado, Illinois, Minnesota, New York, Oregon and Washington – as well as the District of Columbia expanded government-financed insurance for certain income-eligible non-citizen adults, regardless of their immigration status. Fourteen states plus the District provide state-funded care for noncitizen children, whether they are here legally or not.
The modern restrictions in the One Big Beautiful Bill Act, combined with other Trump policies limiting public benefits for immigrants, put these states in a arduous financial situation. With less federal money to provide health benefits to immigrants here legally, it will be arduous for states to maintain their programs that provide protections to all immigrants, regardless of their legal status.
“We are taking a huge step back from this public health and preventive health measure, excluding more people and draining federal resources from states that need it,” said Tanya Broder, senior counsel specializing in immigrant health policy at the advocacy group National Immigration Law Center.
“As a result, our health – individually, as families and as communities – will be at risk, and the health care infrastructure that serves us all will also be at risk,” Broder said.
Already, some states that offered health insurance assistance to all immigrants – regardless of status – are pulling back.
To lend a hand close the $12 billion deficit, California Gov. Gavin Newsom, a Democrat signed in June state budget that prohibits immigrants who are here illegally from enrolling in the state’s Medicaid program, known as Medi-Cal. Current participants ages 19 to 59 will have to pay a modern monthly premium of $30 starting in 2027. In July 2026, the state will eliminate dental coverage for noncitizens.
In July, Illinois ended its state-funded health insurance program for all immigrants between the ages of 42 and 64. The state continues to operate a state-funded plan for residents 65 and older, regardless of immigration status, but enrollment has been suspended. Minnesota also plans to exclude adult immigrants who are here illegally from a program that provided protection regardless of immigration status.
New York is in a particularly arduous situation because the state constitution prohibits discrimination against legal immigrants in the provision of public benefits.
We are taking a huge step back from this public health and preventive health measure, excluding more people and draining federal resources from states that need it.
– Tanya Broder, National Immigration Law Center
“States have some leeway to fund resources for migrant communities if they want,” said Medha Makhlouf, a law professor and founder of the Medical-Legal Partnership Clinic at Penn State Dickinson Law, who studies immigrants’ access to health care. “But now this [federal] the law makes it harder for them.”
Makes your stay less attractive
Jessica Vaughan, director of policy studies at the Center for Immigration Studies, a nonprofit group that advocates for stricter immigration policies, said the efforts fit both Trump’s broader anti-immigration stance and “Congress’s interest in getting rid of any incentives or benefits to people who are in the country illegally.”
“It’s a way to make it less attractive to be here illegally, right?” Vaughan said. “They’re trying to give people reasons to leave, not reasons to stay.”
As foreigners here legally lose access to federally funded benefits, the need for state-funded insurance “is likely to increase,” Drishti Pillai, director of immigrant health policy at KFF, a health policy research group, told Stateline.
“However, states are facing increasing budget pressures, particularly due to Medicaid cuts,” Pillai said. “So it’s almost a double whammy: There will likely be more demand for state-funded insurance programs, but at the same time states will have fewer resources to keep people protected.”
Makhlouf said the Trump administration’s policy changes reflect a broader strategy of taking away public benefits from marginalized and needy communities.
“Anyone who cares about access to health care should pay attention to what is happening to immigrants,” she said. “When it becomes the norm to be able to sacrifice some people’s humanity or vulnerability or minimize their contribution to society and say, ‘You don’t deserve access to health care,’ then it can be targeted at any group.”
Under Trump’s domestic policy law, California expects to lose at least $28.4 billion in federal Medicaid funding, according to Newsom’s office.
On June 27 in the California Senate, state senator María Elena Durazo expressed her sadness over the state’s decision not to provide protection to immigrants.
“I can’t tell you how happy I felt when we expanded primary care,” Durazo said. “Today, this joy that I was so happy with, this joy turned into pain, this joy turned into shame.”
But Senate Democratic supporter Mike McGuire said the state has little choice.
“We are a state of immigrants of 10.6 million people. And we will never turn our backs on those who are at the heart of the largest economy in the United States of America,” McGuire said during the debate. “So we had to make some difficult decisions. I know we won’t please everyone.”
A must in New York
One state, New York, is in particular trouble because its constitution requires it to provide insurance to legally resident foreigners.
Roxana, 27, has lived in the US since she was eight under the Deferred Action for Childhood Arrivals program, known as DACA, and only uses her name out of fear of being targeted. In behind schedule 2019, she experienced a series of debilitating symptoms, including pelvic pain and chronic fatigue, and discovered a non-cancerous lump on her breast.
“Chronic illness has impacted my career, causing a lot of fatigue and chronic pain,” said Roxana, who lives in the Bronx, New York.
Roksana cannot obtain federally funded Medicaid. However, she qualified for state-funded public health care in New York. A 2001 court case, Aliessa v. Novello, requires the state to provide publicly funded health care to all lawful residents under the state constitution. So she was able to afford a visit to the doctor, where she learned that she suffered from a hormonal disease called polycystic ovary syndrome, or PCOS, and managed to have the lump removed.
New York paid mostly for immigrants and other legal immigrants until 2016, when it launched coverage called the Essential Plan under the Affordable Care Act of 2010, also known as Obamacare. Under ACTAthe plan has no deductibles or monthly premiums for patients, and the federal government covered almost the entire cost of the plan – 90% – which is a huge economic relief for the state.
New York currently faces an annual loss of $13.5 billion in federal Medicaid and Affordable Care Act funds. Additionally, phasing out premium tax breaks for foreigners under Trump’s law would result in a loss of $7.5 billion in annual state funding for the Basic Plan, which covers 1.7 million New Yorkers.
“These are billions of dollars being taken out of New York’s delivery system,” Amir Bassiri, director of Medicaid at the New York State Department of Health, said at a July 30 United Hospital Fund conference.
It is unclear whether or how the state will be able to provide protection for people like Roxana, even though it is required under the state constitution. Like other immigrants, she fears that in the face of cuts and narrow access to the safety net for foreigners, she will lose continuity of health care and that her condition will worsen.
“My PCOS symptoms have been getting worse over the years. I really want to do my best with the access to health care I need to have under control.”
Stateline reporter Shalina Chatlani can be reached at: schatlani@stateline.org.
This story was originally produced by Statisticswhich is part of States Newsroom, a nonprofit news network that includes Pennsylvania Capital-Star, and is supported by grants and a coalition of donors as a 501c(3) public charity.
