New state data reveals that hundreds of thousands of legally present immigrants are at risk of losing Medicaid coverage when the One Big Beautiful Bill Act takes effect on Oct. 1. The law, passed by congressional Republicans and signed by President Trump in 2025, is expected to cut more than $900 billion from the program through 2034. While the Congressional Budget Office estimated the changes would leave about 100,000 more immigrants uninsured by that year, figures from nine states and the District of Columbia already show over 281,000 people losing coverage in October alone—suggesting the impact is far larger than anticipated.
Florida leads with nearly 177,000 immigrants set to lose Medicaid, followed by North Carolina (about 29,000), Arizona (nearly 28,000), New Jersey (15,000–25,000), and Washington state (11,000). Those affected include refugees, asylees, sex-trafficking victims, and interpreters who aided U.S. forces in Afghanistan. Green card holders are exempt. The law also removes eligibility for Affordable Care Act subsidies for about 1 million immigrants and Medicare for roughly 100,000, starting in January.
Advocates note that some states only began sending termination notices in September, leaving enrollees little time to respond or correct errors. Without coverage, immigrants lose access to routine care and prescription drugs, though they may still qualify for Emergency Medicaid. One refugee from Syria, who asked to be identified only as Ahin, told KFF Health News that Medicaid covered her recent intestinal surgery and ongoing specialist visits. "I'm really worried about this," she said. "It's truly a terrible situation."