New Rules Impacting Health Coverage for Lawfully Present Migrants

Provisions of the One Big Beautiful Bill Act of 2025 have begun reshaping access to health insurance for many immigrants lawfully present in the U.S. If you are a green-card holder, refugee, asylee, DACA recipient, or otherwise legally residing here, this change could directly affect your ability to afford health coverage. This is a complex policy shift with real consequences. Knowing how the changes work can help you make informed decisions. 

What Changed: Key Policy Shifts Under the 2025 Law

1. Premium Tax Credit Eligibility Is Narrowed

Starting January 1, 2026, new restrictions will apply to premium tax credits under the Affordable Care Act (ACA). Under the old rules, many lawfully present immigrants, including those with very low income, qualified for premium tax credits. Changes in the law will eliminate a special rule that allowed lawfully present noncitizens with incomes below 100% of the federal poverty line—but who are ineligible for Medicaid coverage due to their immigration status—to receive premium tax credits for ACA Marketplace coverage.

Only certain categories of immigrants, such as lawful permanent residents, certain Cuban or Haitian entrants, and individuals from Compact of Free Association nations, will remain eligible. Groups like refugees, asylees, people with Temporary Protected Status, and some on work visas are excluded.

2. DACA Recipients Are Pulled Back

In August 2025, a final rule excluded DACA recipients entirely from ACA premium subsidies. This reverses earlier rules that allowed DACA recipients marketplace eligibility in late 2024.

3. Medicaid and Medicare Eligibility Shrinks

The new law also restricts Medicaid coverage for certain lawful immigrants, effective October 1, 2026. On the Medicare side, many lawfully present immigrants will lose eligibility unless they fall into a narrow set of statuses similar to those who retain subsidy eligibility. The Congressional Budget Office estimates this could result in 100,000 people losing Medicare coverage.

The Projected Impact

More Uninsured Immigrants

Analysts estimate that approximately 1.4 million lawfully present immigrants will become uninsured because of these changes. More than 1 million people are expected to lose access to affordable marketplace coverage, Medicaid, or Medicare by 2026.

Risk Pool Destabilization and Rising Premiums

Many immigrants losing help are relatively young and healthy. When they drop out of marketplace plans, the insurance risk pool becomes smaller and sicker on average. Experts warn this could increase premiums for everyone.

Strain on Community Health Centers

As more lawfully present immigrants lose insurance, some will rely on community health centers for care. This could place new financial pressure on centers that already serve low-income populations.

Increased Administrative Burden

The law reduces automatic reenrollment in marketplace plans and adds more documentation requirements. These changes make it harder for people to maintain coverage even if they remain eligible.

What You Can Do

1. Check Your Status and IncomeReview your immigration status and income. These classifications now determine whether premium tax credits remain available.

2. Evaluate Alternative Coverage OptionsExplore employer-based health insurance, state Medicaid programs, or community health centers that offer sliding-scale care.

3. Act Early During Open EnrollmentTimely enrollment and renewal are critical under the new rules.

4. Seek Professional GuidanceThis policy shift is legally complex and can have long-term effects on your health and finances. Consult a licensed health insurance agent who can help you understand your options and protect your coverage.

Staying Informed

Immigration law changes can affect many aspects of life, including eligibility for programs, legal status, and future planning. Staying up to date is essential to avoid surprises and protect your options.

For reliable updates on immigration law, policies affecting lawfully present immigrants, and guidance from experienced attorneys, follow Tran Flores Law. We provide timely news and insights so you can stay informed about the changes that matter most to you.