The One Big Beautiful Bill Act (OBBBA) included major changes to Medicaid and the Children’s Health Insurance Program (CHIP) that will affect millions in the US. While many people are expected to lose coverage because of increased administrative burdens, the law also sets new eligibility restrictions for many lawfully present noncitizens.
For decades, refugees and other humanitarian immigrants (PDF) who met income and other requirements were eligible to enroll in Medicaid and CHIP upon admission to the US. Now, as of October 1, many refugees are ineligible until they become lawful permanent residents—that is, until they obtain a green card.
As the backlog of green card applications grows, many refugees are expected to lose health insurance coverage indefinitely while they wait for their application to be processed.
These changes may have lasting consequences for refugees’ health and financial stability. Evidence shows that programs like Medicaid and CHIP improve health outcomes (PDF), reduce personal debt, and are cost-effective. They have provided essential support to newcomer families as they rebuild their lives, seek care for medical and mental health needs, and pursue their career goals in the US.
And research suggests these investments pay off. A recent study found that refugees and asylees contributed more than $120 billion more to the US economy (PDF) than they received from federal and state sources over 15 years.
Refugees have accessed critical health care through Medicaid or CHIP for decades
More than 3 million refugees have been resettled since the US Refugee Admission Program was formalized in 1980. In 2024, annual refugee admissions reached a 30-year high. Most of those resettled are families, with children under 18 representing 40 percent of admissions in recent years.
Sources: Refugee admissions reported by fiscal year. Fiscal year (FY) 2020–24 data from the FY 21 and FY 24 Refugee Annual Flow Reports. FY 25 data from the Office of Homeland Security Statistics “Refugee Arrivals by Region and County of Nationality” table.
Note: Data on admissions by age are not yet available for FY 25.
Refugees often arrive from situations in which access to consistent and high-quality health care (PDF) is limited. Before the Trump administration’s decision to primarily resettle Afrikaners, some refugees were even prioritized for resettlement because of a complex medical need or disability.
To ensure refugees can complete required medical screenings, all are eligible for some form of public health insurance following admission to the US, either through Medicaid, CHIP, or Refugee Medical Assistance (RMA), which provides time-limited coverage for those ineligible for Medicaid. Many of those initially enrolled in Medicaid and CHIP have stayed enrolled through their first years in the US, with participation declining (PDF) to general population rates over time.
Now, under changes in the OBBBA, many who have yet to obtain their green card, and are outside the 12-month RMA eligibility period, will lose health insurance coverage.
Green card processing delays could leave refugees waiting indefinitely to become eligible for Medicaid and CHIP
Refugees have always been required to apply for a green card one year after they arrive, at which time their case is reviewed for grounds of inadmissibility. However, since 2025, as part of broader efforts to reshape humanitarian immigration pathways, the Trump administration introduced significant changes to this process that have dramatically increased the backlog of refugees’ green card applications.
In November 2025, US Citizenship and Immigration Services (USCIS) announced they had stopped processing refugees’ green card applications and would reinterview those admitted under the Biden administration. Under Operation PARRIS (Post-Admission Refugee Reverification and Integrity Strengthening) in early 2026, the US Department of Homeland Security began forcefully detaining refugees who had not yet received their green card. A district court barred the enforcement of the detention policy in March 2026, but reinterviewing continues.
According to USCIS data, as of August 2026, over 157,000 refugees had a pending green card application, the highest ever reported. Between January and August 2026, USCIS reported only reviewing 406 refugees’ green card applications, of which 30 percent of cases were denied. The average case denial rate for the previous five calendar years was 5.6 percent.
Sources: Form I-485 application data for refugees reported by quarter and fiscal year (October to September). Fiscal year (FY) 2021 Q1 through FY 26 Q3 data from US Citizenship and Immigration Services (USCIS) “All USCIS Application and Petition Form Types.” Data for FY 26 Q4 are only available for July and August from USCIS “FY22 Appropriations Reporting Requirement - Application Processing Data.”
Effects of eligibility changes will vary by state and individual circumstances
States maintain the option to provide coverage to all lawfully present immigrant children and people who are pregnant without a waiting period through the 2009 Children’s Health Insurance Reauthorization Act (CHIPRA). Thirty-eight states offer this coverage to children, and 32 states offer it to pregnant people. About half of states also offer prenatal coverage regardless of immigration status.
However, for other adults, including those with disabilities and older adults, and for refugees residing in other states, their only remaining option for public health insurance is fully state-funded coverage. Only a few states offer this coverage, and some have limited it in response to recent budget issues.
Under OBBBA, starting in 2027, refugees will also no longer be eligible for Marketplace premium tax credits until they receive a green card, leaving few low-cost options for families in states without extended coverage.
Other humanitarian immigrants face similar barriers to Medicaid and CHIP eligibility
Refugees aren’t the only group losing coverage under OBBBA. People granted asylum, survivors of human trafficking, and people granted parole for at least one year, including Afghan and Ukrainian humanitarian parolees, are among those affected. Of the humanitarian immigrants (PDF) previously eligible for Medicaid, OBBBA only maintains eligibility for Cuban-Haitian entrants, as well as Afghan and Iraqi special immigrant visa holders who are typically admitted to the US as green card holders.
Even after obtaining a green card, these humanitarian immigrants will also have to navigate more-complex Medicaid eligibility and redetermination processes, and many adults will have to meet new work requirements.
Policymakers and community-based organizations can work together to address coverage loss
Many refugees and other humanitarian immigrants losing Medicaid have recently lost federally funded food assistance because of OBBBA, further complicating their financial stability. To address the growing backlog of green card applications, federal policymakers can expand oversight of these processing delays.
State policymakers can maintain access to coverage for children and pregnant women through wider adoption of CHIPRA. States can also consider fully state-funded options, like California, which will continue covering all noncitizens affected by these changes through June 2027.
In the immediate term, state agencies could partner with community-based organizations, resettlement agencies, and refugee health collaboratives to support immigrant communities in locating low-cost ways to address newly unmet medical needs, such as community clinics and health fairs.
