Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act marketplaces have immigration-related restrictions that block many people from obtaining health coverage through these programs. These eligibility restrictions are complex, program-specific and in some cases vary by state. The questions and answers below seek to clarify these eligibility rules.
*Note, this FAQ includes information on changes to coverage programs (including effective dates) as a result of the One Big Beautiful Bill Act of 2025 (“reconciliation megabill”).
- ↓ Download PDF in English: Health Insurance Affordability Programs’ Eligibility Based on Immigration Status
- ↓ Download PDF in Spanish: Elegibilidad para programas de seguro médico asequible según el estatus de inmigración
1. What are the immigration-related eligibility requirements for Medicaid and CHIP?
The general rules related to eligibility based off immigration status for Medicaid and CHIP are grounded in the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. PRWORA restricted eligibility for many people who are immigrants by creating two categories of immigration statuses used in determining eligibility for public benefits: “qualified” and “not qualified.”
In general, people who are immigrants must be in a qualified status to be eligible for Medicaid and CHIP. However, even people with qualified immigration statuses may not be eligible because the law also created a five-year waiting period for many people who have qualified immigration statuses. There are some groups who are not in a qualified status but meet the eligibility standard due to exceptions granted by Congress. All other immigration statuses are considered not qualified for purposes of Medicaid and CHIP eligibility. See Table 1 for specific information about the eligible categories.
Starting October 1, 2026, the “One Big Beautiful Bill Act” of 2025 (the reconciliation megabill) ends federal matching funds for Medicaid and CHIP for most categories of qualified immigration statuses.
Hospitals and other medical providers can get payment from Medicaid when they provide life-saving medical care to individuals who are ineligible for Medicaid due to their immigration status but meet all other eligibility criteria.
Additionally, some states have adopted more inclusive immigration-related eligibility criteria for children and pregnant people under the lawfully residing state option and the from conception to end of pregnancy option. These options were not changed by the reconciliation megabill.
2. Are people with qualified immigration statuses eligible for Medicaid or CHIP immediately upon obtaining a qualified status?
In general, people with qualified immigration statuses who entered the U.S. on or after August 22, 1996, must wait five years after obtaining a qualified status before meeting the immigration-related eligibility requirements for Medicaid or CHIP. This is often referred to as the “five-year bar.” However, there are exceptions and some people with eligible immigration statuses and/or circumstances do not have to meet the five-year waiting period requirement. It is important to note that a few states restrict eligibility for some adults with a qualified immigration status even after the five-year wait.2
3. Can states have less restrictive eligibility requirements for people who are immigrants?
Yes. States have the option to provide Medicaid and CHIP coverage to children and/or
pregnant people who are lawfully residing in the U.S. without a five year-waiting period. The term lawfully residing includes all qualified immigration statuses, as well as people with many other types of immigration statuses who have permission to live or work in the United States.
Under the CHIP from-conception-to-end-of-pregnancy option, states can use CHIP funding to provide pregnancy-related care to people who are otherwise ineligible for Medicaid and/or CHIP due to their immigration status. In addition, a growing number of states use state or local funds to provide Medicaid and CHIP to other groups, such as people who have not met the five-year bar, people with lawfully residing immigration statuses who do not have a qualified status, and people without a documented immigration status.
4. What are the immigration-related eligibility requirements to enroll in an ACA marketplace plan?
People must have a lawfully present immigration status to enroll in an ACA marketplace plan . In general, people permitted under the law to be in the U.S. if they meet all other requirements including state and/or marketplace service area residency requirements.
5. Are people with Deferred Action for Childhood Arrivals (DACA) eligible to enroll in an ACA marketplace plan?
The U.S. Department of Homeland Security can grant temporary administrative relief from deportation, which is referred to as deferred action, for a variety of reasons. Individuals granted deferred action are generally eligible to enroll in marketplace coverage. Beginning November 1, 2024, a Department of Health and Human Services (HHS) rule took effect that changed the “lawfully present” eligibility standard, making people with DACA newly eligible, allowing these individuals to enroll in ACA marketplace coverage. However, a new final rule subsequently issued by HHS bars people with DACA from ACA marketplace enrollment effective August 25, 2025. Any existing ACA coverage for DACA recipients will terminate as of October 1, 2025.
6. What are the immigration-related eligibility requirements for premium tax credits and cost sharing reductions in the ACA marketplaces?
People with a lawfully present immigration status are eligible to purchase ACA marketplace coverage and may also qualify for premium tax credits and cost sharing reductions if they meet all other requirements such as income, tax filing status, residence, etc. However, starting January 1, 2027, a far more limited group will be eligible for premium tax credits in the ACA marketplace. For additional information.
Currently, people who have a lawfully present immigration status but are ineligible for Medicaid based off immigration status can qualify for premium tax credits even with incomes below the poverty level. This provision was terminated by and starting January 1, 2026, no one will be eligible for premium tax credits in the ACA marketplace with income below the poverty level.
7. How are premium tax credits calculated for people with a lawfully present immigration status and household income below the poverty line?
Several states have created their own health coverage programs similar to Medicaid to offer coverage to certain groups who do not meet federal immigration-related eligibility criteria for Medicaid.4 These look-alike programs, which exist in 16 states and the District of Columbia, are primarily for children, but some also cover people who are pregnant and postpartum, older adults, people with specific statuses and/or other groups of adults. Because states do not receive federal matching funds for these Medicaid look-alike programs, coverage options may have narrower eligibility guidelines, provide fewer benefits than Medicaid and CHIP, or have enrollment caps.
Alternatively, Colorado and Washington states utilize Section 1332 State Innovation Waivers to operate state-funded programs that make private health plans accessible and affordable to people with low incomes who are ineligible for ACA marketplace plans due to their immigration status.
8. Are there health coverage options for people who do not meet the immigration-related eligibility requirements for health insurance affordability programs?
People without a documented immigration status are not eligible to purchase health insurance through the marketplaces but may enroll in private coverage outside the marketplace.
People who do not meet the immigration-related eligibility requirements for Medicaid but meet all other eligibility standards may be eligible for having limited treatment for life-threatening medical conditions paid for by Medicaid (including labor and delivery).
There are no immigration-related eligibility requirements for certain public health services including immunizations as well as services provided by Federally Qualified Health Centers, migrant and rural health centers, and hospital charity care. The Administration has issued guidance attempting to restrict access to some of these programs, based on immigration status. However, further guidance is still required before these changes can be implemented, and multiple states and impacted groups have sued to prevent the guidance from going into effect. Please reach out directly to program providers for the latest information.
In addition, some states provide coverage of pregnancy services to people regardless of immigration status, and a few states and local governments provide health coverage to children without a documented immigration status and/or some adults that do not meet the immigration-related requirements for health insurance affordability programs. People without a documented immigration status also can sign up for employer-sponsored insurance if their employer offers it.
9. What changes did the reconciliation megabill make to immigration-related eligibility for health insurance programs?
The reconciliation megabill ends federal Medicaid matching funds for most categories of immigration statuses. Starting October 1, 2026, states can only get federal matching funds to cover a new narrow megabill group in Medicaid and CHIP. This group includes U.S. citizens, lawful permanent residents (after completing the 5-year bar, when applicable), people from Compact of Free Association (COFA) nations residing in the U.S., and Cuban/ Haitian entrants. If states are unable to fully cover the cost of Medicaid and CHIP for these groups, they may opt to stop providing coverage to them.
Additionally, the megabill ends eligibility for premium tax credits (PTCs) in the ACA marketplace for most categories of immigration statuses. Starting January 1, 2027, access to PTCs will be limited to the new narrow megabill group (although these individuals will remain eligible to purchase full-cost ACA marketplace coverage).
The reconciliation megabill also terminates the special PTC rule that allows people with incomes below the poverty level who are lawfully present but ineligible for Medicaid because of their immigration status to get PTCs. Starting January 1, 2026, this group will no longer be eligible for PTCs (although these individuals will remain eligible to purchase full-cost ACA marketplace coverage).
Finally, the reconciliation megabill ends eligibility for Medicare for most categories of immigration statuses, limiting access only to the new narrow megabill group. This provision goes into effect immediately after enactment for new enrollees. Individuals who are already enrolled will have an 18-month window, until January 4, 2027, to terminate benefits.