Lawfully Present Immigrants and Health Coverage in 2026–2027: What Ends, What Stays Open

What the federal law changed, in three steps

The budget law signed on July 4, 2025 rewrote which immigrants federal health money may cover. New York has long covered lawfully present immigrants that federal money does not, under a court ruling, Aliessa v. Novello, which is why most of what follows is a change in who pays, not in who is covered. The exceptions are real, and they are listed plainly below.

Step one, January 1, 2026. Lawfully present immigrants with income below 100% of the federal poverty level lost tax credit eligibility. The state kept them in the Essential Plan using surplus program funds.

Step two, October 1, 2026: Medicaid and the Medicare Savings Program. Federal Medicaid funding is limited to citizens and nationals, lawful permanent residents who have completed or are not subject to the five-year bar, Cuban and Haitian entrants, and citizens of the Compact of Free Association nations. On September 29, 2026 the state Department of Health told local offices that this does not mean people in the other categories lose coverage in New York, only that federal funding is no longer available. Their Medicaid continues with state-only funds. Children and pregnant people stay federally covered through the state’s option for lawfully residing children and pregnant individuals. The exception is the Medicare Savings Program: from October 1, only citizens and the listed groups qualify, and state-only funding is not available for it.

Step three, January 1, 2027. Tax credit eligibility narrows to the same three groups. Refugees, asylees, people with Temporary Protected Status, people with deferred action and other lawfully present categories lose the credit. State officials have estimated that more than 200,000 Essential Plan enrollees above 138% of the poverty level are in the affected categories. And on January 4, 2027, federal Medicare eligibility changes take effect for non-citizens outside the listed groups.

What it means program by program

The honest limit of this table is the Essential Plan row. What New York does for those enrollees from January 1, 2027 is set out in the notice NY State of Health says it sent them; if you are in one of these categories and have not seen it, call 1-855-355-5777 before January.

If you have Medicare: the two dates

This is the group the changes hit hardest, because Medicare has no state-funded twin.

From October 1, 2026, a non-citizen outside the listed groups no longer qualifies for the Medicare Savings Program, which pays the Part B premium and, at the lower income tier, Medicare’s cost sharing. Local offices apply the rule when they decide or renew eligibility, and the state cannot replace it with its own funds.

On January 4, 2027, Medicare eligibility itself changes for the same groups.

Medicaid, in contrast, continues with state funds. If someone in your household is in this situation, get free counseling now, before either date reaches your mailbox: HIICAP, New York’s Medicare counseling program, at 1-800-701-0501. Medicare and Medicaid together.

If you are in an affected category: what to do now

1. Keep your NY State of Health account current. Address, phone, email. Every notice about these changes arrives there, and each change takes effect on a date, not when you happen to log in.

2. Do not drop anything voluntarily. Coverage that is ending will end by notice. Coverage that is not ending continues. Leaving early creates a gap the law did not.

3. Re-check the year-round programs. Children under 19 in the household qualify for Child Health Plus regardless of anyone’s status, at family income limits well above the adult ones. Pregnancy opens Medicaid eligibility at higher incomes, with federal coverage kept. A change in your own status, or a drop in income, can move you into a program that is not affected.

4. If a marketplace plan becomes unaffordable, use the two doors that do not run on status. NYC Care gives you a primary care doctor in the public hospital system for little or nothing, with no status requirement and no income cutoff to join: 1-646-NYC-CARE. And hospital financial assistance caps what any New York hospital may charge up to 400% of the poverty level, with status explicitly off the table.

5. Use the special enrollment period. Losing eligibility for coverage is a qualifying event. It opens a 60-day window to enroll in a marketplace plan outside the November-to-January season, and it is the moment to sit down with a certified navigator, who is free and speaks the neighborhood’s languages. The state line is 1-855-355-5777.

Public charge, stated plainly

Health coverage other than long-term institutional care is not part of the public charge analysis. Emergency Medicaid, Child Health Plus, NYC Care and hospital financial assistance are not counted, and hospitals may not report financial assistance applicants to immigration authorities. This page describes funding changes, not a change in what applying does to your case.

That said, the rules have moved more than once and your file may have facts that matter. If you have a pending application or a case in progress, the question goes to an immigration attorney, and New York City funds free immigration legal services for exactly that conversation.