300,000 Lawfully Present Immigrants Will Be Newly Ineligible for Health Care Help in This Open Enrollment Period

The 2025 reconciliation law enacted this summer imposed new restrictions on access to health coverage for lawfully present immigrants. Among the first of these restrictions will take effect during the upcoming open enrollment period for coverage under the Affordable Care Act (ACA), which begins Nov. 1. This change restricts access to affordable health care tax credits for many low-income immigrants considered “lawfully present,” including green card holders in their first five years of residency and people with temporary statuses. The Congressional Budget Office (CBO) estimates that 300,000 lawfully present immigrants with low incomes will be disqualified from these tax credits that reduce the cost of health insurance. This will leave families with no affordable pathway to medical care.

Background – ACA Tax Credits for Low-Income Immigrants

Under the ACA, people receive tax credits to lower the cost of buying private health insurance on marketplaces run by the federal government and states. These Advanced Premium Tax Credits make monthly health insurance premiums much more affordable, generally costing no more than around 9% of a household’s income. Prior to the passage of the 2025 reconciliation law, these tax credits were available to all lawfully present immigrants who are ineligible for Medicaid. Undocumented immigrants have never been eligible for ACA coverage, despite their significant tax contributions.

The ACA also anticipated that most people earning less than the federal poverty level ($32,150 for a family of four) would not enroll in private health insurance but would be covered under Medicaid instead. Therefore the law blocked most people earning less than the poverty level from receiving these health insurance tax credits. Many individuals then lost a pathway to health coverage when the Supreme Court blocked the expansion of Medicaid.

However, many lawfully present immigrants are excluded from Medicaid. This especially includes green card holders, many of whom must wait five years before receiving Medicaid. Other categories of lawfully present immigrants excluded from Medicaid include people with Temporary Protected Status, applicants for asylum, U-visa holders, asylum seekers, people with nonimmigrant visas, recipients of deferred action, and others who are living in the United States with the permission of the government. Therefore, Congress created a special exception from the restrictions on ACA tax credits for low-income, lawfully present immigrants who are ineligible for Medicaid.

Since the implementation of ACA coverage, uninsured rates in the United States have dropped to all-time lows, including among immigrants. However, the new reconciliation law will start to reverse these trends next year.

2025 Reconciliation Law – Kicking People Off 2026 Health Care

The new law imposes a number of new restrictions on access to health care and nutrition assistance for lawfully present immigrants. The ban on the ACA’s health insurance tax credits for low-income immigrants will go into effect at the end of this year. While families may purchase health insurance at full cost, a family with two adults and two children would be expected to pay well over $1000 a month, an unaffordable price for a low-income family. People seeking to enroll in coverage for next year will start to learn of this exclusion beginning Nov. 1.

The health research organization KFF estimates that nearly 550,000 people who earn less than the poverty level are currently enrolled in ACA coverage. Given the ACA’s general restrictions, most of these individuals are likely in immigrant households. This number is higher than the CBO’s estimate of 300,000 people who will lose health insurance, likely because the CBO may be assuming that some affected individuals will find other, potentially more expensive, sources of health insurance. Through KFF’s estimates, we know that the new ACA restrictions will harm people in every state, including tens of thousands in Georgia, Texas, Florida, Massachusetts, Maryland, New Jersey, and Virginia.

Low-income immigrants disproportionately work in construction, food services, waste management, and other essential industries. Many people who are newly excluded from coverage, such as refugees and asylees, have a pathway to a green card and eventual citizenship, meaning they will eventually become eligible for this coverage but will have lacked access to important preventive care along the way. When anyone is excluded from health insurance, entire communities suffer.

Immigrant families may not be aware that they will lose access to affordable health insurance. The Trump administration slashed funding for the outreach Navigator program by 90% earlier this year, stripping community-based organizations of resources needed to help hard-to-reach populations understand their health insurance options. Immigrants already face barriers to health care due to insufficient resources in their primary language, confusion caused by the country’s complex health care systems, and distrust of government agencies. Families may visit the doctor next year and be shocked to discover that their health insurance is denied.

What Families Should Expect When Enrolling in Health Coverage This Year

Immigrant families enrolled in ACA coverage should be extra vigilant during the upcoming ACA open enrollment period. Affected families should expect to get a letter or email from their marketplace informing them about their potential lack of eligibility for tax credits during the beginning of open enrollment, which runs from Nov. 1 through Jan. 15, 2026 in most states. The notice will likely indicate that the family may be no longer eligible for financial help and encourage them to ensure that their information is accurate. It is important that families do so, especially if their income is expected to be above the poverty line in 2026, therefore retaining their eligibility for subsidies.

For example, if a family of four green card holders in the five-year Medicaid waiting period estimated their 2025 income would be $30,000, just below the poverty line, but now expects to earn $40,000 in 2026, they would remain eligible for tax credits by renewing during open enrollment. But if families do not act, they may be reenrolled automatically in their current health plan or an equivalent at full cost. For example, if that family did not update their income, they could receive a January 2026 bill for health insurance that is many times higher than they are used to paying. If they do not pay that bill, their health insurance would be canceled.

Many families allow their ACA health insurance to be automatically renewed out of convenience or because enrollment occurs during a busy time of year. But this year, low-income immigrant families are advised to avoid auto-reenrollment, which may occur if they do not act by Dec. 15. If a family loses eligibility for the tax credits but their health insurance plan is automatically renewed, they could receive a very expensive bill from their insurance company. Some families could be even charged for that full premium if their insurance company has a payment on file. Instead, families should log into their marketplace account, update their information, and ensure they are not enrolled in full price coverage they cannot afford.

Some states currently offer state-funded coverage to low-income immigrants who are ineligible for federal Medicaid, meaning that these individuals do not rely on the ACA marketplaces for coverage. Potentially affected families should be sure to learn about any options that may be available to them.

Some families may be concerned about whether the information they provide when enrolling in health care programs will be confidential. They may find these resources from Protecting Immigrant Families helpful in decision making.

Additional ACA Restrictions Coming in 2027

On top of these restrictions taking effect for 2026 health insurance, many more immigrants will be excluded from the tax credits in the future. Starting in 2027, the law bans all lawfully present immigrants from ACA assistance who are not green card holders or certain Cubans, Haitians, Micronesians, Marshaellese, and Palauans. The CBO says this will deprive an additional 900,000 people from access to health care.

Considerations for Policymakers

Congress should immediately act to repeal the harmful reconciliation bill, which used the money that should be going to hard working families to provide a slush fund for at-all-costs immigration enforcement. Congress should start by passing the Protecting Health Care and Lowering Costs Act, which repeals all of the health provisions in the new law, including these cuts to health insurance tax credits for lawfully present immigrants.

In the meantime, states should consider how they can support families who are losing coverage. State policy makers can help ensure that state-funded health care programs limit the reconciliation bill’s harmful impact on low-income immigrant communities. State and local governments should also invest in outreach, enrollment, and health care connection services to ensure that potentially affected families can navigate the ACA enrollment process and find alternative sources of care if they lose access to tax credits.