On October 1, 2026, a provision of the 2025 federal budget law known as the One Big Beautiful Bill Act (H.R. 1) took effect. It limits federally funded Medicaid to U.S. citizens and a short list of immigrant groups. Many people who came to the U.S. legally, and who had qualified for Medicaid until now, no longer do.
Florida has more people at risk than any other state that has reported numbers: nearly 177,000, according to state counts compiled by STAT and Medical Daily. Across nine states and Washington, D.C., more than 281,000 people were reported at risk for October alone.
Who loses Medicaid
Refugees and asylees who don’t have a green card yet
Survivors of human trafficking
Other lawfully present immigrants without a green card, including parolees who don’t meet the definition of a Cuban or Haitian entrant
Who keeps it
U.S. citizens and lawful permanent residents (green card holders)
Cuban and Haitian entrants
Citizens of the Compact of Free Association nations (Micronesia, the Marshall Islands and Palau)
Lawfully residing children, whom Florida continues to cover under a separate federal option
Emergency Medicaid remains available for emergency medical conditions regardless of immigration status. It does not cover routine visits or most prescriptions.
Being Cuban or Haitian isn’t automatic protection. What matters is your exact immigration status.
What it means in Miami
For South Florida, the Cuban and Haitian entrant exception is the detail that matters most. Under federal law, the “Cuban and Haitian entrant” category covers Cuban and Haitian nationals who were paroled into the U.S., who have an asylum application pending, or who are in removal proceedings without a final order, according to reporting by CiberCuba. That means many Cuban and Haitian families in Miami keep their coverage.
But it isn’t automatic. The Florida Department of Children and Families (DCF) is verifying immigration status through the federal SAVE system and mailing notices to people whose status it can’t confirm. Coverage can end for people who don’t respond or don’t pass verification.
Cubans with an I-220A form are a gray area. CiberCuba reports that the I-220A alone doesn’t guarantee protection, but holders may qualify as entrants if they are in removal proceedings and have no final order of removal. Anyone in that situation should check with an immigration attorney or a legal aid organization.
What patients and families should do now
Open every DCF notice. If it asks for documents, send them before the deadline. Check your ACCESS Florida account for updates.
Refill essential medications early. Ask for 90-day supplies while coverage is still active.
Find a community health center. Federally qualified health centers (FQHCs) charge on a sliding scale based on income.
Refugees and asylees: contact your resettlement agency, which can help find low-cost care.
Don’t skip the ER in an emergency. Emergency Medicaid still applies.
Unsure of your status? Talk to an immigration attorney or legal aid office before assuming you’re covered, or not.
What nurses and caregivers will see
Patients who lose coverage are likely to miss follow-ups, stretch medications, or show up sicker in the emergency department. Hospital officials have already warned about “the strain and stress on the hospital system,” and advocates describe lost medication access as “a life-or-death situation” for people with chronic illness.
A few things help: confirm a patient’s coverage before scheduling, flag patients on critical medications such as insulin, anticoagulants or seizure drugs, and keep a list of nearby community health centers ready for referrals. Mixed-status families may also avoid care for U.S. citizen children out of fear, so it’s worth saying clearly that those children’s coverage hasn’t changed.
What’s next
More changes are scheduled. Starting January 1, 2027, subsidized coverage on the ACA marketplace will be limited to green card holders, Cuban and Haitian entrants and Compact of Free Association citizens, according to KFF. Other lawfully present immigrants will still be able to buy marketplace plans, but without financial help. Changes to Medicare eligibility for some immigrants are also coming, on a separate timeline.
To be fair
Supporters of the law argue that federal Medicaid dollars should go first to citizens and permanent residents, and that the change reduces federal spending. The Congressional Budget Office estimated the provision would leave about 100,000 more immigrants uninsured nationally by 2034, a smaller number than early state counts suggest. Opponents counter that the people affected entered the country legally, many fleeing persecution, and that pushing them out of routine care shifts the cost to emergency rooms.
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This article is general information, not legal advice. Eligibility depends on each person’s exact immigration status. Contact the Florida Department of Children and Families, an immigration attorney, or a legal aid organization about your specific situation. The photo used with this article is illustrative.
Sources
STAT, “U.S. poised to boot legal immigrants from Medicaid, including refugees and sex-trafficking victims,” September 30, 2026 — statnews.com
Medical Daily, “Refugees and Asylees Start Losing Medicaid as Nine States and DC Report More Than 281,000 at Risk” — medicaldaily.com
KFF, “Implementation of Medicaid Immigrant Eligibility Restrictions Under the 2025 Reconciliation Law” — kff.org
Georgetown University Center for Children and Families, “New Policies Pose Risks to Health of Lawfully Present Immigrant Families and Children,” September 30, 2026 — ccf.georgetown.edu
CiberCuba, “Nearly 177,000 immigrants in Florida could lose Medicaid starting this Thursday: which Cubans remain protected?” October 1, 2026 — cibercuba.com
