Confused about how new policy changes affect newcomer health coverage? Use this blog post to identify alternative services and supports that newcomers may still qualify for.
Accessing health care in the United States can be complicated, especially for newcomers. Health coverage helps pay for medical care, prescriptions, and other health-related costs. Historically, most ORR-eligible newcomers accessed health coverage through Medicaid and the Children’s Health Insurance Program (CHIP). However, due to recent legislative changes that impact eligibility for certain public benefits, some ORR-eligible newcomers may experience gaps in health coverage.
This blog post explains these changes and identifies six alternative health services and supports to help newcomers access care.
Defining ORR Eligibility
This blog focuses on alternative health care coverage and services for individuals and families eligible for programs funded by the Office of Refugee Resettlement (ORR), including refugees, asylees, Cuban and Haitian Entrants, Iraqi and Afghan Special Immigrants, Victims of Human Trafficking, some Afghan and Ukrainian Humanitarian Parolees, and Special Immigrant Juveniles as well as U visa holders within the Unaccompanied Refugee Minors (URM) Program.
Recent Legislative Changes Impacting Health Coverage
The Working Families Tax Cut (WFTC), passed in July 2025, made changes to eligibility for some public benefit programs, including the Supplemental Nutrition Assistance Program (SNAP) and health coverage programs such as Medicaid, CHIP, and financial support for Marketplace Insurance. As a result, some ORR-eligible newcomers who were previously eligible may no longer qualify. All states are required to complete eligibility redetermination before October 1, 2026, and disenroll individuals who no longer meet eligibility requirements. Some states may choose to fund their own health coverage programs for those who do not qualify for federally funded coverage.
Understanding Medicaid Changes
Medicaid is a government-funded program that provides free or low-cost health coverage. To be eligible for Medicaid, newcomers must meet federal and state-specific requirements, such as income threshold. Furthermore, beginning in 2027, some adults enrolled through Medicaid expansion may also be subject to new work or community engagement requirements. Coverage varies by state; please contact your local Medicaid office or State Refugee Health Coordinator for state-specific guidance.
Emergency Medicaid is a limited Medicaid program that covers the cost of services needed to treat an emergency medical condition. States determine which services are reimbursed under the law’s definition of “emergency.” Emergency Medicaid is available to individuals who are not eligible for Medicaid due to their immigration status but meet all other Medicaid eligibility requirements.
Program Changes: Beginning October 1, 2026, some ORR-eligible newcomers will no longer be eligible for Medicaid upon arrival in the United States.
| ORR Eligible Population | Medicaid Eligibility Before October 1, 2026 | Medicaid Eligibility After October 1, 2026 |
|---|---|---|
| Iraqi and Afghan Special Immigrants | Yes | Yes |
| Cuban and Haitian Entrants (CHE)* | Yes | Yes |
| Refugees, Asylees, Victims of Human Trafficking, some Afghan and Ukrainian Humanitarian Parolees, Special Immigrant Juveniles, and U visa holders within the URM Program** | Yes | No |
*Cuban and Haitian Entrants (CHEs) are generally eligible for Medicaid for seven years from the date they become eligible as a CHE. States can choose to provide full Medicaid benefits for CHEs beyond the seven-year period.
**All other listed ORR-eligible populations will be eligible for Medicaid upon adjustment of status to Lawful Permanent Resident (LPR). Once they adjust their status, they will not be required to meet the five-year waiting period to access Medicaid.
The Five-Year Waiting Period
The Five Year Bar is a policy that requires many individuals with LPR status to wait five years before they are eligible for certain public benefits, including SNAP and Medicaid. However, this law includes exemptions for refugees, asylees, CHEs, and Victims of Human Trafficking. Therefore, some ORR-eligible individuals who are or become LPRs are exempt from this waiting period and should apply for Medicaid immediately if they meet all other eligibility requirements.
Six Alternative Health Services and Supports
- Refugee Medical Assistance (RMA)
RMA is a government-funded program that provides short-term health coverage to most ORR-eligible newcomers who do not qualify for Medicaid.
Program Changes: In 2026, the RMA eligibility period increased from four months to eight.
- Children’s Health Insurance Program (CHIP)
CHIP is a government-funded program that provides low-cost or free (in some states) health coverage to children under age 19. Beginning October 1, 2026, most ORR-eligible newcomers will no longer be eligible for CHIP. CHEs, and Iraqi and Afghan Special Immigrants should generally remain eligible. States choose how to administer CHIP, so eligibility, benefits, and costs vary. Some states extend coverage to pregnant mothers.
To learn how CHIP is administered in your clients’ state:
Step 1: Look up the CHIP program name in your state.
Step 2: Review how CHIP is administered in your state, then follow the state-specific links to apply.
Understanding State Options in CHIP Eligibility and Enrollment
Under the Children’s Health Insurance Program Reauthorization Act (CHIPRA), states may elect the CHIPRA 214 option to provide Medicaid or CHIP coverage to lawfully residing children and pregnant mothers, including some ORR-eligible populations, if they meet all other eligibility requirements.
- Employer-Sponsored Health Insurance
Health coverage may be offered through an individual’s or family member’s job. Employees usually pay part of the cost, while the employer pays the rest. Cost and coverage vary by employer.
- Marketplace Health Insurance
Individuals who do not qualify for Refugee Medical Assistance, Medicaid, or employer-sponsored insurance may be eligible to buy private coverage through the Health Insurance Marketplace. Some individuals may also qualify for Marketplace financial assistance.
Program Changes: Beginning January 1, 2027, some ORR-eligible newcomers may no longer qualify for Marketplace financial assistance unless they are a CHE, an Iraqi or Afghan Special Immigrant, or if they adjust status to LPR.
Understanding the Health Insurance Marketplace
Created under the Affordable Care Act (ACA), the Health Insurance Marketplace is a website where people can compare and enroll in private health coverage. Some states operate their own Marketplace websites, while others use HealthCare.gov. Marketplace eligibility, available plans, cost, and financial assistance (premium tax credits and cost-sharing reductions) vary by state, income, household size, and immigration status.
Unless someone qualifies for a Special Enrollment Period (e.g., loss of health coverage, moving, getting married, having a baby, or adopting a child), Open Enrollment begins November 1 for states using HealthCare.gov. Individuals typically must enroll by December 15 and pay their first month’s premium for benefits to begin January 1. State-based websites may have different deadlines, so check your state’s Marketplace for more information.
- Services through Federally Qualified Health Centers (FQHCs)
FQHCs are government-funded community-based health centers that provide primary care and other health services regardless of a person’s ability to pay. FQHCs offer services on a sliding fee scale based on income and family size and generally serve patients regardless of insurance or immigration status. Find a health center near you.
Identifying Community-Based Health Care Providers
In addition to FQHCs, your community may have other low-cost or no-cost health care options, such as public health clinics, faith-based clinics, mobile clinics, and hospitals offering charity care. Explore the Society of Refugee Healthcare Providers’ Refugee Healthcare Provider Directory.
- Prescription Cost Savings Services
Prescription cost savings services can provide free discount coupons that may lower the cost of some prescription medications. Individuals should research prescription cost savings programs to ensure they are able to access the most affordable prescriptions.
Questions for Researching Health Coverage Eligibility in Your State
- Has [State] elected the CHIPRA 214 option, which allows states to provide Medicaid and/or CHIP coverage for lawfully residing children and pregnant mothers?
- How does [State] administer Emergency Medicaid, and which services qualify for coverage?
- Does [State] provide state-funded financial assistance for Marketplace coverage for lawfully residing residents?
- Does [State] run its own Health Insurance Marketplace, or does it use HealthCare.gov?
- Does [State] provide full Medicaid benefits to Cuban and Haitian Entrants (CHEs) beyond seven-years from the date they became eligible as a CHE?
- Does [State] offer any state-funded health coverage programs for individuals who do not qualify for federally funded coverage? (e.g., California, Massachusetts, Oregon, etc.)
- Are there any local organizations or medical providers in [City, State] that provide support with free or low-cost health care? For example, is there a local Lions Clubs International chapter in [City] that participates in the Lions Eyeglass Assistance Program (LEAP)?
- Are there other charity care resources or financial assistance programs in [State]?
Additional Resources
In addition to reviewing the resource list below, please contact Refugee Health Program providers to ask about any state-specific resources available to help navigate health coverage.
- Switchboard resource collection: Getting Started in Navigating ORR Eligibility
- Switchboard blog: Find Food Resources for Newcomers in Your City, in Your State, and at the Federal Level
- Medicaid.Gov web page: A List of States Providing Medicaid and CHIP Coverage for Lawfully Residing Children and Pregnant Women
- KFF web page: Status Expansion Decisions by State
- Settle In: Health Resources for Newcomers
The IRC received competitive funding through the U.S. Department of Health and Human Services, Administration for Children and Families, Grant #90RB0053. The project is 100% financed by federal funds. The contents of this document are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services, Administration for Children and Families.
