Federal Medicaid funding ends Oct. 1 for refugees, asylees and other legal immigrants without green cards; nine states and DC count 281,000 losing coverage

Starting Thursday, Oct. 1, the One Big Beautiful Bill Act (the Republican tax-and-spending law passed in 2025) stops federal Medicaid payments for many immigrants who are in the U.S. legally. That includes refugees, asylees (people granted asylum), trafficking victims and Afghan interpreters. Green-card holders keep coverage. State data gathered by KFF Health News counts more than 281,000 people in nine states and DC expected to lose Medicaid (the joint federal-state health program for low-income people) in October. Where the largest counts are: * Florida: nearly 177,000 * Arizona: nearly 28,000 * New Jersey: 15,000-25,000

What the Oct. 1 cutoff leaves in place for affected immigrants:

• Emergency Medicaid still pays for emergency care, though the law trims its federal match for expansion adults
• States must give at least 10 days' notice and a fair hearing before ending anyone's coverage
• States have until Jan. 4, 2027 to actually terminate current enrollees; until then, keeping them costs state dollars only