CMS Releases Immigrant Medicaid Eligibility Guidance

In an April 8 letter to state health officials, the Centers for Medicare & Medicaid Services (CMS) outlined which immigrants will no longer be eligible for Medicaid on Oct. 1, due to Working Families Tax Cut legislation (WFTCL) eligibility changes. CMS also reminded states to update their Medicaid eligibility and renewal processes to reflect these changes.

The WFTCL restricted which immigration statuses will remain eligible for nonemergency Medicaid beginning Oct. 1, 2026. Immigrants that remain eligible include legal permanent residents, Cuban/Haitian entrants, and Compact of Free Association migrants. Other immigration statuses, including refugees, asylees, or victims of human trafficking, no longer will qualify for nonemergency coverage. This group will be eligible for emergency Medicaid and coverage under the Children's Health Insurance Program (CHIP) Reauthorization Act 214 option, which allows states to cover noncitizen children and pregnant women in their CHIP programs. States may continue to provide health coverage to these groups with state-only funding. Guidance on noncitizens who are dually eligible for Medicare and Medicaid is forthcoming.

Also beginning Oct. 1, the WFTCL reduces the federal medical assistance percentage (FMAP) for emergency Medicaid to the state's regular FMAP, disallowing enhanced FMAPs for certain services.

State health officials must redetermine Medicaid eligibility for all immigrants by identifying all individuals potentially affected by this change, then verifying they have satisfactory immigration status to remain Medicaid eligible. States must follow regular procedures to verify eligibility with available information before attempting to contact the beneficiary and give the beneficiary a reasonable period to respond before taking adverse action.

CMS expects state health officials to update Medicaid applications and renewal forms and processes accordingly by Oct. 1. The agency reminds states of their options to verify immigration status and the availability of federal financial participation for updating eligibility systems. States must submit an updated state plan amendment to reflect these eligibility changes by Dec. 31 for an effective date of Oct. 1.

Contact Director of Policy Rob Nelb, MPH, at [email protected] or 202.585.0127 with questions or for more information.