Immigrant Health Coverage in PA: One Month Until Changes Take Effect

The budget reconciliation bill passed last summer — H.R. 1 — makes significant changes to immigrants’ eligibility for federally funded Medicaid beginning October 1, 2026. This article explains what is changing, who is affected, and what steps people should take now to keep their coverage.

• Oct. 1, 2026 Federally funded Medicaid narrows to four immigration categories.
• Jan. 1, 2027 Pennie subsidies and Medicare eligibility narrow to the same categories.

Eligibility Under Current Law

Medicaid — known in Pennsylvania as Medical Assistance, or MA — is funded in one of two ways. Federally funded Medicaid means the state receives a percentage of its funding from the federal government to provide coverage. State-funded Medicaid is paid for entirely by the Commonwealth. The type of Medicaid a person is eligible for depends on their immigration status.

Under current law, immigrants with the following statuses are eligible for federally funded Medicaid:

* The five-year bar is a federal rule requiring most immigrants to hold a qualified immigration status for five years before they become eligible for certain public benefits.
** Lawfully present means immigrants who are permitted by the federal government to be present in the United States.

Individuals who are not currently eligible for federally funded Medicaid include:

• People who have held a green card for less than five years and are subject to the five-year bar;
• People who have been VAWA petitioners for less than five years and are subject to the five-year bar; and
• Lawfully present adults who are not pregnant.

Eligibility Starting October 1, 2026

Beginning October 1, 2026, eligibility for federally funded Medicaid will be restricted to four groups:

Everyone else must seek state-funded Medicaid, Emergency Medical Assistance, or coverage through Pennie, Pennsylvania’s health insurance marketplace. Beginning January 1, 2027, however, subsidized Pennie coverage will also be restricted to green card holders, Cuban/Haitian entrants, and COFA migrants.

Emergency Medical Assistance vs. State-Funded Medicaid

People who are ineligible for federally funded Medicaid will have two remaining pathways to coverage: state-funded Medicaid or Emergency Medical Assistance (EMA).

Emergency Medical Assistance

EMA is a specific type of federally funded Medicaid that covers care for an emergency medical condition. You do not need to go to an emergency department to qualify. An emergency medical condition is any condition, acute or chronic, that presents with symptoms severe enough that going without immediate medical attention would seriously jeopardize the person’s health, impair bodily functions, or cause serious dysfunction of a bodily organ or part. EMA covers only treatment related to that emergency condition.

State-Funded Medicaid

State-funded Medicaid is broader than EMA and provides the full package of Medicaid benefits, but it carries restrictive financial and other eligibility criteria. There are two subcategories:

• Medically Needy Only (MNO) — income below $425 per month, and either age 59 or older or the parent of a child under 21.
• General Assistance (GA) — income below $205 per month, and either a disability or caregiving responsibility for a person with a disability or an unrelated child.

Domestic violence survivors and people in substance use disorder treatment programs are also eligible, subject to a nine-month lifetime limit.

What to Do Now

County Assistance Offices (CAOs) began sending letters at the end of June to people who may be affected by these changes. Recipients must send documentation to the CAO by the stated deadline showing that they meet one of the following:

• • They are a U.S. citizen;
• • They are a lawful permanent resident with a green card;
• • They are a citizen of Cuba or Haiti (Cuban/Haitian entrant);
• • They are a citizen of Micronesia, the Marshall Islands, or Palau (COFA migrant);
• • They are lawfully present and under age 21; or
• • They are lawfully present and are pregnant, or were pregnant within the last 12 months.

After you submit your documentation

If the CAO determines that you are no longer eligible for federally funded MA, you will receive a notice by October 1, 2026, stating that your coverage has ended. The CAO should then review you for state-funded Medicaid and Emergency Medical Assistance. People who are not eligible for federally funded MA, state-funded MA, or EMA will be referred to Pennie.

If you need help

If you need assistance providing information to the CAO, contact the DHS Statewide Customer Service Center at 1-877-395-8930, or 1-215-560-7226 for Philadelphia residents. If you need more time to gather documents, submit a written statement to the CAO, in person or by mail, stating that you meet one of the immigration statuses and need additional time.

If you are unsure whether you qualify for state-funded Medicaid or EMA — or if you believe you qualify but the CAO has not reviewed you — contact PHLP’s Helpline at 1-800-274-3258. The Helpline is open Mondays and Wednesdays beginning at 8:00 AM ET.

Other Eligibility Changes: Marketplace and Medicare

H.R. 1 also restricts immigrants’ access to Medicare and to financial assistance through Pennie. Immigrants losing federally funded Medicaid under H.R. 1 cannot receive Pennie subsidies unless their income is above 100% of the Federal Poverty Level ($1,330 per month for a household of one in 2026). Beginning January 1, 2027, Pennie subsidies and Medicare eligibility will be limited to green card holders, Cuban/Haitian entrants, and COFA migrants — the same categories that apply to Medicaid.

Resources

• • PHLP Helpline — 1-800-274-3258 or staff@phlp.org, open Mondays and Wednesdays beginning at 8:00 AM ET.
• • PA Legal Aid Network (PLAN): Find a Legal Aid Program
• • Pennsylvania Health Access Network (PHAN)
• • What You Need to Know About Immigrant Access to Medicaid, presented by CLS