A Closer Look

A monthly in-depth look at issues affecting people experiencing homelessness and the broader Health Care for the Homeless community

More Immigration Restrictions Set to Take Effect Soon

Immigrant communities across the country are experiencing a wave of policy attacks that threaten access to health care and other critical supports. Over the past year and a half, increased immigration enforcement, elimination of protections at sensitive locations, and heightened fear have made it more difficult for people to access care, enroll in coverage, and get the services they need.   

This fall, two additional policy changes will further reduce access to care:

  1. Gutting the Guardrails of Public Charge Rule – A new Department of Homeland Security “public charge” regulation will further limit approval of immigration applications.
  2. Elimination of Medicaid Coverage for Immigrants – Provisions from H.R. 1 will take effect that limit Medicaid eligibility.

Change #1: Public Charge Rule Creates Uncertainty and Fear

On July 17, the Trump administration finalized a new public charge rule changing how immigration officials evaluate applications for lawful permanent residency and admission into the U.S. The rule eliminates a previous public charge rule and replaces it with undefined standards that give immigration officials broad discretion when determining if someone is likely to depend on the government for assistance.

Beginning September 18, 2026, immigration officials may assess an individual’s use of any public benefit in the green card or visa application process. Under previous iterations of the public charge rule, officials were limited to examining only cash assistance and long-term institutionalization, in addition to other circumstances like income, employment, health, and education.

The new rule eliminates these guardrails without providing an updated list of public benefits that can be considered. The lack of guidelines allows officials to examine any benefit the officer believes the individual might use—as well as family members’ use of those benefits—to deny immigration applications. This broad authorization of agents’ personal assessments creates broad permissiveness for discrimination and bias in the process. It will also create massive uncertainty and fear among immigrant families. Even individuals who are not subject to the public charge test will likely be hesitant to access public benefits out of fear it could impact their immigration status.  

Although public charge only applies to certain immigration applications, the chilling effects extend far beyond those impacted. Estimates project that Medicaid and CHIP enrollment is likely to decline by 1.4 and 4.1 million people. This impact is consistent with a similar 2019 public charge rule (later reversed by the Biden administration) where more than one in seven adults in immigrant families avoided noncash public benefits including Medicaid, housing subsidies, CHIP, and SNAP out of fear.

Learn more about public charge and the impact on health centers! Register here for the National Health Center Immigration Workgroup’s webinar on the new regulation – August 19th at 1pm ET.

Additional Resources from our partners at Protecting Immigrant Families:

Change #2: H.R. 1 Eliminates Medicaid Coverage for Immigrants

On October 1, 2026, a provision from H.R. 1 takes effect that significantly limits which lawfully present immigrants qualify for federally funded Medicaid. For decades, many lawfully present immigrants were eligible for Medicaid, however the new provisions eliminate eligibility for many of these groups.

Starting in October, federally funded Medicaid will only be available to lawfully permanent residents after the five year waiting period, Cuban/Haitian entrants, Compacts of Free Association (COFA) migrants, and lawfully residing children and pregnant individuals. This eliminates eligibility for asylees, refugees, and survivors of domestic violence and human trafficking (all of whom were previously eligible).

In response to these changes, CMS requested states identify all immigrant patients who will lose Medicaid coverage and ensure the state does not request Federal matching funds for services provided after October 1. If a state cannot confirm whether an individual remains eligible, they must not request Federal matching funds – essentially requiring states to conduct broad eligibility redeterminations for any potentially affected person. The financial fear will likely result in states taking an overly cautious approach that discourages immigrant patients, even those who remain eligible, from seeking care.  

Two additional H.R. 1 provisions take effect on January 1, 2027:

Together, these three provisions will result in 1.4 million lawfully present immigrants losing health coverage. Losing insurance doesn’t take away people’s need for care. Instead, many people will forego care until conditions worsen, creating a downward spiral of poor health, disability, premature mortality, and needless misery.

Additional Resources:

Actions the HCH Community Can Take:

Taken together, these policies create a string of new challenges for immigrant communities who rely on HCH programs for their care. Even individuals who remain eligible for coverage may avoid seeking care or enrolling due to confusion and fear of the new rules. The result will be more uninsured patients, delayed care, worse health, and financial strain on providers.

External Advocacy Actions:

The HCH Community can advocate against harmful policies by:

  1. Add or expand state-level coverage. Find out whether your state will offer state-funded coverage and, if they do not, advocate with state lawmakers to provide immigrant coverage.
  2. Support federal policies that protect immigrant health. Call your federal representatives and express your concern/opposition to these changes. Ask them to support the Protect American Values Act to prevent implementation and enforcement of the new public charge rule and the Protecting Sensitive Locations Act to prohibit immigration enforcement at/near protected areas including community health centers, health clinics, and hospitals, among others.
  3. Vote for constructive policymakers: In the upcoming mid-term elections, support federal, state, and local candidates who promote health care coverage and access for all people, including immigrants.

Internal Operational Strategies:

HCH programs can prepare for these changes and the increase in uninsured by:

  1. Identify state-only funds that can fill coverage gaps: Maximize state- or local-funded coverage options, if available.
  2. Encourage hospitals to maximize emergency Medicaid to offset revenue loss. Make sure hospitals are screening all eligible patients for emergency Medicaid and that eligibility staff understand the upcoming changes.
  3. Talk with patients/clients about changes and ongoing options for care. Make sure patients are aware of the upcoming changes and clearly explain whether these changes apply to them and which do not. Remind patients that there are other options for care.  
  4. Provide multiple months of prescription drugs and other supplies. When appropriate, provide patients with multiple months of medications and other supplies to prevent interruptions to care.
  5. Adapt care plans to accommodate loss of insurance coverage. As patients lose coverage, make sure your program is prepared to reconsider where you are referring patients for specialty care and be ready to identify low-cost options.  
  6. Educate patients and staff on who this applies to and who it does NOT apply to. Make sure staff are trained to communicate these changes to impacted patients.

Prior NHCHC Resources on Immigration Issues:

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