Two federal provisions limiting Medicaid coverage for non-citizens go into effect on Thursday, October 1. The changes are part of a Medicaid overhaul enacted by Republicans last year as part of the One Big Beautiful Bill Act.
One provision reduces federal reimbursements for emergency care provided to uninsured immigrants, while the other revokes Medicaid eligibility for certain lawfully present non-citizens.
Starting Oct. 1, non-citizen Medicaid eligibility will be limited to lawful permanent residents (“green card” holders), certain immigrants from Cuba, Haiti, Micronesia, Palau, and the Marshall Islands, as well as some people who are pregnant or under 21.
Lawfully present non-citizens who will lose their Medicaid eligibility include refugees, people granted asylum, victims of trafficking and abuse, and people granted temporary admission under a pending application.
A spokesperson for the Michigan Department of Health and Human Services (MDHHS) said just over 5,000 people in Michigan were expected to lose coverage under the change.
Dr. John Ayanian, director of the Institute for Healthcare Policy and Innovation at the University of Michigan, said losing Medicaid coverage can lead to an increase in medical emergencies.
“What's concerning is that [people without insurance] may go without health care for chronic health conditions—like diabetes or high blood pressure or asthma—that could be treated effectively if they had Medicaid coverage,” Ayanian said. “And then their problems may progress and they'll end up in emergency departments and need care when they have complications.”
Ayanian said insurance not only improves health outcomes, but is also cost effective: access to primary care keeps people in the workforce and helps avoid expensive emergency procedures.
“If people start to lose their coverage, we will then see both negative health effects, but also negative economic effects,” Ayanian said.
Also beginning on Oct. 1, the federal government will reduce its contribution to the Emergency Medicaid program, which reimburses hospitals for emergency care provided to patients who cannot afford treatment but are ineligible for Medicaid due to their immigration status. Hospitals are required to provide life-saving care regardless of a patient’s ability to pay.
Both the state and federal government contribute to Emergency Medicaid reimbursements. Under the new provision, the federal government will reduce its contribution, requiring states to pay a larger share. In Michigan, the federal contribution will drop from 90% of the cost to 65.7%. According to MDHHS, that reduction is anticipated to cost Michigan $5.5 million next year.
Broader changes to Medicaid enacted by the One Big Beautiful Bill Act are still to come.
In January, a new work requirement goes into place, affecting hundreds of thousands of Michiganders. With some exceptions, the new requirement will apply to people aged 19-64 who are enrolled under the state’s Medicaid Expansion. Eligibility checks will also occur more frequently.
MDHHS estimates 200,000 Michiganders could lose Medicaid coverage under next year's changes. The state of Michigan has designated nearly $300 million to mitigate reductions in Medicaid eligibility and address new federal requirements.
