Tens of thousands of refugees, victims of human trafficking and domestic violence, and others who legally immigrated to Pennsylvania and New Jersey will lose Medicaid coverage next fall, when new eligibility rules established under President Donald Trump’s signature “big beautiful bill” take effect.

Currently, people with certain legal immigration statuses can qualify for Medicaid, the publicly funded health care program for low-income families and people with disabilities.

But beginning October 2026, only legal permanent residents, and immigrants from Cuba, Haiti and certain Pacific Island countries will continue to be covered. All others — including individuals granted asylum and those who are temporary humanitarian parolees — will no longer be eligible for Medicaid.

New Jersey’s Department of Human Services estimates that between 15,000 and 25,000 immigrants with legal status will lose coverage.

Pennsylvania’s Department of Human Services isn’t sure yet how many of the 150,000 noncitizen immigrants with legal status who are covered by Medicaid will be dropped. Administrators will need to manually parse out who remains eligible and who will lose coverage, sometimes requiring them to dig deep into notes added to files during their initial enrollment.

Republicans who championed the legislation say the changes will ensure public resources go to those in greatest need.

But public health officials and advocates say the move unfairly penalizes immigrants who have taken every necessary step to enter the country legally. Many are on a path to permanent residency or citizenship and have been living in the United States for years, with full-time jobs and families.

Pennsylvania’s Department of Health said stripping coverage for thousands of immigrants poses a “serious public health risk” for families who will lose access to important health services, such as prenatal care.

Chilling effect on health care

Advocates worry that the Trump administration’s focus on deportations will have a chilling effect on health care access, even for immigrants who remain eligible for public programs, said Colleen McCauley, policy and advocacy director at Camden Coalition, a nonprofit healthcare advocacy group.

She worries families that will forgo medical care out of fear that disclosing personal information could make them a target for immigration officials.

“It’s pretty devastating for parents to have to make a decision about how easy or hard it’s going to be to access health care for their kids, balanced with their ability to stay here in their community,” she said.

New Jersey is among a handful of states that allows all children — including undocumented immigrant children — to enroll in Medicaid. (Early versions of the federal legislation would have slashed federal funding for states like New Jersey, but the provision did not make it into the final version.) Pennsylvania’s Medicaid program does not cover undocumented immigrants.

U.S. Immigration and Customs Enforcement officials have sought access to data from Medicaid and food assistance programs as part of its effort to ramp up deportations.

Raids have not targeted immigrants that have legal status, but have made people hesitant to seek health services, especially as health care facilities are no longer protected from ICE raids.

Next steps for states

For now, state officials are urging people who currently are enrolled in Medicaid to continue using their health plan while they can.

Pennsylvania and New Jersey officials are working with advocacy groups and community organizations to communicate changes as they get more information.

Pennsylvania officials said they are awaiting more guidance from the federal government on new rules that will require some people with Medicaid to report their work hours every month and renew their coverage every six months.

In New Jersey, stakeholders are looking ahead at what policy maneuvers can minimize the number of people who could lose coverage. Most of the decline in Medicaid enrollment is expected to come from people who lose coverage because they’re unable to navigate the complex new reporting requirements — not because they aren’t working enough or otherwise aren’t eligible.

New Jersey could consider a buy-in program to Medicaid-like coverage for people who can’t afford a private health plan through the state’s Obamacare marketplace, but who are also no longer able to be covered under Medicaid, said Laura Waddell, health care program director for NJ Citizen Action, which helps people enroll in coverage.

Lawmakers could also codify a health care cost transparency and affordability office, tasked with trying to tamp down rising health care costs, she said.

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