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As the administration escalates its war on immigrants, beyond the front-line horrors and violence lies another threat: a slew of new health care policies that advocates say will leave millions more immigrants uninsured and unable to seek medical care.

President Donald Trump’s signature bill, H.R. 1, which passed last summer, further restricts which legal immigrants are eligible for public benefits and Affordable Care Act (ACA) plans and subsidies, and includes other cuts that are set to go into effect over the next year. His administration has also ratcheted up fears around immigrants using public benefits, allowed the presence of Immigration and Customs Enforcement (ICE) agents in sensitive locations such as hospitals, and now requires the Centers for Medicare and Medicaid Services to share some enrollment data with the Department of Homeland Security (DHS). 

Immigrant and health care advocates fear that the government’s actions, which add a risk to interacting with any government services, could discourage immigrants from seeking needed care and lead to negative health outcomes. 

The Trump administration’s actions deepen existing barriers to immigrants receiving health care, which have long kept undocumented people from enrolling in any federal government health care plan and have imposed yearslong waiting periods for many visa holders to become eligible for Medicaid, Medicare, and the Children’s Health Insurance Program (CHIP). 

With less access to preventive care, advocates say  immigrants will become more reliant on already overburdened safety-net hospitals, which also faces cuts as a result of the bill. 

Eligibility restrictions

Beginning in October, immigrant groups, including refugees, asylees, victims of trafficking and domestic violence, and most recipients of Temporary Protected Status, will become ineligible for Medicaid, according to Ben D’Avanzo, an expert in health care access at the National Immigration Law Center. Eligibility for Medicare, which covers adults 65 and over, will also be restricted over the next 18 months.

“The immigrants under attack now include not only undocumented immigrants, but immigrants that have historically had strong bipartisan support,” D’Avanzo said. 

Once in effect, the only immigrants eligible for Medicaid, CHIP, and Medicare would include legal permanent residents after a five-year waiting period, certain immigrants from Cuba and Haiti, and those from the few small nations that have a Compact of Free Association agreement with the U.S. The Congressional Budget Office estimates that these coverage restrictions will lead to 1.4 million legal permanent residents becoming uninsured by 2034. 

The ACA also imposes new eligibility restrictions and reduces access to premium tax credits, disqualifying some 300,000 lawfully present immigrants from health insurance coverage during last fall’s open enrollment period, according to the National Immigrant Law Center.  

“A variety of people who are here working with legal authorization and are now without any sort of pathway to affordable health care,” D’Avanzo said.

These policy changes, which have staggered implementation dates, have caused confusion and anxiety for advocates and immigrant communities, Celia Valdez, the executive director of Maternal and Child Health Access in Los Angeles, told Prism. 

California is among the handful of states that allow undocumented immigrants to sign up for Medicaid, CHIP, and Medicare, but due to budget cuts is also cutting its program so that most new adult applicants will only be able to enroll in restricted insurance that only covers emergencies, Valdez said. 

In addition, Medicaid and Medicare cuts that go into effect at the end of 2026 will impose work requirements that may be difficult for some immigrants to prove, especially those who get paid in cash and must fill out complex paperwork verifying their income, according to Valdez.

Meanwhile, funding for care navigators, who help people parse the health insurance system and sign up for plans, as well as language access resources, has been slashed, which will disproportionately impact immigrants with limited English proficiency. 

Public charge changes sow fears

Changes to immigration policy that limit who is able to get a green card could further impact immigrants’ access to health care benefits. 

In deciding whether to issue someone a visa to live in the U.S., the government has long considered whether that person could become a “public charge,” or “primarily dependent on the government for subsistence.” But the Trump administration broadened that definition in November. 

“We’re very concerned that it will be very easy to use these public charge rules to deny immigration status to people who the administration deems undesirable, whether it’s the country you’re from or the disease you have,” D’Avanzo said. 

Refugees, asylees, Cubans, Haitians, and certain other humanitarian groups will no longer be exempt from consideration as a public charge. Consular officers have even been instructed to consider factors such as age and obesity in disqualifying an applicant, reported KFF. 

In early January, DHS based its recent visa ban on the claim that the 75 countries it targeted were at high risk of straining government welfare programs, even though immigrants use public benefits at a far lower rate than native-born Americans and pay more taxes into government programs than they take.

The new rule acknowledges that dissuading immigrants from using public benefits could lead to “worse health outcomes,” “increased rates of uncompensated care,” and “increased poverty, housing instability, reduced productivity, and lower educational attainment.”

For immigrants with chronic health conditions or disabilities, the consequences of the rule change could be even more dire. Many of Valdez’s clients “don’t really have a choice right now unless they completely forego care,” she said, including new or expectant parents.

For those who rely on Medicaid and Medicare to pay for in-home care aides, going without that assistance would be “life-threatening,” Valdez said. 

According to KFF, 11% of immigrant adults surveyed in the fall of 2025 said they had stopped participating in a government program that helps pay for food, housing, or health care due to immigration-related fears, up from 2023, when the Biden administration had loosened public charge rules. 

Is it safe to seek care? 

At the same time, a new data-sharing agreement between the Centers for Medicare and Medicaid Services and ICE has made immigrants even more fearful of giving over their information to sign up for benefits.

“The government has told people for years that their data is safe, that their use of public benefits data and application data … will only ever be used for the purposes of determining their eligibility,” D’Avanzo said. With this policy change, the administration “betrayed many years of trust.” 

According to Valdez, “We can’t really tell people it’s completely safe” to sign up for benefits. At the same time, “we wouldn’t want people to drop their benefits because we know their needs.”

Drishti Pillai, the director of immigrant health policy at the think tank KFF, said some immigrants are not seeking care out of fear, unless they “feel like they are dying.”

Valdez said this has resulted in many clients reporting untreated high blood pressure and diabetes, as well as dental emergencies. Some are afraid to leave their houses, go to doctors’ appointments, or pick up prescriptions due to ICE raids.

There are myriad examples of the sometimes fatal consequences of immigrants avoiding health care for fear of deportation, including among care workers themselves. 

The message from the Trump administration’s policies is clear, D’Avanzo said: “We are in this world where no immigrant is supposed to feel welcome.”

Editorial Team:
Sahar Fatima, Lead Editor
Carolyn Copeland, Top Editor
Stephanie Harris, Copy Editor