The changes that are coming for Medicaid will affect immigrants in North Carolina differently depending on their immigration status, as some program users will lose coverage entirely.
These drastic changes As we have already reported, they arise with the approval of the Budget Reconciliation Package, or the tax reforms of President Trump’s “Big Beautiful Act” passed in July.
The North Carolina Department of Health and Human Services (NCDHHS) and immigration experts have been analyzing the impact this law will have on the immigrant community.
Currently, the Medicaid program provides affordable health coverage, access to doctors, and prescription drugs to more than 3 million children, seniors, people with disabilities, veterans, and workers in North Carolina. The program covers one in four people, as well as half of all births in the state.
However, an estimated 220,000 people in the state will lose their health coverage due to the changes to Medicaid, according to an analysis released in August by the Kaiser Family Foundation (KFF).
According to data According to NCDHHS, there are currently a total of 3,104,834 people enrolled in Medicaid in North Carolina, of which 44,177 are pregnant women, 569,600 are children, and 324,942 are Hispanic.
Changes from October 1, 2026
Although changes The changes coming for Medicaid are worrying for many users, both native and immigrant, but the truth is that these will not come into effect until within a year.
“The most important thing to know is that the Medicaid changes won’t go into effect until October 1, 2026, so no one’s Medicaid eligibility will change until then,” said attorney Kate Woomer-Deters of the North Carolina Justice Center. Enlace Latino NC .
There will be no changes for pregnant women and children.
The lawyer stressed that the second most important thing to know is that “There are no changes to Medicaid eligibility for pregnant women and children. ".
“Under current federal and North Carolina rules, pregnant women and children in all legal statuses except DACA are eligible for Medicaid,” Woomer-Deters emphasized.
The lawyer explained that this means that any legal status, including asylum seekers, U visa holders, TPS, H-2A visa holders, green cards, asylees, refugees, and all nonimmigrant visa holders, are eligible for Medicaid in North Carolina. if they are pregnant women or children , as their eligibility will not change in 2026.
Related: Where to get free or low-cost health care in North Carolina?
The changes that are coming for other immigrants
Under current law, before the upcoming changes, Medicaid for other adults (19 to 64 years old) is generally available to skilled immigrants, which are: green card holders, refugees, Cuban/Haitian entrants, victims of human trafficking (T visa) and people on parole for more than 1 year and other very small categories.
“Many of these people even have additional restrictions on Medicaid; some (but not all) have to wait five years to be eligible,” Woomer-Deters said.
Categories of immigrants who will be eligible for Medicaid
Only the following three categories of immigrants will be eligible for Medicaid (unless they are pregnant or children):
- Holders of green cards (must wait five years)
- COFA Migrants: Immigrants from the Marshall Islands, Micronesia, and Palau
- Cuban/Haitian starters.
All other categories that are currently eligible will no longer be eligible.
Related: How to apply for Medicaid in North Carolina?
What happens to mixed-status families?
The attorney noted that, for mixed-status families, Medicaid has unfortunately only recently begun to share data with immigration.
However, if undocumented members of a household that They do not apply for Medicaid for themselves (parents, guardians, only children or other family members), They do not have to provide any information about their immigration status .
“So that means Medicaid will know they exist and their names/addresses, but it won't know their immigration status,” the attorney explained.
According to Woomer-Deters, there could be many reasons why a person living with a Medicaid applicant might not apply for themselves, such as because they already have private insurance elsewhere, or perhaps they have a green card but aren't yet eligible for Medicaid, among other situations.
"So, for example, a parent who simply completes a Medicaid application for their child but doesn't apply for themselves, there's no proof that the person is undocumented. But, of course, it's still very concerning that agencies share data," he said.
But if an undocumented person who is on a child's Medicaid application has applied for any type of immigration benefit (such as asylum, a U visa, etc.), then the government already knows you exist and already knows your address, and there is no additional risk in eligible family members continuing to use Medicaid.
Related: Primary health care for undocumented immigrants in community clinics is at risk
Immigrants and Emergency Medicaid
An August update from NCDHHS indicates that anyone can apply for the Medicaid emergency medical coverage , regardless of their immigration status , although some requirements must be met, including age and income.
What does emergency Medicaid cover?
- Medical expenses for childbirth: The mother can apply for coverage up to three months after giving birth.
- Payment for emergency services: a heart attack, a stroke, a serious accident. The person can apply for coverage up to three months after the emergency.
What to do to get emergency coverage
The NCDHHS document explains that the person who is going to apply for emergency Medicaid must fill out a enforcement, which does not ask about immigration status, nor does it require showing immigration documents.
Town Hall on Medicaid Changes
NCDHHS will hold a virtual Medicaid Town Hall on Wednesday, September 24, from 6:00 p.m. to 7:00 p.m., to discuss “who is eligible for Medicaid, how the expansion supports the health of communities across the state, ways to apply for health coverage, and what you need to know about federal changes to the program.”
The informal chat will be streamed live on the NCDHHS Facebook, X (Twitter) and YouTube accounts, where viewers can submit questions.
The event also includes a "tele-town," inviting callers to listen and submit questions. Callers can dial into the event by calling 855-756-7520, ext. 126224.
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