New Medicaid Regulations Impact Non-Citizens and Emergency Care Funding
As of October 1, significant changes to Medicaid coverage for non-citizens are being implemented, part of a broader legislative agenda passed last year by Republicans under the One Big Beautiful Bill Act. These modifications have stirred concerns among healthcare professionals and affected communities.
The first major change involves a reduction in federal reimbursements for emergency care provided to uninsured immigrants. The second change revokes Medicaid eligibility for certain lawfully present non-citizens. As outlined by the Michigan Department of Health and Human Services (MDHHS), non-citizen Medicaid coverage will now be restricted to lawful permanent residents, certain migrants from specific nations, and individuals who are pregnant or under 21.
Those losing eligibility include refugees, asylum seekers, victims of trafficking, and individuals with pending applications for temporary admission. According to MDHHS, over 5,000 people in Michigan may lose their coverage due to these changes.
Dr. John Ayanian, director of the Institute for Healthcare Policy and Innovation at the University of Michigan, highlighted the potential fallout: “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 stated. He emphasized that lack of insurance could lead to increased emergency room visits and higher costs.
The new regulations are also affecting the Emergency Medicaid program, which provides reimbursement to hospitals for essential care given to those who cannot pay and are ineligible for standard Medicaid. The federal government will now contribute less to this program, dropping from 90% to 65.7% in Michigan, potentially costing the state an estimated $5.5 million next year.
Looking ahead, additional Medicaid changes are set to take place. Starting in January, a new work requirement will be enacted, which is expected to impact hundreds of thousands of Michiganders. This requirement will apply to those aged 19-64 enrolled under the state’s Medicaid Expansion, with certain exceptions. More frequent eligibility checks are also anticipated.
The MDHHS projects that 200,000 individuals in Michigan might lose Medicaid coverage due to next year’s changes. In response, nearly $300 million has been designated by the state to mitigate the impacts of these federal changes and support continued access to healthcare.
For more information on these Medicaid changes, visit the non-citizen Medicaid eligibility page. Details on the upcoming work requirements can be found here, and information on how the state is addressing healthcare costs is available here.
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