Refugees, asylees and several other groups of lawfully present immigrants in Maryland lost standard Medicaid eligibility when new federal rules took effect October 1. The state health department estimates about 15,000 non-citizens may lose coverage, according to its September 9 H.R. 1 update. That is down sharply from an earlier published estimate of about 60,000.
Which immigration statuses lost Medicaid?
Maryland’s Department of Human Services, which runs eligibility, spelled out the list in an Action Transmittal issued October 5. Statuses no longer eligible include asylees, refugees, parolees, conditional entrants, battered immigrants under the Violence Against Women Act and victims of trafficking. Ukrainian and Afghan humanitarian parolees and certain Amerasians are on the list too.
The change comes from Section 71109 of the federal law signed July 4, 2025. It narrows adult Medicaid to a short list of immigration categories, and the memo is titled as a modification to the qualified immigrant statuses that Maryland Medicaid recognizes. Pregnant women and children are the main carve-outs. The memo says coverage for previously qualified non-citizens who no longer fit ended September 30, 2026.
Notices went out under the memo’s instructions. It says termination letters state that benefits end 09/30/2026, and active cases that fall outside the new rules close automatically in the state’s eligibility system. Applications and late renewals sent on or after October 1 are denied if the person does not meet the criteria.
Who keeps coverage under the new list
The state says adult eligibility is now limited to U.S. citizens and nationals and a handful of immigrant groups. Lawful permanent residents keep Medicaid if they have met the five-year waiting period or are exempt from it. Cuban and Haitian entrants and migrants from the Compact of Free Association nations, which include the Marshall Islands, Micronesia and Palau, are also covered with no wait.
The memo adds that lawful permanent residents who adjusted from refugee, asylee or Cuban or Haitian entrant status skip the five-year wait. So do certain veterans, active-duty service members and their qualifying family members. Special Immigrant Visa holders are exempt from the waiting period as well.
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Children and pregnant women are treated differently. The health department’s deck says pregnant women and children are not affected, and the DHS memo keeps coverage for lawfully present pregnant women and children under 21. Emergency Medicaid is not affected either.
Why the estimate fell from 60,000 to 15,000
The September deck says only that the figure is a reduction from the previously published estimate of about 60,000. It gives no breakdown by status or county, and it does not say what drove the smaller number. A May presentation to the Maryland Health Benefit Exchange board used the same 15,000 figure.
The state’s cost notice shows what is at stake in dollars. A public notice released September 24 projects savings of $30,619,190 in total funds in state fiscal year 2027, made up of $10,447,759 in state general funds and $20,171,431 in federal funds. The notice does not say how many people that assumes.
That savings figure and the 15,000 estimate describe the same cutoff from two sides. For the state budget it is a reduction. For a household, it can mean a doctor visit, a prescription or a hospital stay that no longer has coverage behind it.
The health department says it built targeted materials for non-citizens and updates translated versions regularly. Its deck says focus groups found that many members fear Medicaid is being eliminated entirely, so the messages stress that only some people are affected. The timeline slide marks October 2026 as the month some groups move off standard programs.
What happens next for someone whose coverage ended?
The DHS memo says every person gets notice of appeal rights in the denial letter, with fair hearings handled under an earlier transmittal, AT 24-23. The memo does not give a filing deadline. The letter itself is the place to find the date.
Immigration status must be verified through the federal SAVE system at application, at a change in circumstances and at renewal. If status cannot be confirmed electronically, the person gets a reasonable period to provide information before action is taken. A person who submits new status information that still cannot be verified gets a 90-day reasonable opportunity period.
Some people who do not qualify may be enrolled in Refugee Medical Assistance if they are within the refugee eligibility period and meet income and status requirements. Emergency Medicaid remains available, though it must be applied for after each emergency event. The state’s Maryland Health Connection site says federal changes to Medicaid and marketplace eligibility are coming and links to its immigrant families section.
Which of those paths fits depends on a status that only the notice and a caseworker can confirm. With coverage already ended for some and appeals open for others, the question is which letter, and which date on it, applies to the household.
Did a Maryland Medicaid termination letter arrive this month?
A household that received an October termination notice has to find the appeal language, the date and the status listed in the memo before it can act. Missing that date can leave a family without coverage after the cutoff.
The SNAP & Medicaid Renewal Organizer includes the 90-day window after coverage is dropped, a renewal document checklist and a renewal and reporting calendar. Its Maryland state pack is one of 51 in the kit.
Sort termination letters and reply dates with the Medicaid renewal organizer kit →
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
