Upcoming Changes to Medicaid and Medicare
What's Happening to Medicare and Medicaid?
What's Happening to Medicare and Medicaid?
There are changes happening this year and after that may affect your health insurance coverage. Please see below for upcoming changes to Medicaid and Medicare.
Medicare Changes
Medicare is a health insurance program for people who are elderly and disabled.
As of July 4, 2025, the federal government has put new limitations on who can apply for Medicare. Only U.S. citizens, lawful permanent residents (green card holders), Cuban/Haitian entrants, or Compact of Free Association (COFA) migrants will be able to file new applications for Medicare.
This means that immigrants granted official humanitarian protections, including refugees, asylees, and trafficking survivors (such as T Visa holders), will not be able to apply if they do not already have Medicare.
Anyone already enrolled in Medicare as of July 4, 2025, will be able to stay enrolled for now assuming they meet all non-immigration-related eligibility criteria, but anyone who is not a U.S. citizen or in one of the more limited immigrant categories will be kicked off Medicare in January 2027.
Medicaid Changes
Medicaid provides health insurance for adults and children with low income.
Many Immigration Statuses Will Now Be Ineligible
Starting October 1, 2026, only the following immigration statuses will be eligible for Medicaid:
- U.S. citizens
- Lawful permanent residents (green-card holders)
- Cuban and Haitian entrants
- Compact of Free Association (COFA) migrants
This means that some immigrants granted official humanitarian protections, including refugees, asylees, and trafficking survivors (such as T Visa holders), will no longer be eligible for Medicaid starting October 1, 2026.
Medicaid Recipients Over a Certain Income Will Be Moved Off Medicaid
Starting January 1, 2026, some adults (those without children and parent/caretaker relatives) earning over 138% of the Federal Poverty Level ($1,800 for a household of one) will no longer be eligible for Medicaid in DC.
The District provides that everyone between 138% and 200% of the Federal Poverty Level (for a single person, with monthly income between $1,800 and $2,608) who is moved off of Medicaid will be automatically enrolled in the District’s new Basic Health Program, or BHP, which will provide more limited health insurance coverage.
Anyone with monthly income over 200% of the Federal Poverty Level (more than $2,608 per month for a single person) will not be eligible for the BHP and will need to apply for coverage on the Health Benefit Exchange.
DHS and/or DHCF should send more detailed information to all Medicaid recipients about these changes and how they will apply to you before they go into effect.
Future Medicaid Changes
Starting January 1, 2027, some Medicaid applicants and/or enrollees:
- Will have to recertify every six months instead of once a year.
- Will have retroactive coverage cut from 90 days to just 30 or 60.
- Will be subject to work requirements, generally 20 hours per week of work or community service, for enrollees aged 19 to 64. Some people will be excluded from this requirement, including:
- Caretakers for children 13 and under
- Caretakers for individuals with disabilities
- Pregnant individuals
- People with disabilities
Starting October 1, 2028, some low-income Medicaid enrollees may be required to pay a $35 copay per service.
DHS and/or DHCF should send more detailed information to all Medicaid recipients about these changes and how they will apply to you before they go into effect, and Legal Aid will share updated information before these changes occur.