Florida Leads Nation as New Federal Rules Strip Medicaid From Refugees and Other Legal Immigrants

Florida is absorbing the largest share of a nationwide Medicaid cutoff for refugees, asylees and other lawfully present immigrants that took effect Oct. 1 under the 2025 federal tax and spending law, with state officials identifying nearly 177,000 people who no longer qualify, more than any other state.

The Florida figure comes from a Florida Department of Children and Families spokesperson, according to KFF Health News, which tallied more than 281,000 immigrants expected to lose Medicaid across nine states and the District of Columbia. The Associated Press reported Saturday that the change has stripped coverage from hundreds of thousands of legal immigrants nationwide, including refugees, asylum seekers and survivors of human trafficking and domestic violence.

Who lost coverage and who kept it

The law, signed by President Donald Trump in July 2025, narrows federally funded Medicaid and the Children's Health Insurance Program to a short list of noncitizen groups. Since Oct. 1, eligible noncitizens are limited to:

• Lawful permanent residents, or green card holders
• Cuban and Haitian entrants
• People living in the U.S. under the Compacts of Free Association with the Marshall Islands, Micronesia and Palau

Refugees, asylees and humanitarian parolees, including trafficking and domestic violence survivors, no longer qualify unless they also fit one of those categories, according to Central Florida Public Media and state notices. Green card holders were not affected, the AP reported. Emergency Medicaid, which covers emergency care but not routine visits or most prescriptions, remains available to otherwise eligible noncitizens.

The Cuban and Haitian entrant carve-out matters more in Florida than almost anywhere else, given the state's large Cuban and Haitian communities. Immigrants from other countries who arrived through humanitarian parole or as refugees, and who have not yet obtained green cards, fall outside the protected list.

How Florida carried out the change

In Florida, DCF determines Medicaid eligibility. The agency checked enrollees' immigration status against government databases and, in August, mailed letters to noncitizen beneficiaries it could not verify, asking for documents showing they still qualified, according to WUSF and Central Florida Public Media. Coverage ended for those who did not respond or could not show eligibility at the end of September.

DCF's website lists about 193,000 refugees who used federal services, including Medicaid, in Florida in 2025, a broader measure than the number losing coverage. State counts gathered by KFF Health News are initial estimates; final figures on how many enrollees were actually terminated are not expected until later this fall.

The state has said lawfully residing children 18 and younger remain eligible under a 2009 federal option known as CHIPRA. Some families reported that their children received termination notices anyway, and DCF said it was looking into those cases, Central Florida Public Media reported. The protection is not universal: in Arizona, even children were cut, KJZZ reported.

Florida has not announced any state-funded replacement coverage for those who lost Medicaid.

Florida compared with other states

State estimates gathered by KFF Health News and cited by the AP show Florida's count far ahead of other states that reported numbers:

The state counts run well above federal projections. The Congressional Budget Office estimated the immigrant eligibility changes would cut federal spending by $6.2 billion and leave about 100,000 more people uninsured by 2034.

The administration's case

The immigrant restrictions are a small part of the law's broader Medicaid changes, which the CBO projected in 2025 would leave 7.5 million fewer people with health insurance. KFF has estimated federal Medicaid spending will fall by $911 billion. Many of the law's other Medicaid provisions take effect early next year.

White House spokesperson Lauren Bis told the AP that immigrants must be able to support themselves without drawing on overburdened benefit programs. Steven Camarota of the Center for Immigration Studies, which favors lower immigration, told the AP the administration is trying to nibble around the edges.

Concerns from Florida health advocates

Florida health advocates worry that eligible people will be swept out along with those who no longer qualify. During the 2023 Medicaid unwinding, about 58% of Florida's terminations were for procedural reasons, such as outdated addresses or missed paperwork, according to KFF.

Katie Roders Turner, executive director of the Family Healthcare Foundation, told Central Florida Public Media the process creates "an opportunity for something to get missed." Scott Darius, executive director of Florida Voices for Health, said fear is keeping many immigrant families from seeking care they need. The AP noted the administration has also revived a federal rule that could deny green cards to immigrants who use public benefits.

Federally funded community health centers will continue to see patients regardless of insurance status, charging on a sliding scale based on income. National groups that partner with clinics told the AP they do not have the capacity to absorb everyone losing coverage.

More changes coming in January

The Medicaid cutoff is the first of several eligibility restrictions in the 2025 law. Lawfully present immigrants with incomes below the federal poverty line already lost Affordable Care Act premium tax credits on Jan. 1, 2026. Starting Jan. 1, 2027, those credits will be limited to the same short list of groups that keep Medicaid, according to Georgetown University's Center for Children and Families, which could leave refugees and asylees without subsidized marketplace coverage as well.

Medicare is also affected. Current Medicare enrollees who fall outside the qualifying categories face termination of their coverage in early January 2027, according to the advocacy group Justice in Aging.

What's next

Floridians who received a termination notice and believe they still qualify, including green card holders, Cuban and Haitian entrants and lawfully residing children, can submit documentation to DCF showing their status. Final state counts of how many Floridians were removed are expected later this fall, and the January changes to marketplace subsidies and Medicare will widen the effects of the law in 2027.