Medicaid and Marketplace subsidy changes for people without a green card: primary sources

Verified September 17, 2026. Official documents only: the statute, CMS letters to states, HHS rules, IRS guidance. No summaries and no advice here — just where each rule is written, when it takes effect, and how to verify it yourself.

To see what is available in a specific state after these dates: https://map.insur.live — state by state, no registration. The map makes no recommendations; it only shows what exists where.

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1. The Law

Public Law 119-21, signed July 4, 2025. It moved through Congress as H.R. 1, 119th Congress. In CMS documents it is called the "Working Families Tax Cut" (WFTC) legislation — searching medicaid.gov for "H.R. 1" may return nothing; search for "WFTC" or the section number instead.

Full text and legislative history: congress.gov → H.R.1, 119th Congress → Text.

Congressional Research Service overview of the subsidy changes, including the return of the 400% FPL cap: https://www.congress.gov/crs-product/R48290

The sections discussed below:

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✓ Public Law 119-21 (H.R. 1, 119th Congress) — statute text · 2025 — reviewed 2026-09-17

2. Medicaid and CHIP — from October 1, 2026 (§71109)

What the rule says

Beginning October 1, 2026, federal financial participation (FFP) for full Medicaid and CHIP benefits is available only to those who are "FFP-eligible non-citizens" or who fall within the exceptions in §1903(v)(5) of the Social Security Act. FFP-eligible non-citizens are three groups: lawful permanent residents (green card holders), Cuban/Haitian entrants, and Compact of Free Association (COFA) migrants.

For other "qualified non-citizens" — refugees, asylees, parolees, victims of trafficking — federal funding for full Medicaid ends October 1, 2026, unless the person also holds one of the statuses above.

Separately: states that elected the CHIPRA 214 option retain coverage for lawfully residing children and pregnant individuals, including refugees, asylees, and other humanitarian categories.

Emergency Medicaid remains a separate track; §71110 changes the federal matching rate, not the existence of the coverage.

Where it is written

CMS State Health Official letter SHO #26-001, dated April 8, 2026 — the operative document states are using to redetermine cases and issue termination notices: https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf

Appendix A of that letter contains a table covering every "qualified non-citizen" status: availability of FFP for full Medicaid and CHIP before and after October 1, 2026, plus emergency Medicaid separately. This is the most direct way to check a specific category.

CMS presentations on the same provision (shorter than the letter, same source): https://www.medicaid.gov/medicaid/downloads/alien-elgblty-section-71109-deck.pdf https://www.medicaid.gov/medicaid/downloads/impl-alien-elg-section-71109-wftc-deck.pdf

The second deck addresses SSI recipients specifically: SSI recipients who are qualified non-citizens but not FFP-eligible generally will not qualify for full Medicaid benefits on and after October 1, 2026; the exception is children and pregnant women in CHIPRA 214 states.

CMS informational bulletin of November 18, 2025 on §71110 (emergency Medicaid funding): https://www.medicaid.gov/federal-policy-guidance/downloads/cib11182025.pdf

CMS implementation guide for state plan amendments: https://www.medicaid.gov/resources-for-states/downloads/macpro-ig-citizenship-and-non-citizen-eligibility.pdf

How to verify it yourself

1. Open SHO #26-001, Appendix A, and locate the status in the table.
2. The termination notice comes from the state, not from the federal government. It contains the individual termination date and the instructions for submitting documents. States must redetermine eligibility and give advance notice before terminating coverage.
3. If the state cannot verify a status through its data sources, there is a period during which the person may supply documentation before an adverse action is taken.

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3. Marketplace Subsidies (§71301, §71302, §71303, §71305)

What the rules say

Three separate provisions with three separate dates:

From January 1, 2026 (§71302). Lawfully present non-citizens with income below 100% of the federal poverty level who are Medicaid-ineligible because of immigration status no longer receive the marketplace premium tax credit. An exception previously applied to this group.

Through December 31, 2026. Lawfully present non-citizens with income at or above 100% FPL remain eligible for the premium tax credit and cost-sharing reductions for plan year 2026.

From January 1, 2027 (§71301). The premium tax credit is allowed for the coverage of a lawfully present non-citizen only if that person is an "eligible alien" — the same three groups as in Medicaid: LPRs, Cuban/Haitian entrants, COFA migrants. Marketplace plans remain available to all lawfully present people, but without the federal subsidy.

Separately, applying to everyone and not only to non-citizens (§71305 and the expiration of the temporary rules). Beginning with tax year 2026, the cap on repayment of excess advance premium tax credit is repealed — the entire difference between estimated and actual income comes back. At the same time, the 400% FPL upper income limit for credit eligibility returned on January 1, 2026, because the temporary 2021–2025 expansion was not extended.

Where it is written

HHS final rule, "Notice of Benefit and Payment Parameters for 2027," Federal Register, May 20, 2026 — it quotes §71301, §71302, and §71303 with their effective dates: https://www.federalregister.gov/documents/2026/05/20/2026-10050/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2027-and

The same rule as a PDF on cms.gov — it describes how Exchanges will verify "eligible alien" status for plan years beginning on or after January 1, 2027 (new definition at §155.20, changes at §155.305(f)(1) and §155.320): https://www.cms.gov/files/document/cms-9883-f-patient-protection.pdf

IRS Fact Sheet FS-2025-10, December 23, 2025 — premium tax credit questions and answers updated for the statute, including the removal of the repayment cap for tax years beginning after December 31, 2025: https://www.eitc.irs.gov/pub/taxpros/fs-2025-10.pdf

IRS news release IR-2025-127 announcing that fact sheet: https://www.irs.gov/node/153736

Congressional Budget Office analysis of the law's marketplace effects, August 2025: https://www.cbo.gov/system/files/2025-08/61506-marketplace.pdf

How to verify it yourself

1. Subsidy eligibility runs by plan year, not by application date. A 2026 plan operates under 2026 rules through December 31, 2026.
2. The 100% FPL threshold for 2026 coverage uses the 2025 HHS poverty guidelines, by tax household size.
3. Loss of Medicaid is a qualifying event that opens a special enrollment period outside the annual window. Open enrollment for plan year 2027 begins November 1, 2026.

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4. Official State and County Materials (examples)

States and local agencies publish their own guidance on the same law. Examples of official pages:

Colorado Department of Health Care Policy and Financing: https://hcpf.colorado.gov/hr1-key-changes

King County, Washington — page in Ukrainian: https://kingcounty.gov/uk-ua/dept/dph/health-safety/health-centers-programs-services/health-insurance/hr1-bill-changes

Michigan Department of Health and Human Services, bulletin MMP 26-34 on implementing §71109: https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Assistance-Programs/Medicaid-BPHASA/2026-Bulletins/Final-Bulletin-MMP-26-34-Eligibility.pdf

For any other state, search the state Medicaid agency site for "H.R. 1," "WFTC," "section 71109," or "noncitizen eligibility."

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5. Timeline

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To see what is available in your state: https://map.insur.live

This material is informational and is not legal, tax, or insurance advice. All links point to official sources; verify currency — these documents are updated.

✓ Public Law 119-21 (H.R. 1, 119th Congress) — statute text · 2025 — reviewed 2026-09-17