If someone in your family came to Houston as a refugee or was granted asylum, Texas Medicaid or CHIP may have been one of the first things that felt settled here. A card in the wallet. A pediatrician in Alief or Gulfton who knows your children by name. Now you may be hearing that this coverage ends on October 1, and a group chat is a hard place to learn what that means for your family.
This guide slows it down. A federal law changes who Medicaid and CHIP can pay for, starting October 1, 2026. It does not affect every immigrant, and in Texas it does not affect every person in a household the same way. Some family members will keep their coverage. Some will need a new plan. And for a few, acting before the date instead of after it will make a real difference.
The short answer. Section 71109 of Public Law 119-21, the 2025 budget reconciliation law, limits federal funding for full Medicaid and CHIP, beginning October 1, 2026, to U.S. citizens and nationals, lawful permanent residents, Cuban and Haitian entrants, and COFA migrants. Refugees, asylees, parolees, people granted withholding of removal, and certain survivors of trafficking or domestic violence lose that funding unless they also hold a qualifying status, most often a green card. Texas has elected a federal option for lawfully residing children, so a refugee or asylee child under 19 can keep Medicaid or CHIP if the child meets the other rules. Adults, including pregnant adults, do not have that protection. Emergency Medicaid continues, and losing coverage opens a Marketplace enrollment window.
- Four groups keep federal funding for full Medicaid and CHIP after October 1, 2026: citizens and nationals, green-card holders, Cuban and Haitian entrants, and COFA migrants.
- Refugees, asylees, parolees, and certain survivors of trafficking or domestic violence are affected unless they have adjusted to a green card or hold another qualifying status.
- Texas covers lawfully residing children in CHIP and in Medicaid up to age 19 through the CHIPRA 214 option. It has not elected that option for pregnant women.
- Coverage should not switch off without warning. The state must re-check each case, look for other ways a person qualifies, and send advance written notice.
- Losing Medicaid or CHIP opens a Marketplace Special Enrollment Period. For the rest of 2026, a lawfully present person with income at or above 100% of the poverty level may still get a premium tax credit.
- January 1, 2027 brings a second change, to the premium tax credit. Open Enrollment for 2027 runs November 1, 2026 through January 15, 2027.
What this guide covers
- What changes on October 1, 2026
- Who keeps full Medicaid and CHIP
- What Texas’s choices mean for your family
- How the review and notice work
- Why this matters in Houston
- Your Marketplace option for the rest of 2026
- Refugee Medical Assistance and emergency Medicaid
- What changes on January 1, 2027
- Other options after January 1, 2027
- A practical checklist
- Frequently asked questions
What changes on October 1, 2026?
Medicaid and CHIP are paid for jointly by the federal government and the states. Section 71109 tells the federal government which noncitizens it may help pay for, and that shapes who the programs can cover.
CMS explained how states must carry it out in State Health Official Letter #26-001, issued April 8, 2026. Beginning October 1, federal matching funds for full Medicaid and CHIP benefits are limited, with narrow exceptions, to U.S. citizens and nationals, lawful permanent residents, Cuban and Haitian entrants, and COFA migrants — citizens of Micronesia, the Marshall Islands, or Palau who live in the U.S. under their countries’ compacts. CMS also wrote that it “will not require states to provide state-only funded health coverage” to the groups losing federal funding. For most families, then, the real question is whether each person in the household still fits one of the recognized categories.
Three exceptions survive: emergency Medicaid, coverage under the CHIPRA 214 option in states that chose it, and certain CHIP health services initiatives. The Congressional Research Service confirms that the provision “does not apply to individuals eligible under emergency Medicaid and those eligible through the Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Women state plan option.”
Who keeps full Medicaid and CHIP, and who does not
CMS’s letter includes a status-by-status table. Here is a plain-language version of the main rows.
| Status | Full Medicaid or CHIP before Oct 1, 2026 | Federal funding for full benefits starting Oct 1, 2026 | Emergency Medicaid |
|---|---|---|---|
| U.S. citizen or U.S. national | Yes | Yes | Not needed |
| Green-card holder who has met or is exempt from the five-year wait | Yes | Yes | Not needed |
| Green-card holder still in the five-year wait | No | No | Yes |
| Cuban or Haitian entrant | Yes | Yes | Not needed |
| COFA migrant (Micronesia, Marshall Islands, Palau) | Yes | Yes | Not needed |
| Refugee | Yes | No | Yes |
| Person granted asylum | Yes | No | Yes |
| Paroled into the U.S. for at least one year, including certain Afghan and Ukrainian parolees | Yes | No | Yes |
| Granted withholding of deportation or removal | Yes | No | Yes |
| Survivor of trafficking with qualifying status or a qualifying pending application | Yes | No | Yes |
| Survivor of battery or extreme cruelty by a U.S. citizen or green-card-holder relative | Yes | No | Yes |
| Lawfully residing veterans, active-duty service members, and certain family members | Yes | No | Yes |
Adapted from Appendix A of CMS SHO #26-001. Emergency Medicaid assumes the person meets Medicaid’s other rules, such as income and Texas residency. The table leaves out the CHIPRA 214 option, which changes the answer for many Houston children.
The “unless” matters as much as the list. CMS says funding ends for groups such as “asylees, refugees, parolees, or victims of trafficking” unless they have “another immigration status or category” that qualifies. The most common example is a refugee or asylee who has already become a lawful permanent resident; the CRS notes that “asylees and refugees may become lawful permanent residents after one year in refugee or asylee status.”
If you already have a green card
Green-card holders usually face a five-year wait before full Medicaid or CHIP, but people who entered as refugees or were granted asylum are exempt from it. According to the April 2026 FAQ from State Health and Value Strategies, refugees and asylees who adjust keep that exemption and should be able to get Medicaid or CHIP as soon as they adjust, if they meet the other rules.
What Texas’s choices mean for your family
Federal law lets each state cover children and pregnant women who are “lawfully residing” in the U.S. without a five-year wait, usually called the CHIPRA 214 option. CMS confirms that refugees count as lawfully residing for this option, and that a state that elected it “would maintain full Medicaid or CHIP benefits” for those enrollees after October 1.
Texas took that option for children. The Medicaid.gov state list, updated April 2, 2026, shows Texas covering lawfully residing children in CHIP and in Medicaid, with Medicaid coverage “up to age 19.” KFF’s state tracker, as of January 2026, agrees, and shows that Texas does not do the same for pregnant women.
Children under 19
A refugee or asylee child under 19 who meets Texas’s income and other rules can stay on Medicaid or CHIP after October 1. The state may still send a letter, sometimes just to confirm that coverage continues. Answer it anyway. Our guide to kids’ health coverage in Harris County explains which program fits which age and income.
Young people turning 19
Texas’s CHIPRA 214 coverage in Medicaid is listed up to age 19, so a refugee or asylee who turns 19 is looked at under the adult rules. Plan for that birthday the way you would for any other coverage change.
Pregnant adults
A pregnant refugee or asylee adult without a green card or another qualifying status is expected to lose full Medicaid after the state reviews her case. Emergency Medicaid, which the CRS says covers emergency conditions “including emergency labor and delivery,” remains for people who otherwise qualify. Routine prenatal care is a separate question, so talk with us early and read our guide to having a baby in Houston.
Other adults
Texas has not expanded Medicaid — KFF’s expansion tracker lists it as “Not Adopted” as of August 2026 — so most adults here qualify for Medicaid only through a category such as pregnancy, disability, older age, or being a parent with very low income. Adults in those categories who hold an affected status are the people most likely to receive a notice.
Mixed-status families
One person’s status does not end another person’s coverage. Eligibility is decided person by person, and a U.S. citizen child keeps his or her own eligibility even if a parent’s coverage changes. HealthCare.gov’s guidance for immigrant families also notes that “family members who aren’t applying for health coverage for themselves won’t be asked their immigration status.”
| Household member in Texas | Starting October 1, 2026 | Starting January 1, 2027 |
|---|---|---|
| U.S. citizen child | No change from section 71109; eligibility is the child’s own | No change from the 2027 tax-credit rule |
| Refugee or asylee child under 19 | Medicaid or CHIP can continue under Texas’s CHIPRA 214 election for children, if other rules are met | Medicaid and CHIP are not governed by the 2027 tax-credit rule |
| Refugee or asylee who turns 19 | Evaluated under adult rules once past Texas’s age-19 CHIPRA 214 limit | A Marketplace plan is available, but without a premium tax credit |
| Pregnant refugee or asylee adult without a green card | Full Medicaid expected to end after review and notice; emergency Medicaid remains if otherwise eligible | A Marketplace plan is available, but without a premium tax credit |
| Other refugee or asylee adult on Medicaid | Full Medicaid expected to end after review and notice; Marketplace Special Enrollment Period opens | A Marketplace plan is available, but without a premium tax credit |
| Former refugee or asylee who now has a green card | Counted as a lawful permanent resident; exempt from the five-year wait | Eligible for a premium tax credit if other rules are met |
How the review and notice are supposed to work
The agency that runs Medicaid and CHIP here, Texas Health and Human Services (HHSC), must follow steps CMS set out for people enrolled on October 1:
- Identify who may be affected. A state that cannot pinpoint affected enrollees may need to re-check a broader group of noncitizens, so some people who are not affected may still get a letter.
- Check electronic records first through the federal SAVE system, before contacting you.
- Ask you when the records do not settle it, and give you a reasonable period of time to respond.
- Consider “all bases of eligibility,” including the CHIPRA 214 option and emergency Medicaid.
- Send advance notice. For Medicaid, the rules CMS cites require at least ten days’ notice before a proposed termination and an opportunity for a fair hearing. For CHIP, they require timely written notice and a chance for review.
The review may not line up with your usual renewal date. And if you report a new qualifying status the state cannot verify right away, CMS says you get a 90-day reasonable opportunity period to provide documents, with benefits continuing if you meet the other rules. CMS’s June 2026 implementation deck for state staff walks through the same steps.
Why this matters so much in Houston
Texas resettled more refugees than any other state in fiscal year 2024. According to the Department of Homeland Security’s Refugees: 2024 annual flow report, 9,750 of the nation’s 100,060 refugee arrivals — 9.7% — listed Texas as their state of residence, up from 5,050 in fiscal 2023.
Harris County’s immigrant community is large and long-established. The 2024 American Community Survey counted 1,421,711 foreign-born residents out of 5,009,302 people, about 28 in every 100. That Census category includes 556,334 naturalized citizens, whose coverage section 71109 does not touch, and the 865,377 non-citizens include green-card holders, who stay in the protected group. No public dataset counts how many local Medicaid or CHIP enrollees are refugees, asylees, or parolees.
The coverage backdrop is thin: the Census Bureau’s 2024 estimates put Harris County’s uninsured rate at 20.8%, or 1,038,207 people. CMS’s 2026 Open Enrollment county file shows 731,300 Harris County Marketplace plan selections, 681,933 of them — 93.2% — with an advance premium tax credit, and an average premium of $647 a month before the credit and $78 after. Those are county-wide averages, not a quote for anyone, but they show how much the credit matters here.
Your Marketplace option for the rest of 2026
Losing Medicaid or CHIP is a qualifying life event. Refugees, asylees, parolees, and the other affected groups are lawfully present, so they can still buy a Marketplace plan. HealthCare.gov sets two timing rules:
- Before your coverage ends: you can pick a plan up to 60 days before the date your coverage will end. Coverage starts “the first day of the month after your coverage ends and you pick a plan.”
- After your coverage ends: if you lost Medicaid or CHIP, you have 90 days after the date coverage ended to pick a plan, and coverage starts “the first day of the month after you pick a plan.”
Choosing before your end date is how you avoid a gap; choosing afterward means at least part of a month without coverage. Our guide to the special enrollment path after losing Texas Medicaid covers the documents you may need, and our 2026 Special Enrollment Period guide lists other qualifying events.
Will you get help with the premium?
- Income at or above 100% of the federal poverty level: a lawfully present person who meets the other requirements can still receive a premium tax credit for 2026 coverage.
- Income below 100% of the poverty level: section 71302 removed the credit, starting with plan year 2026, for people who are ineligible for Medicaid because of their immigration status. CMS’s plan year 2026 guidance says they “will still be eligible to enroll in a full-price plan.”
Because Texas has not expanded Medicaid, an adult who loses Medicaid with income below the poverty line has no credit to fall back on. For a household near that line, the income figure on the application matters a great deal, so run the numbers with a licensed agent before choosing.
| Your situation | October through December 2026 | Plan year 2027 |
|---|---|---|
| Refugee, asylee, parolee, or other affected status; income at or above 100% of poverty | Can enroll through a Special Enrollment Period; may qualify for a premium tax credit | Can enroll; no premium tax credit under section 71301 |
| Same statuses; income below 100% of poverty | Can enroll at full price; no premium tax credit under section 71302 | Can enroll at full price; no premium tax credit |
| Green-card holder, Cuban or Haitian entrant, or COFA migrant | Usual Marketplace rules | Premium tax credit remains available if other rules are met |
| U.S. citizen family members | Usual Marketplace rules | Usual Marketplace rules |
When you are ready to compare plans and networks, start with our ACA Marketplace plans page.
Refugee Medical Assistance and emergency Medicaid
Refugee Medical Assistance
Refugee Medical Assistance is a time-limited program funded by the federal Office of Refugee Resettlement (ORR) for refugees and other ORR-eligible people who do not qualify for certain mainstream assistance programs. In fiscal year 2025, ORR cut the eligibility period to 4 months “due to limited funding availability.” A Federal Register notice published July 14, 2026 raised it to 8 months: people “whose eligibility date is on or after January 1, 2026, will be eligible for up to 8 months,” if they meet the program’s other requirements. People who received fewer months under the 4-month limit may receive more, up to eight, if they are still eligible.
ORR noted that “recent legislative changes have limited access to certain government benefits for some ORR-eligible populations, increasing reliance on ORR-funded assistance during the initial resettlement period.” For a newly arrived family, it is a real bridge, but a short one. Ask your resettlement caseworker when yours ends.
Emergency Medicaid
Emergency Medicaid continues after October 1. It pays for treatment of an emergency medical condition for people who meet Medicaid’s other rules but not its immigration rules, and CMS notes that the new funding limit “did not make any changes to coverage of emergency Medicaid.” It is built for emergencies, not checkups or prescriptions. And CMS points out that “there is no authorization for coverage of emergency services in a separate CHIP.”
What changes again on January 1, 2027
If you move to a Marketplace plan this fall, expect a second change on January 1, 2027. Section 71301 limits the premium tax credit to citizens and nationals, lawful permanent residents, Cuban and Haitian entrants, and COFA migrants — the same noncitizen groups as the Medicaid change. Refugees, asylees, and the other affected groups can still enroll, but without the credit. Our guide to the 2027 Marketplace immigration rule explains who is affected and how a mixed-status household’s credit is calculated.
Separately, section 71201 ends Medicare entitlement for people in these same groups who are already enrolled, effective January 4, 2027, so if an older relative in your household is on Medicare, please have them talk with us about their situation.
The 2027 Open Enrollment dates
You may see two sets of dates online. Some published versions of the federal rules show a shorter window, but after court orders in City of Columbus v. Kennedy, CMS confirmed in a July 27, 2026 statement that “Open Enrollment at the Federally-facilitated Marketplace will begin on November 1, 2026 and end on January 15, 2027.” Texas uses that Marketplace. Per HealthCare.gov’s dates and deadlines, a plan chosen by December 15 starts January 1, and one chosen December 16 through January 15 starts February 1.
Other options after January 1, 2027
If your household will buy coverage without a premium tax credit in 2027, the question becomes what the strongest coverage is that you can build at a price you can carry. Several pieces can be combined within one family.
| Option | Who it tends to fit | What to know |
|---|---|---|
| Job-based health plan | Workers, and their families, at an employer that offers coverage | Employees usually have 60 days after losing Medicaid or CHIP eligibility to request special enrollment. The employer’s share of the premium does the work a tax credit would have done. |
| ICHRA or QSEHRA | Workers whose employer reimburses individual premiums instead of offering a group plan | The reimbursement helps pay for an individual plan you choose. |
| Full-price Marketplace plan | Anyone who is lawfully present | The same ACA protections as a subsidized plan, including essential health benefits and no exclusions for pre-existing conditions. |
| ACA plan bought outside the Marketplace | Households that will not receive a tax credit either way | Individual plans sold directly by insurers follow the same ACA rules, so comparing both is reasonable. |
| Short-term health plan | Short gaps for people with no ongoing health needs | Not ACA-compliant. It can exclude pre-existing conditions and does not qualify for tax credits. |
| Harris Health Financial Assistance Program | Harris County residents with gross family income at or below 150% of the poverty level | Not health insurance. Used within the Harris Health System; people who may qualify for Medicaid, CHIP, or Marketplace coverage must apply for those first. |
| Community health centers | Anyone, including people without insurance | What you pay depends on your income. Useful for primary and prenatal care. |
| Refugee Medical Assistance | Recently arrived refugees and other ORR-eligible people | Up to 8 months for people whose eligibility date is on or after January 1, 2026. |
Look at job-based coverage again. The Department of Labor’s special enrollment fact sheet means you do not have to wait for your employer’s open enrollment after losing Medicaid or CHIP. Our employer health insurance page explains group plans from the employee side, and our guide to ICHRA in Houston covers employers that reimburse individual premiums.
Be careful with short-term plans. They can bridge a brief gap for a healthy person, but they are not ACA plans, and federal duration rules are in flux: in an August 7, 2025 statement, the Departments of Labor, Health and Human Services, and the Treasury said they did not intend to prioritize enforcing the 2024 duration limits while they reconsider the rule. Before buying, ask what happens after a week in the hospital. Our guide to short-term health plans in Texas goes further.
County and community care is a floor, not a plan. Harris Health’s eligibility FAQ describes its Financial Assistance Program, once called the Gold Card, as “not health insurance.” Community health centers, as HealthCare.gov describes them, offer primary care, prenatal care, and children’s vaccines, with costs based on income. Both help with everyday care; neither travels with you to providers outside its own system.
A practical checklist for the next few weeks
- Open every letter from HHSC and write down any document deadline and coverage end date.
- Update your address and phone number with HHSC if they have changed.
- List each family member’s current status, person by person, not for the family as a whole.
- If anyone now has a green card, report it and keep a copy of what you sent.
- Keep immigration documents current. If a case is pending, ask your immigration attorney or accredited representative how the timing could affect coverage.
- Do not cancel your children’s coverage. Wait for the state’s decision on each child.
- Estimate your 2026 household income against 100% of the poverty level.
- If a notice gives an end date, pick a Marketplace plan before it so the new plan starts the next month.
- Price 2027 options before November, including job-based coverage.
- Call Wise Insurance Agency with your letters and documents.
Find out where each person in your family stands
Wise Insurance Agency is an independent, Texas-licensed agency with offices in north and south Houston. Bring your HHSC letters and your household’s documents, and we will sort out who is likely to keep Medicaid or CHIP, who needs a new plan, and how to start it without a gap. There is no charge for the conversation.
Talk to a licensed Houston agent 832-400-6538How a Houston agency can help
We are not immigration attorneys, and nothing here changes anyone’s status or is legal advice about it. What we can do is read the HHSC letter with you, work out who in the family is likely to keep Medicaid or CHIP, time a Marketplace enrollment so there is no gap, and price 2026 and 2027 coverage with and without a premium tax credit. Call 832-400-6538, email sara@wisehealthins.com, or visit our north Houston or south Houston office. For background, see our Medicare vs. Medicaid page and our health insurance page.
Frequently asked questions
Will my refugee or asylee child lose Texas Medicaid or CHIP on October 1, 2026?
I am an adult refugee on Texas Medicaid. What happens on October 1?
I came as a refugee but now have a green card. Does the October 1 change affect me?
How long do I have to pick a Marketplace plan after losing Medicaid or CHIP, and when does it start?
Can I get a premium tax credit for a Marketplace plan for the rest of 2026?
Does emergency Medicaid still exist after October 1?
How long does Refugee Medical Assistance last now?
When is Open Enrollment for 2027 coverage in Texas?
Sources
All sources accessed September 12, 2026.
- Public Law 119-21, sections 71109, 71201, 71301 and 71302 (July 4, 2025) — congress.gov.
- Centers for Medicare & Medicaid Services, State Health Official Letter #26-001, “Implementation of Section 71109 ‘Alien Medicaid Eligibility’ of the Working Families Tax Cut Legislation (Public Law 119-21),” April 8, 2026, including Appendix A — medicaid.gov.
- CMS, “Implementation of Section 71109 ‘Alien Medicaid Eligibility’ of the Working Families Tax Cut Legislation (Public Law 119-21),” slide deck, June 2026 — medicaid.gov.
- Medicaid.gov, “Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Individuals,” state list updated April 2, 2026 — medicaid.gov.
- KFF, “Medicaid/CHIP Coverage of Lawfully-Residing Immigrant Children and Pregnant Women,” State Health Facts, as of January 2026 — kff.org.
- KFF, “Status of State Action on the Medicaid Expansion Decision,” State Health Facts, as of August 2026 — kff.org.
- Congressional Research Service, “Health Provisions in P.L. 119-21, the FY2025 Reconciliation Law,” Report R48633, August 18, 2025 — congress.gov.
- CMS Center for Consumer Information & Insurance Oversight, “Working Families Tax Cuts Act (WFTCA), Section 71302: Guidance for Plan Year 2026,” December 22, 2025 — cms.gov.
- CMS Center for Consumer Information & Insurance Oversight, “Updated Statement regarding the Failure to File and Reconcile requirement for Plan Years 2026-2027,” July 27, 2026 — cms.gov.
- HealthCare.gov, “Send documents to confirm why you’re eligible for a Special Enrollment Period” — healthcare.gov.
- HealthCare.gov, “Health coverage for immigrant families” — healthcare.gov.
- HealthCare.gov, “Dates and deadlines” — healthcare.gov.
- HealthCare.gov, “Community health centers” — healthcare.gov.
- Office of Refugee Resettlement, “Federal Register Notice: Change in Eligibility Period for Refugee Cash Assistance and Refugee Medical Assistance,” 91 Fed. Reg. 43107, July 14, 2026 — govinfo.gov.
- U.S. Department of Homeland Security, Office of Homeland Security Statistics, “Refugees: 2024,” Annual Flow Report, August 2025, Table 5 — ohss.dhs.gov.
- U.S. Census Bureau, 2024 American Community Survey 1-Year Estimates, Table B05002, “Place of Birth by Nativity and Citizenship Status,” Harris County, Texas — data.census.gov.
- U.S. Census Bureau, 2024 American Community Survey 1-Year Estimates, Table S2701, “Selected Characteristics of Health Insurance Coverage,” Harris County, Texas — data.census.gov.
- CMS, “2026 Marketplace Open Enrollment Period Public Use Files,” County-Level Public Use File, Harris County, Texas (FIPS 48201) — cms.gov.
- Harris Health System, “Eligibility Frequently Asked Questions,” August 2024 — harrishealth.org.
- U.S. Department of Labor, Employee Benefits Security Administration, “HIPAA Special Enrollment under the Children’s Health Insurance Program Reauthorization Act” fact sheet — dol.gov.
- U.S. Departments of Labor, Health and Human Services, and the Treasury, “Statement regarding short-term, limited-duration insurance,” August 7, 2025 — dol.gov.
- State Health and Value Strategies, “H.R.1’s Changes to Non-Citizen Coverage: Frequently Asked Questions,” April 17, 2026 (corroborating source) — shvs.org.
For general educational purposes; reflects federal statutes, CMS guidance, and data published as of September 2026. How Texas carries out these changes, the notices it sends, and several related federal rules can change, and some remain in federal litigation. Nothing here is legal or immigration advice — questions about immigration status belong with a qualified immigration attorney or an accredited representative. Wise Insurance Agency is a licensed insurance agency in the State of Texas, not affiliated with or endorsed by any federal or state agency. Medicaid and CHIP eligibility is determined by Texas Health and Human Services, and Marketplace eligibility by the Marketplace, based on your application.