North Dakota stopped covering refugees, asylees, humanitarian parolees and human trafficking victims under Medicaid on October 1, and Delaware and Massachusetts ended coverage for some legal immigrants the same month. All three are applying the federal law President Trump signed on July 4, 2025, the One Big Beautiful Bill Act, which cut those groups from the program.
What North Dakota ended on October 1
North Dakota’s Department of Health and Human Services says that beginning October 1, 2026, refugees, asylees, humanitarian parolees and human trafficking victims no longer qualify for Medicaid under the new federal law. The department’s enrollment information was last updated September 11. It does not say how many people are affected.
The Association of State and Territorial Health Officials, in its summary of the law, says the act cancels Medicaid eligibility for refugees, asylees and humanitarian parolees effective October 1, 2026. It lists the only noncitizens left eligible: lawful permanent residents, certain Cuban and Haitian entrants, and citizens of the Freely Associated States.
For anyone in those groups who found coverage gone, North Dakota says the department may mail a letter about coverage, with steps to keep benefits for people who still qualify. Neither North Dakota nor Delaware describes an appeal process. North Dakota’s Customer Support Center takes questions at 866-614-6005, weekdays from 8 a.m. to 5 p.m. Central.
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Some people stay covered. North Dakota says newly arrived refugees may qualify for Refugee Medical Assistance during their first eight months in the country, applying through its Apply for Help system. Pregnant women may qualify during pregnancy and for 12 months after birth, and Cuban and Haitian entrants remain eligible. Emergency Medicaid, the state adds, covers only serious, life-threatening emergencies.
Delaware’s list of lost and kept statuses
Delaware’s Division of Medicaid and Medical Assistance says that starting October 1, 2026, noncitizens must hold one of a short list of immigration statuses. Those that keep full coverage are green card holders who finished the five-year waiting period or whose status never required one, Cuban or Haitian entrants, and migrants from the Marshall Islands, Micronesia and Palau.
The state lists who no longer qualifies: asylees, refugees admitted under section 207 of immigration law, parolees, certain abuse survivors with petitions under the Violence Against Women Act, trafficking victims, and certain Afghan and Ukrainian parolees. Pregnant women and children may still qualify under a separate option the state calls CHIPRA 214.
Delaware tells members to report changes through its Change Report Center at 302-571-4900, option 2, online through its ASSIST portal, or at a local state office. Its Medicaid Customer Relations Unit is at 1-866-843-7212. As in North Dakota, the state does not describe a way to contest the status rule itself.
MassHealth moves about 7,300 members to other coverage
MassHealth says that in October 2026 some lawfully present immigrants stopped being eligible for comprehensive Medicaid. The agency estimates about 7,300 members are affected and says it will reach out to anyone the change touches. It also says the changes will not affect most MassHealth members.
The possibly affected groups are refugees, people granted asylum, people given humanitarian parole, people whose status rests on surviving abuse or trafficking, noncitizen veterans, people whose deportation was withheld, pre-1980 conditional entrants, certain Iraqi, Afghan, Ukrainian and Amerasian immigrants, and certain Native Americans born outside the United States.
Green card holders who met or are exempt from the five-year bar, Cuban and Haitian entrants, Compact of Free Association migrants, children under 21 and pregnant or postpartum people should not be affected, MassHealth says, even if they fall into a category above. The agency adds that its information may change with federal guidance.
Massachusetts members who lose comprehensive coverage switch to a different type of MassHealth. Those 65 or older or disabled generally move to MassHealth Family Assistance, which is comprehensive. Those 21 to 64 and not disabled generally move to MassHealth Limited, the Health Safety Net, or both. Questions can go to a MassHealth representative through its federal changes information.
What January 1 adds
A second round of change starts January 1, 2027. North Dakota says Medicaid expansion adults must work, volunteer, attend school or train for 80 hours a month, and Delaware puts the same rule as earning at least $580 a month or completing 80 hours for adults 19 to 64. Both list exemptions, including parents of children 13 or younger and veterans with a total disability rating.
Renewals also speed up. Delaware says expansion members renew every six months, and North Dakota says the same for its expansion enrollees. North Dakota will also limit retroactive coverage from three months back to one month for expansion members and two months for traditional Medicaid. Massachusetts says some members will face new work and education rules, more frequent renewals, or both.
The open question for a household that lost coverage on October 1 is which route fits: a status the state still covers, replacement coverage like MassHealth Limited, Refugee Medical Assistance for new arrivals, or the state office that handles reports of changes. Massachusetts says it will reach out to affected members, and North Dakota says it may mail a letter.
Did Medicaid end October 1 over immigration status?
A household that lost Medicaid on October 1 faces new rules on January 1, with work reporting for expansion adults and renewals every six months. A missed notice or a late report is how coverage that someone still qualifies for gets dropped a second time.
The SNAP & Medicaid Renewal Organizer lays out the 90-day window after coverage is dropped, with a renewal document checklist, a renewal and reporting calendar and 51 state packs. Part 6, The New Medicaid Work Rule, and the 90-Day Rescue, covers the January rules before they arrive.
Get the 90-day coverage-rescue steps and a renewal calendar in one organizer →
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
