Another coverage cliff arrives: 33K legal Mass. immigrants to lose health insurance aid

Federal policy changes enacted by President Trump’s “One Big Beautiful Bill Act” in 2025 continue to unfold during a second open enrollment season, with approximately 33,000 lawfully present immigrants in Massachusetts slated to lose health insurance subsidies.

As of Jan. 1, 2027, certain noncitizens will no longer qualify for advanced premium tax credits or Massachusetts ConnectorCare plans, which have $0 or low monthly premiums, low out-of-pocket costs and no deductibles.

According to the Massachusetts Health Connector, the state’s health insurance marketplace, immigration statuses that will no longer qualify include:

Not all of those approximately 33,000 people will ultimately become uninsured. The eventual number will depend on how many can afford unsubsidized premiums. But according to the Health Connector, the expectation is most of those affected will be challenged to do so, potentially resulting in disenrollment from health insurance coverage.

“There will be another tranche of individuals losing their subsidy eligibility because of federal policy,” Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, said during a press conference last week, ”and we are going to be doing everything we can working with those populations to help support them in deciding if they can afford to or want to remain in coverage, but without those subsidies."

Noncitizens must qualify for one of three immigration statuses in order to be eligible for a ConnectorCare health or dental plan and advanced premium tax credits, including:

On Oct. 1, an estimated 7,300 lawful immigrants also lost benefits through MassHealth Standard, the state’s Medicaid program’s most comprehensive coverage.

Those losing coverage because of their immigration status will remain eligible for only emergency care under MassHealth Limited, and care provided by hospitals and community health centers through the state’s Health Safety Net, the state’s health care charity fund that has seen budget challenges in recent years.

State House News Service recently reported the Health Safety Net “is poised to see a ballooning deficit as residents lose their MassHealth coverage due to policy changes incorporated in the federal One Big Beautiful Bill Act.”

Last month, Gov. Maura Healey proposed a new health care stabilization fund that would help support the safety net.

Additional changes affecting immigrants are occurring alongside new work and education requirements and more frequent renewals affecting some MassHealth members. The Centers for Medicare & Medicaid Services finalized a rule requiring certain Medicaid enrollees to log at least 80 hours per month of work, school, community service or volunteering, starting Jan. 1, 2027, in most states.

State officials estimate 175,000 people will lose MassHealth coverage because of the work requirements and six-month eligibility checks, though not all of the losses will happen at once.

Under federal law, if someone becomes ineligible for MassHealth because they don’t meet the work requirements, they won’t be eligible for subsidized coverage through the Health Connector, either.

The landscape for 2027 resembles the 2026 open enrollment season, when an initial 34,000 Massachusetts immigrants lawfully in the U.S. lost coverage when the state eliminated the ConnectorCare Plan Type 1. That plan covered immigrants who weren’t yet eligible for MassHealth Standard because of their immigration status (they must have been in the country legally for five years) and incomes below 100% of the federal poverty level.

Some of those individuals could overlap with the estimated 33,000 affected this enrollment season.

Also grabbing headlines last year — as the central sticking point during the longest federal government shutdown in history — was the expiration of Biden-era enhanced premium tax credits. Impacting an estimated 22 million of the 24 million Affordable Care Act marketplace enrollees nationwide, 337,000 in Massachusetts saw those credits expire and, in turn, their premiums increase.

State officials believe between 250,000 and 300,000 people will ultimately lose coverage over time because of the federal budget reconciliation bill Trump signed into law on July 4, 2025.

Gasteier said the federal policy changes have in many ways “undermined coverage options and made it harder for our members to afford health insurance plans that they rely on.”

This year, open enrollment in Massachusetts runs from Oct. 23 to Jan. 23, 2027.

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