Millions of people, including US children, could lose Medicaid coverage over new rule

A new federal rule could push millions of people off Medicaid and the Children’s Health Insurance Program — and researchers say most of those affected won’t be losing coverage because they’re newly ineligible, but out of fear and confusion about what the change means for their immigration status.

What the new rule changes

The Department of Homeland Security finalized the rule, titled “Public Charge Ground of Inadmissibility,” on July 20.

It rescinded 2022 Biden-era regulations that counted only cash assistance and government-funded long-term institutional care against immigrants applying for a visa, admission to the country or a green card.

Under the new rule, officers can weigh an applicant’s receipt of any means-tested public benefit, including Medicaid and CHIP.

According to KFF, a nonpartisan health policy research organization, the change could also open the door to officers considering other family members’ use of assistance programs.

How many people could lose coverage

KFF estimates that 13.5 million Medicaid or CHIP enrollees nationwide live in a household with at least one noncitizen, including 5.6 million children who are themselves U.S. citizens.

KFF predicts that if the rule pushes disenrollment rates to somewhere between 10% and 30% among that group, between 1.4 million and 4.1 million people could drop their coverage.

An estimated 560,000 to 1.7 million U.S. citizen children are included, all of whom would remain eligible the entire time.

KFF estimates that between 166,000 and 498,000 uninsured people who are already eligible for Medicaid or CHIP and living with a noncitizen family member could simply never apply.

Who’s affected — and who’s exempt

Public charge determinations apply narrowly.

Only people applying for a visa, seeking admission to the country, or adjusting their status toward a green card are subject to the rule. Several groups, including humanitarian immigrants, are exempt outright.

But researchers say the practical reach is far broader. Fear and confusion tend to push eligible immigrants and their citizen relatives to quietly drop coverage or avoid signing up in the first place — a dynamic researchers call a “chilling effect.”

History may be repeating

When the first Trump administration expanded public charge criteria in 2019, Medicaid participation among low-income noncitizens fell 20% nationally between 2016 and 2019, according to the Migration Policy Institute’s analysis of Census data.

The same analysis found that participation fell twice as fast for U.S. citizen children with a noncitizen in the household compared to children in citizen-only households.

In the KFF/New York Times 2025 Survey of Immigrants, 11% of immigrant adults said they had already stopped participating in a program that helps pay for food, housing or health care since January 2025 because of immigration-related worries.

That share rose to 36% among adults with a likely undocumented person in their household.

The bigger picture

Nationally, about one in four children live in a family with at least one immigrant parent, according to KFF — meaning the fallout from this week’s rule could reach well beyond the population directly subject to public charge review.

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