Thousands of immigrants in Maryland to lose Medicaid coverage under H.R. 1

Treatments for cancer, diabetes and other conditions could be disrupted for up to 4,500 Maryland residents who will no longer qualify for Medicaid under a federal rule that takes effect Thursday that will disqualify people for Medicaid based on immigration status.

It's just one of the provisions that kick in Thursday under the federal "One Big Beautiful Bill Act," including a change to the way states are charged for operation of the Supplemental Nutrition Assistance Program, the food assistance program known as SNAP. That change could end up costing Maryland up to $57 million.

The changes under H.R.1 have been phased in since the budget reconciliation bill was passed by Congress in July 2025, and more will come in 2027.

One of the biggest current changes will bar certain noncitizen immigrants from federal assistance programs. Leidi Garcia, director of health and human services at the immigrant advocacy group We Are CASA, worries about a woman diagnosed with colon cancer who recently contacted the organization. Garcia is concerned that the woman will not be able continue treatment when she loses coverage Thursday.

"That's my biggest concern," Garcia said. "Where are we going to be sending these individuals where they are actually going to be seen and provided with the care that they need in that moment? Especially when we see someone with a chronic disease diagnosed."

Undocumented residents' access to state health insurance marketplace delayed from 2026 to 2028

She expects more families to reach out to We Are CASA in the coming weeks, as an estimated 4,500 Maryland residents face the loss of Medicaid under H.R.1.

Under the new Medicaid restrictions, lawful permanent residents, also known as green-card holders, can still qualify for Medicaid along with Cuban and Haitian immigrants and migrants from the Compact of Free Association — Micronesia, Palau and the Marshall Islands. But starting Thursday, other noncitizens will get kicked from Medicaid, including those who came to the United States as refugees, asylum seekers, humanitarian parolees or victims of trafficking.

Options for immigrants who've lost Medicaid coverage could be limited. Those who had been receiving Medicaid coverage are likely low-income households, so the ability to purchase a private plan will be limited based on their income.

State officials suggest that those who no longer qualify for Medicaid get in contact with local community clinics, which can help those without insurance receive certain preventive care offered on a sliding fee scale. But in situations needing attentive and comprehensive care, community clinics may be limited in what services they can provide.

"There might be some resources to cover specific treatments," Garcia said. "But when we're talking about the comprehensive care of someone that is going through cancer, it's not so much about just the treatment of the cancer, but the other issues that might come from that. Full coverage is needed in these cases."

Otherwise, those who are booted from Medicaid and cannot afford other healthcare options will likely go without coverage until a medical emergency places them in the emergency room.

For those families who might be able to afford it, coverage on a subsidized health plan on Maryland's insurance marketplace under the Affordable Care Act might be a solution. But it would be a temporary one, as those same immigrant populations will be barred from receiving subsidies after January 2027 due to H.R. 1.

Maryland may be steeply penalized after reducing SNAP payment error rates

Thursday also launches provisions under H.R. 1 that require state governments to contribute more to food assistance programs, increasing the state's share of administrative costs to 75% while the federal government covers 25%. Previously, state and federal funds split administrative costs down the middle.

That means Maryland will now contribute around $57 million more to administer SNAP, on top of the $115 million it already pays for administrative costs.

Those increased administrative costs to the state, potentially growing by another $240 million in 2027, will strain an already constricted fiscal situation for Maryland, risking the resources and funds available to support state programs – some that could help the struggling immigrant populations.

Other federal policies increasing deportation efforts stoke fear in Maryland immigrant communities. Garcia says that more families are reaching out to groups like CASA for help in navigating those changes.

"We're seeing the impact of these policies and how it has increased the fear," Garcia said.

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Courtesy of Maryland Matters

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