Guía del consumidor
Derechos

Derechos y situaciones especiales

Cambios en el subsidio, carga pública, Medicaid y atención programada, con el texto de las fuentes oficiales.

Qué cambia en 2027

Quién puede recibir un subsidio de la ACA a partir del 1 de enero de 2027

Con la ley actual, hasta 2026, cualquier inmigrante con presencia legal (por ejemplo, permiso de trabajo) podía recibir un subsidio de la ACA. Con la nueva ley, a partir de la cobertura de 2027, el subsidio se limita a ciudadanos estadounidenses e inmigrantes elegibles: residentes permanentes (green card), entrantes cubanos y haitianos, y ciudadanos de Micronesia, las Islas Marshall y Palaos. Vea la comparación y el texto de CMS.

Cuidado con la renovación automática. Quienes pierden el subsidio y no actualizan su solicitud durante la Inscripción Abierta pueden quedar renovados automáticamente a precio completo.

Fuente: CMS, Guía sobre la elegibilidad de los no ciudadanos para APTC y CSR para el año del plan 2027 (5 de octubre de 2026; en inglés), que aplica la sección 71301 de la Ley Pública 119-21.

Elegibilidad para el subsidio

Elegibilidad para el subsidio

El texto exacto de la guía de CMS detrás de Qué cambia en 2027. Las citas son textuales y están en inglés; “…” indica texto omitido.

Ley anterior (hasta 2026)

Quién podía recibir el subsidio
Ciudadanos estadounidenses y todos los inmigrantes con presencia legal cuyo ingreso calificaba.

Nueva ley (a partir de 2027)

Quién puede recibir el subsidio
Solo ciudadanos estadounidenses e inmigrantes elegibles: residentes permanentes, entrantes cubanos y haitianos, y ciudadanos COFA.
Los demás con presencia legal
Perderán su subsidio.
Quién conserva el subsidio

CMS guidance, Q1

“Beginning in plan year 2027, eligibility for financial assistance (i.e., APTC and CSRs) is allowed only for the coverage of U.S. citizens, U.S. nationals, and eligible noncitizens. “Eligible noncitizens” are a defined subset of “lawfully present” noncitizens and must be one of the following:
  • Lawful Permanent Residents (i.e., LPRs, or “green card holders”)
  • Cuban or Haitian Entrants
  • Individuals lawfully residing under a Compact of Free Association (i.e., COFA migrants)”
Los demás con presencia legal pagan el precio completo

CMS guidance, Q1

“Lawfully present noncitizens who are not eligible noncitizens will remain eligible to enroll in a qualified health plan (QHP) through the Marketplace, if otherwise eligible. However, APTC and CSRs will not be allowed for their coverage beginning in plan year 2027, meaning they will have to pay full price for their QHP.”
La base legal

CMS guidance, Q2

“Effective for taxable years beginning after December 31, 2026, a lawfully present individual must be an “eligible alien” for a premium tax credit (PTC), and therefore APTC and CSRs, to be allowed for the individual’s coverage. There is no change to the requirement that an individual must be “lawfully present” to enroll in a QHP through the Marketplace.”
Cómo se comprueba el estatus elegible

CMS guidance, Q5

“When a consumer attests to being an eligible noncitizen, but the FFE cannot verify their eligible noncitizen status electronically through DHS SAVE when their application is submitted, the consumer will receive a data matching issue (DMI) and will have 95 calendar days to submit documentation to verify their eligible noncitizen status. Such consumers will be eligible to enroll in a QHP and to receive APTC and CSRs, if otherwise eligible, during their DMI period.”
Renovación automática a precio completo

CMS guidance, Q6

“If the FFE does not have access to previously verified data indicating that the enrollee is an eligible noncitizen, and the FFE is unable to verify eligible noncitizen status through DHS SAVE, the enrollee will be redetermined ineligible for APTC and CSRs effective January 1, 2027. Generally, this means that they will be automatically re-enrolled in a QHP through the Marketplace without APTC and CSRs.”
Cómo evitar la renovación

CMS guidance, Q8

“The enrollee should cancel their Marketplace coverage for plan year 2027. … If the enrollee does not cancel their coverage for plan year 2027, they may be automatically re-enrolled in a QHP without APTC or CSRs, if they are determined to still be lawfully present.”
Sin período de gracia de tres meses

CMS guidance, Q10

“Noncitizens who are no longer eligible for financial assistance will no longer be afforded the three-month APTC grace period required in 45 CFR 156.270(d), as it applies only to enrollees receiving APTC when they entered delinquency. Instead, these enrollees would be subject to any grace period policy set by the issuer, subject to applicable state laws …”
Familias de estatus mixto

CMS guidance, Q11

“In a mixed status household the monthly enrollment premium and monthly SLCSP premium amounts reported on Form 1095-A may be reduced to exclude the portion of the premiums allocable to individuals in the household who are lawfully present noncitizens who are not eligible noncitizens.”
Medicaid es un cambio aparte

CMS guidance, Q13

“No. Section 71301 impacts noncitizen eligibility for APTC and CSRs through the Marketplace. However, section 71109 of the WFTC legislation impacts Federal financial participation for coverage provided to certain noncitizens in Medicaid and CHIP.”

Fuente: CMS Center for Consumer Information and Insurance Oversight, “Guidance on Noncitizen Eligibility for Advance Payments of the Premium Tax Credit (APTC) and Cost-Sharing Reductions (CSRs) for Plan Year 2027,” publicada el 5 de octubre de 2026. Aplica al Mercado federal (HealthCare.gov), que usan Florida y Texas.

Carga pública

Carga pública

  1. 1
    Emergencias: vaya siempre a la sala de emergencias más cercana. Los hospitales con sala de emergencias deben evaluar y estabilizar a todos, sin importar su estatus migratorio ni su capacidad de pago (EMTALA). Nunca retrase la atención de emergencia.
  2. 2
    La regla: desde el 18 de septiembre de 2026, solicitar o recibir un beneficio del gobierno puede tomarse en cuenta si más adelante solicita la green card a través de un cónyuge, un hijo o hija adulto, o un empleador, aunque nunca use el beneficio. Los refugiados, asilados y quienes se ajustan bajo la Ley de Ajuste Cubano están exentos. La regla está siendo impugnada en los tribunales.
  3. 3
    Quienes pierden el subsidio tampoco pueden recibir Medicaid completo. A partir del 1 de octubre de 2026, una nueva ley federal limita Medicaid completo a ciudadanos estadounidenses, residentes permanentes (generalmente después de 5 años), entrantes cubanos y haitianos, y ciudadanos COFA, los mismos grupos que conservan el subsidio. Los adultos con parole, TPS, asilo pendiente, refugio o asilo no califican.
  4. 4
    Pocas personas califican para Medicaid de emergencia. Florida y Texas no expandieron Medicaid, así que el Medicaid de emergencia cubre principalmente a mujeres embarazadas, niños, padres con muy pocos ingresos y personas mayores o con discapacidad. No califican: adultos de 21 a 64 años (de 19 a 64 en Texas) que no están embarazadas, no tienen discapacidad y no cuidan a un menor, con cualquier ingreso.
  5. 5
    Importa qué hospital le ayuda a pagar. Cuando un hospital privado sin fines de lucro reduce o perdona su factura bajo su propia política de asistencia financiera, el hospital lo paga, así que no es un beneficio público. Los programas de hospitales públicos (marcados con PC), como Jackson Prime, se pagan con dinero del gobierno y podrían tomarse en cuenta. Recibir atención en un hospital público y pagar usted mismo o con un plan privado no es un beneficio público. Ejemplo: Jackson Prime y la asistencia financiera de Baptist Health ofrecen atención gratuita hasta el 300% FPL; para alguien que más adelante podría solicitar la green card por vía familiar o laboral, la de Baptist probablemente es la opción de menor riesgo para atención programada. Baptist no tiene límite de ingreso, cubre a residentes de Miami-Dade, Broward, Palm Beach y los Cayos superiores, y no indica requisitos migratorios.
  6. 6
    Si un hospital le pide solicitar Medicaid primero (muchos lo hacen), pregunte antes de firmar. Una aprobación puede tomarse en cuenta; una negación pesa poco; solicitar para un hijo ciudadano estadounidense no se usa en contra del padre o la madre.
  7. 7
    Busque asesoría: hable con un abogado de inmigración o un representante acreditado por el DOJ antes de solicitar cualquier beneficio, incluso para un parto programado. Un notario público no puede dar asesoría legal de inmigración.
Propósito de la regla de carga pública

El Congreso (ley de asistencia social de 1996, 8 U.S.C. 1601) declaró como política nacional que:

  • “La autosuficiencia ha sido un principio básico de la ley de inmigración de los Estados Unidos desde las primeras leyes de inmigración de este país.”
  • Los inmigrantes “no dependan de recursos públicos para satisfacer sus necesidades, sino que confíen en sus propias capacidades y en los recursos de sus familias, sus patrocinadores y organizaciones privadas.”
  • “La disponibilidad de beneficios públicos no constituya un incentivo para la inmigración a los Estados Unidos.”

Traducción; el texto oficial está en inglés.

Historia de la regla desde 2019

De 1999 a 2019, solo contaban la asistencia en efectivo (SSI, TANF, asistencia general) y la atención institucional a largo plazo pagada por el gobierno. Medicaid, los cupones de alimentos y la ayuda de vivienda no contaban.

  • Regla de 2019: agregó la mayoría de Medicaid, SNAP y la ayuda de vivienda, con un límite de más de 12 meses de beneficios en cualquier período de 36 meses. Excluía el Medicaid de emergencia, el Medicaid para menores de 21 años y el Medicaid durante el embarazo. Entró en vigor en febrero de 2020, después de una suspensión de la Corte Suprema.
  • 2021: después de un año de demandas, el gobierno dejó de defender la regla de 2019 y volvió el estándar de 1999.
  • Regla de 2022 (vigente desde el 23 de diciembre de 2022): convirtió el estándar de 1999 en reglamento. Solo contaban la asistencia en efectivo y la atención institucional a largo plazo; Medicaid, SNAP y la vivienda no.
  • Noviembre de 2025: el DHS propuso eliminar la regla de 2022.
  • Regla de 2026 (publicada el 20 de julio, vigente desde el 18 de septiembre de 2026): eliminó las definiciones y la lista cerrada. Los oficiales pueden tomar en cuenta cualquier beneficio público basado en los ingresos, incluidos los programas federales, estatales y locales, y también las solicitudes y aprobaciones, no solo los beneficios recibidos. Los beneficios recibidos antes del 18 de septiembre de 2026 se siguen evaluando con el estándar de 2022. USCIS reescribió su Manual de Políticas el 18 de agosto de 2026.
  • Ahora: varios estados, ciudades y organizaciones han demandado. A octubre de 2026, la regla sigue vigente.

En resumen: Medicaid estuvo excluido de 1999 a 2019, contó en 2019–2021, volvió a excluirse de 2021 a 2026 y ahora puede contar de nuevo.

Reglas de Medicaid a partir del 1 de octubre de 2026

Sección 71109 de la Ley Pública 119-21; guía de CMS del 8 de abril de 2026. Medicaid completo y CHIP se limitan a:

  • Ciudadanos y nacionales de EE. UU.
  • Residentes permanentes (green card), generalmente después de un período de espera de 5 años
  • Entrantes cubanos y haitianos
  • Ciudadanos de Micronesia, las Islas Marshall y Palaos (COFA)
  • Niños y mujeres embarazadas con residencia legal, en los estados que decidan cubrirlos

Pierden Medicaid completo: refugiados, asilados, personas con parole, personas con suspensión de deportación (withholding of removal), víctimas de trata y otros grupos que antes calificaban. Los estados deben verificar el estatus y avisar con derecho a apelación antes de terminar la cobertura.

El Medicaid de emergencia no cambia. No tiene requisito de estatus migratorio; cualquier persona que cumpla las reglas de ingreso y de grupo puede calificar.

En qué se diferencia del subsidio de la ACA:

  • Los residentes permanentes pueden recibir el subsidio de inmediato, pero normalmente esperan 5 años para Medicaid.
  • Los estados pueden cubrir en Medicaid a niños y mujeres embarazadas con residencia legal; el subsidio no tiene esa opción.
  • Las reglas de ingreso van en direcciones opuestas. En Florida y Texas, Medicaid cubre solo grupos específicos con ingresos bajos, mientras que el subsidio generalmente empieza en el 100% FPL, y una persona que califica para Medicaid no puede recibir el subsidio.

Medicaid de emergencia

Florida: quién puede calificar para Medicaid de emergencia

Debe cumplir todas las reglas de Medicaid excepto el estatus migratorio y vivir en Florida.

  1. Mujeres embarazadas con ingreso del hogar hasta el 196% FPL (el bebé por nacer cuenta como miembro del hogar)
  2. Menores de 19 años con ingreso del hogar hasta el 211% FPL (menores de 1 año), 145% (de 1 a 5 años) o 138% (de 6 a 18 años)
  3. Padres o cuidadores con poco o ningún ingreso*
  4. Jóvenes de 19 a 20 años con poco o ningún ingreso*
  5. Personas de 65 años o más, ciegas o con discapacidad, bajo reglas separadas relacionadas con el SSI

No califican: adultos de 21 a 64 años que no están embarazadas, no tienen discapacidad y no cuidan a un menor, con cualquier ingreso.

* Poco o ningún ingreso: ingreso total del hogar menor de unos $478 al mes para un padre y un hijo, más unos $122 por cada miembro adicional del hogar. El padre o cuidador debe vivir con un menor de 18 años y cuidarlo; los jóvenes de 19 a 20 años tienen el mismo límite. La cobertura dura solo lo que dura la emergencia. Fuente: DCF de Florida, Apéndice A-7 (abril de 2026 a marzo de 2027). Un profesional médico debe certificar la emergencia y sus fechas, y el Medicaid de emergencia no cubre la atención después del parto.

Texas: quién puede calificar para Medicaid de emergencia

Debe cumplir todas las reglas de Medicaid excepto el estatus migratorio y vivir en Texas. Un médico certifica la emergencia y las fechas en que comenzó y terminó.

  1. Mujeres embarazadas con ingreso del hogar hasta el 198% FPL
  2. Menores de 19 años con ingreso del hogar hasta el 198% FPL (menores de 1 año), 144% (de 1 a 5 años) o 133% (de 6 a 18 años)
  3. Padres o cuidadores con poco o ningún ingreso**
  4. Personas de 65 años o más, ciegas o con discapacidad, que cumplen las reglas del SSI excepto la ciudadanía

No califican: adultos de 19 a 64 años que no están embarazadas, no tienen discapacidad y no cuidan a un menor, con cualquier ingreso.

CHIP Perinatal: Texas cubre la atención prenatal del bebé por nacer de una mujer que no puede recibir Medicaid por su estatus migratorio, hasta el 202% FPL. La cobertura es del bebé por nacer, que será ciudadano estadounidense; USCIS no toma en cuenta contra el padre o la madre los beneficios de un hijo, pero ninguna guía trata específicamente el CHIP Perinatal. El trabajo de parto y el parto de la madre se cobran al Medicaid de emergencia, que es un beneficio de ella.

** Poco o ningún ingreso: un límite mensual de $196 para un padre o madre solo con un hijo, $230 para tres personas y $277 para cuatro (con dos padres: $251 para tres, $285 para cuatro). Texas también resta el 5% del FPL del ingreso cuando eso decide la elegibilidad. Fuente: Salud y Servicios Humanos de Texas, Texas Works Handbook C-131.

¿Puede el Medicaid de emergencia afectar una solicitud de green card?

Nuestra lectura: ya no está excluido automáticamente. Puede tomarse en cuenta, pero probablemente pesa menos que otros beneficios.

  • El Medicaid de emergencia es un programa del gobierno basado en los ingresos, y la regla anterior que lo excluía se eliminó en 2026.
  • La nueva guía permite a los oficiales tomar en cuenta cualquier beneficio del gobierno basado en los ingresos, incluidas las solicitudes y aprobaciones.
  • También les indica considerar por qué el Congreso puso un beneficio a disposición de todos. La atención de emergencia es uno de esos beneficios, así que probablemente cuenta menos.
  • Ninguna guía oficial menciona todavía el Medicaid de emergencia por nombre, y la regla está siendo impugnada en los tribunales.

La mayoría de los adultos no califican para Medicaid de emergencia, y una solicitud negada pesa poco. Consulte con un abogado de inmigración antes de basarse en esto.

Atención programada y procedimientos electivos

Elija una región y luego indique el ingreso familiar de su paciente como porcentaje del FPL para ver dónde la atención sería gratuita. "Preevaluación" muestra si un paciente puede solicitar antes de una atención programada y médicamente necesaria; la atención electiva y cosmética está excluida casi en todas partes.

Ninguna ley garantiza una cirugía o un parto programados. La Política de Asistencia Financiera del hospital decide si un paciente sin seguro puede ser preevaluado y aprobado antes de programar la atención.

Emergencia o programada

Fuentes y extractos

Extractos de las fuentes: el texto exacto detrás de estas afirmaciones (en inglés)

Quotes are verbatim; “…” marks omitted text. Retrieved October 7, 2026.

1. Emergency care regardless of status or ability to pay

42 U.S.C. § 1395dd(a)

“In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1)) exists.”

42 U.S.C. § 1395dd(h)

“A participating hospital may not delay provision of an appropriate medical screening examination required under subsection (a) or further medical examination and treatment required under subsection (b) in order to inquire about the individual’s method of payment or insurance status.”

Source: Cornell LII: 42 U.S.C. § 1395dd

2. The rule took effect September 18, 2026

Federal Register 2026-14539, Action and Dates

“U.S. Citizenship and Immigration Services (“USCIS”), Department of Homeland Security (“DHS”). ACTION: Final rule. The final rule is effective on September 18, 2026.”

Federal Register 2026-14539, Dates

“This rule applies to applications for admission made on or after September 18, 2026 or applications for adjustment of status postmarked or electronically submitted on or after September 18, 2026.”

Source: Federal Register: Public Charge Ground of Inadmissibility (July 20, 2026)

3. Officers may consider applying for, approval for, or use of some public benefits

Federal Register 2026-14539, Summary (… marks text omitted)

“DHS is rescinding the 2022 public charge ground of inadmissibility regulations (“2022 Final Rule”)… officers will more accurately assess an alien’s likelihood at any time of becoming a public charge, in the totality of the circumstances, as Congress intended.”

Federal Register 2026-14539, “Future Guidance and Compliance With the APA”

“This guidance will explain how officers will be able to consider the receipt of any means-tested public benefits by the alien”

Federal Register 2026-14539, Dates

“Receipt of means-tested public benefits before September 18, 2026 will be considered consistently with the 2022 Final Rule.”

8 U.S.C. § 1182(a)(4)(A) (the law the rule applies)

“Any alien who, in the opinion of the consular officer at the time of application for a visa, or in the opinion of the Attorney General at the time of application for admission or adjustment of status, is likely at any time to become a public charge is inadmissible.”

USCIS Policy Manual, Vol. 8, Part G, Ch. 2, Receipt (current as of Oct. 2, 2026)

“While not constituting “receipt,” the alien’s own application for, or certification or approval to receive, a benefit in the future may be considered in the totality of the alien’s circumstances along with any evidence that the alien withdrew his or her application or notified the benefit granting agency that he or she wished to disenroll from a benefit he or she was receiving or was approved or certified to receive in the future.”

USCIS Policy Manual, Vol. 8, Part G, Ch. 7

“Additionally, officers will consider any evidence in the record pertaining to whether the alien has applied for any means-tested public benefits and/or whether the alien has been approved or certified to receive any means-tested public benefits on or after September 18, 2026.”

Source: Federal Register: Public Charge Ground of Inadmissibility (July 20, 2026); Cornell LII: 8 U.S.C. § 1182; USCIS Policy Manual, Vol. 8, Part G, Ch. 2: Key Concepts; USCIS Policy Manual, Vol. 8, Part G, Ch. 7: Consideration of Applications, Approvals and Receipt

4. Who is exempt

8 U.S.C. § 1157(c)(3) (refugees)

“The provisions of paragraphs (4), (5), and (7)(A) of section 1182(a) of this title shall not be applicable…”

8 U.S.C. § 1159(c) (adjustment of status for refugees and asylees)

“The provisions of paragraphs (4), (5), and (7)(A) of section 1182(a) of this title shall not be applicable to any alien seeking adjustment of status under this section…”

Form I-485 (Edition 09/18/26), Part 9, Item Number 56

“56. I am exempt from the public charge ground of inadmissibility because I am a/an (select only one box): … Asylee … Refugee … Cuban Adjustment Act …”

USCIS Policy Manual, Vol. 8, Part G, Ch. 3, Exemptions (… marks omitted text)

“The public charge ground of inadmissibility does not apply, based on statutory or regulatory authority, to the following applicants for visas, admission, and adjustment of status (or other immigration benefit requests that require admissibility): Asylees and refugees; … Applicants seeking adjustment under the Cuban Adjustment Act; … Applicants seeking temporary protected status (TPS); …”

Source: Cornell LII: 8 U.S.C. § 1157; Cornell LII: 8 U.S.C. § 1159; USCIS Form I-485; USCIS Policy Manual, Vol. 8, Part G, Ch. 3: Applicability

5. The rule is being challenged in court

Visa Lawyer Blog, Jacob Sapochnick (Oct. 5, 2026), a law-firm article, not a court record

“the new public charge policy is facing multiple federal lawsuits from states, local governments, and immigrant-rights organizations. However, as of October 2026, the policy remains in effect while the litigation continues.”

Source: Visa Lawyer Blog: Public Charge Changes Took Effect September 18, 2026

6. Who can give immigration legal advice

8 CFR § 1292.1(a)

“A person entitled to representation may be represented by any of the following:” The list includes “Any attorney as defined in § 1001.1(f) of this chapter…” and “An individual whom EOIR has authorized to represent immigration patients on…” (accredited representatives).

Federal Trade Commission consumer alert (May 18, 2023)

“notarios (also called notaries or notarios públicos) in the U.S. are not licensed attorneys. They can’t give you legal advice.” and “Some specialized lawyers and accredited representatives can help people with immigration.”

Source: Cornell LII: 8 CFR § 1292.1; FTC: Avoiding scams that target immigrants

7. Which programs may count as public

USCIS Policy Manual, Vol. 8, Part G, Ch. 2, Means-Tested Public Benefits

“A benefit is generally a “public” benefit if the payments or assistance are provided by an agency of the government or by appropriated funds of the government; Examples of public benefits that could potentially be means-tested public benefits … include but are not limited to cash assistance, public or assisted housing, financial aid for postsecondary education, food assistance, government-funded health coverage, or any other similar benefit …”

USCIS Policy Manual, Vol. 8, Part G, Ch. 2, Government

“The term “government,” for the purpose of implementing the public charge ground of inadmissibility, is generally understood to refer to any federal, state, tribal, territorial, or local government entity or entities of the United States.”

Source: USCIS Policy Manual, Vol. 8, Part G, Ch. 2: Key Concepts

Fuentes sobre la carga pública (9)
Consumer guide
Rights

Rights and special situations

Subsidy changes, public charge, Medicaid and planned care, with the text of the official sources.

What changes in 2027

Who can get an ACA subsidy starting January 1, 2027

Under current law, through 2026, any immigrant who was lawfully present (for example, work permit) could get an ACA subsidy. Under the new law, starting with 2027 coverage, the subsidy is limited to U.S. citizens and eligible immigrants: green card holders, Cuban and Haitian entrants, and citizens of Micronesia, the Marshall Islands and Palau. See the comparison and the CMS text.

Watch for automatic renewal. People who lose the subsidy and don't update their application during Open Enrollment may be automatically renewed at full price.

Source: CMS, Guidance on Noncitizen Eligibility for APTC and CSRs for Plan Year 2027 (October 5, 2026), implementing section 71301 of Public Law 119-21.

Eligibility for subsidy

Eligibility for subsidy

The exact text of the CMS guidance behind What changes in 2027. Quotes are verbatim; “…” marks omitted text.

Old law (through 2026)

Who could get the subsidy
U.S. citizens and all lawfully present immigrants whose income qualified.

New law (starting 2027)

Who can get the subsidy
U.S. citizens and eligible immigrants only: green card holders, Cuban and Haitian entrants, and COFA citizens.
Everyone else lawfully present
Will lose their subsidy.
Who keeps the subsidy

CMS guidance, Q1

“Beginning in plan year 2027, eligibility for financial assistance (i.e., APTC and CSRs) is allowed only for the coverage of U.S. citizens, U.S. nationals, and eligible noncitizens. “Eligible noncitizens” are a defined subset of “lawfully present” noncitizens and must be one of the following:
  • Lawful Permanent Residents (i.e., LPRs, or “green card holders”)
  • Cuban or Haitian Entrants
  • Individuals lawfully residing under a Compact of Free Association (i.e., COFA migrants)”
Everyone else who is lawfully present pays full price

CMS guidance, Q1

“Lawfully present noncitizens who are not eligible noncitizens will remain eligible to enroll in a qualified health plan (QHP) through the Marketplace, if otherwise eligible. However, APTC and CSRs will not be allowed for their coverage beginning in plan year 2027, meaning they will have to pay full price for their QHP.”
The legal basis

CMS guidance, Q2

“Effective for taxable years beginning after December 31, 2026, a lawfully present individual must be an “eligible alien” for a premium tax credit (PTC), and therefore APTC and CSRs, to be allowed for the individual’s coverage. There is no change to the requirement that an individual must be “lawfully present” to enroll in a QHP through the Marketplace.”
Proving eligible status

CMS guidance, Q5

“When a consumer attests to being an eligible noncitizen, but the FFE cannot verify their eligible noncitizen status electronically through DHS SAVE when their application is submitted, the consumer will receive a data matching issue (DMI) and will have 95 calendar days to submit documentation to verify their eligible noncitizen status. Such consumers will be eligible to enroll in a QHP and to receive APTC and CSRs, if otherwise eligible, during their DMI period.”
Automatic renewal at full price

CMS guidance, Q6

“If the FFE does not have access to previously verified data indicating that the enrollee is an eligible noncitizen, and the FFE is unable to verify eligible noncitizen status through DHS SAVE, the enrollee will be redetermined ineligible for APTC and CSRs effective January 1, 2027. Generally, this means that they will be automatically re-enrolled in a QHP through the Marketplace without APTC and CSRs.”
How to avoid renewal

CMS guidance, Q8

“The enrollee should cancel their Marketplace coverage for plan year 2027. … If the enrollee does not cancel their coverage for plan year 2027, they may be automatically re-enrolled in a QHP without APTC or CSRs, if they are determined to still be lawfully present.”
No three-month grace period

CMS guidance, Q10

“Noncitizens who are no longer eligible for financial assistance will no longer be afforded the three-month APTC grace period required in 45 CFR 156.270(d), as it applies only to enrollees receiving APTC when they entered delinquency. Instead, these enrollees would be subject to any grace period policy set by the issuer, subject to applicable state laws …”
Mixed-status families

CMS guidance, Q11

“In a mixed status household the monthly enrollment premium and monthly SLCSP premium amounts reported on Form 1095-A may be reduced to exclude the portion of the premiums allocable to individuals in the household who are lawfully present noncitizens who are not eligible noncitizens.”
Medicaid is a separate change

CMS guidance, Q13

“No. Section 71301 impacts noncitizen eligibility for APTC and CSRs through the Marketplace. However, section 71109 of the WFTC legislation impacts Federal financial participation for coverage provided to certain noncitizens in Medicaid and CHIP.”

Source: CMS Center for Consumer Information and Insurance Oversight, “Guidance on Noncitizen Eligibility for Advance Payments of the Premium Tax Credit (APTC) and Cost-Sharing Reductions (CSRs) for Plan Year 2027,” released October 5, 2026. It applies to the Federally-facilitated Exchange (HealthCare.gov), which Florida and Texas use.

Public charge

Public charge

  1. 1
    Emergencies: always go to the nearest emergency room. Hospitals with an ER must screen and stabilize everyone, regardless of immigration status or ability to pay (EMTALA). Never delay emergency care.
  2. 2
    The rule: since September 18, 2026, applying for or getting a government benefit can be considered if you later apply for a green card through a spouse, an adult son or daughter, or an employer, even if you never use the benefit. Refugees, asylees and people adjusting under the Cuban Adjustment Act are exempt. The rule is being challenged in court.
  3. 3
    People losing the subsidy also can't get full Medicaid. Starting October 1, 2026, a new federal law limits full Medicaid to U.S. citizens, green card holders (generally after 5 years), Cuban and Haitian entrants, and COFA citizens, the same groups that keep the subsidy. Adults who are parolees, TPS holders, asylum applicants, refugees or asylees don't qualify.
  4. 4
    Few people qualify for Emergency Medicaid. Florida and Texas didn't expand Medicaid, so Emergency Medicaid mainly covers pregnant women, children, parents with very low income, and people who are elderly or disabled. Not eligible: adults aged 21–64 (19–64 in Texas) who are not pregnant, not disabled and not caring for a child, at any income.
  5. 5
    Which hospital helps you pay matters. When a private nonprofit hospital reduces or forgives your bill under its own financial assistance policy, the hospital pays for it, so it is not a public benefit. Programs at public hospitals (marked PC), such as Jackson Prime, are paid with government money and could be considered. Being treated at a public hospital and paying yourself or with a private plan is not a public benefit. Example: Jackson Prime and Baptist Health's financial assistance both offer free care up to 300% FPL; for someone who may later apply for a green card through family or work, Baptist's is likely the lower-risk choice for planned care. Baptist has no income cap, covers residents of Miami-Dade, Broward, Palm Beach and the Upper Keys, and states no immigration requirement.
  6. 6
    If a hospital asks you to apply for Medicaid first (many do), ask before you sign. An approval can be considered; a denial carries little weight; applying for a U.S.-citizen child is not held against the parent.
  7. 7
    Get advice: talk to an immigration attorney or a DOJ-accredited representative before applying for any benefit, including for a planned delivery. A notario público may not give immigration legal advice.
Purpose of the public charge rule

Congress (1996 welfare law, 8 U.S.C. 1601) declared it national policy that:

  • “Self-sufficiency has been a basic principle of United States immigration law since this country’s earliest immigration statutes.”
  • Immigrants should “not depend on public resources to meet their needs, but rather rely on their own capabilities and the resources of their families, their sponsors, and private organizations.”
  • “The availability of public benefits not constitute an incentive for immigration to the United States.”
History of the rule since 2019

From 1999 to 2019, only cash assistance (SSI, TANF, general assistance) and long-term institutional care at government expense counted. Medicaid, food stamps and housing aid did not.

  • 2019 rule: added most Medicaid, SNAP and housing assistance, with a threshold of more than 12 months of benefits in any 36 months. It excluded Emergency Medicaid, Medicaid for people under 21 and Medicaid during pregnancy. It took effect in February 2020 after a Supreme Court stay.
  • 2021: after a year of court challenges, the government stopped defending the 2019 rule, and the 1999 standard returned.
  • 2022 rule (effective December 23, 2022): put the 1999 standard into regulation. Only cash assistance and long-term institutional care counted; Medicaid, SNAP and housing did not.
  • November 2025: DHS proposed repealing the 2022 rule.
  • 2026 rule (published July 20, effective September 18, 2026): removed the definitions and the closed list. Officers may weigh any means-tested public benefit, including federal, state and local programs, and may consider applications and approvals, not only benefits received. Benefits received before September 18, 2026 are still judged under the 2022 standard. USCIS rewrote its Policy Manual on August 18, 2026.
  • Now: several states, cities and organizations have sued. As of October 2026, the rule remains in effect.

In short: Medicaid was excluded from 1999 to 2019, counted in 2019–2021, excluded again from 2021 to 2026, and can be counted again now.

Medicaid rules starting October 1, 2026

Section 71109 of Public Law 119-21; CMS guidance of April 8, 2026. Full Medicaid and CHIP are limited to:

  • U.S. citizens and nationals
  • Green card holders, generally after a 5-year waiting period
  • Cuban and Haitian entrants
  • Citizens of Micronesia, the Marshall Islands and Palau (COFA)
  • Lawfully residing children and pregnant women, in states that choose to cover them

Lose full Medicaid: refugees, asylees, parolees, people granted withholding of removal, trafficking victims and other groups that qualified before. States must verify status and give notice with appeal rights before ending coverage.

Emergency Medicaid doesn't change. It has no immigration-status requirement; anyone who meets the income and group rules can qualify.

How this differs from the ACA subsidy:

  • Green card holders can get the subsidy right away but usually wait 5 years for Medicaid.
  • States may cover lawfully residing children and pregnant women in Medicaid; the subsidy has no such option.
  • The income rules point in opposite directions. In Florida and Texas, Medicaid covers only specific groups at low incomes, while the subsidy generally starts at 100% FPL, and a person eligible for Medicaid can't get the subsidy.

Emergency Medicaid

Florida: who can qualify for Emergency Medicaid

You must meet every Medicaid rule except immigration status and live in Florida.

  1. Pregnant women with household income up to 196% FPL (the unborn child counts as a household member)
  2. Children under 19 with household income up to 211% FPL (under age 1), 145% (ages 1–5) or 138% (ages 6–18)
  3. Parents or caretakers with little or no income*
  4. Young adults aged 19–20 with little or no income*
  5. People aged 65 or older, blind or disabled, under separate SSI-related rules

Not eligible: adults aged 21–64 who are not pregnant, not disabled and not caring for a child, at any income.

* Little or no income: total household income under about $478 a month for a parent and one child, plus about $122 for each additional household member. A parent or caretaker must live with and care for a child under 18; young adults aged 19–20 follow the same limit. Coverage lasts only as long as the emergency. Source: Florida DCF, Appendix A-7 (April 2026 – March 2027). A medical professional must certify the emergency and its dates, and Emergency Medicaid does not cover care after the birth.

Texas: who can qualify for Emergency Medicaid

You must meet every Medicaid rule except immigration status and live in Texas. A doctor certifies the emergency and the dates it began and ended.

  1. Pregnant women with household income up to 198% FPL
  2. Children under 19 with household income up to 198% FPL (under age 1), 144% (ages 1–5) or 133% (ages 6–18)
  3. Parents or caretakers with little or no income**
  4. People aged 65 or older, blind or disabled, who meet SSI rules except citizenship

Not eligible: adults aged 19–64 who are not pregnant, not disabled and not caring for a child, at any income.

CHIP Perinatal: Texas covers prenatal care for the unborn child of a woman who can't get Medicaid because of her immigration status, up to 202% FPL. The coverage belongs to the unborn child, who will be a U.S. citizen; USCIS doesn't count a child's benefits against the parent, but no guidance addresses CHIP Perinatal specifically. The mother's labor and delivery is billed to Emergency Medicaid, which is her own benefit.

** Little or no income: a monthly limit of $196 for a single parent and one child, $230 for three people and $277 for four (with two parents: $251 for three, $285 for four). Texas also subtracts 5% of FPL from income when that decides eligibility. Source: Texas Health and Human Services, Texas Works Handbook C-131.

Can Emergency Medicaid affect a green card application?

Our reading: it is no longer automatically excluded. It can be considered, but it likely carries less weight than other benefits.

  • Emergency Medicaid is a government program based on income, and the old rule that excluded it was repealed in 2026.
  • The new guidance lets officers consider any government benefit based on income, including applications and approvals.
  • It also tells officers to weigh why Congress made a benefit available to everyone. Emergency care is one of those benefits, so it likely counts for less.
  • No official guidance names Emergency Medicaid yet, and the rule is being challenged in court.

Most adults don't qualify for Emergency Medicaid, and a denied application carries little weight. Ask an immigration attorney before relying on this.

Planned care and elective procedures

Pick a region, then set your household income as a percentage of FPL to see where care would be free. "Pre-screening" shows whether a patient can apply before planned, medically necessary care; elective and cosmetic care is excluded almost everywhere.

No law guarantees a planned surgery or delivery. The hospital's Financial Assistance Policy decides whether an uninsured patient can be pre-screened and approved before care is scheduled.

Emergency or planned

Sources and excerpts

Source excerpts: the exact text behind these statements

Quotes are verbatim; “…” marks omitted text. Retrieved October 7, 2026.

1. Emergency care regardless of status or ability to pay

42 U.S.C. § 1395dd(a)

“In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1)) exists.”

42 U.S.C. § 1395dd(h)

“A participating hospital may not delay provision of an appropriate medical screening examination required under subsection (a) or further medical examination and treatment required under subsection (b) in order to inquire about the individual’s method of payment or insurance status.”

Source: Cornell LII: 42 U.S.C. § 1395dd

2. The rule took effect September 18, 2026

Federal Register 2026-14539, Action and Dates

“U.S. Citizenship and Immigration Services (“USCIS”), Department of Homeland Security (“DHS”). ACTION: Final rule. The final rule is effective on September 18, 2026.”

Federal Register 2026-14539, Dates

“This rule applies to applications for admission made on or after September 18, 2026 or applications for adjustment of status postmarked or electronically submitted on or after September 18, 2026.”

Source: Federal Register: Public Charge Ground of Inadmissibility (July 20, 2026)

3. Officers may consider applying for, approval for, or use of some public benefits

Federal Register 2026-14539, Summary (… marks text omitted)

“DHS is rescinding the 2022 public charge ground of inadmissibility regulations (“2022 Final Rule”)… officers will more accurately assess an alien’s likelihood at any time of becoming a public charge, in the totality of the circumstances, as Congress intended.”

Federal Register 2026-14539, “Future Guidance and Compliance With the APA”

“This guidance will explain how officers will be able to consider the receipt of any means-tested public benefits by the alien”

Federal Register 2026-14539, Dates

“Receipt of means-tested public benefits before September 18, 2026 will be considered consistently with the 2022 Final Rule.”

8 U.S.C. § 1182(a)(4)(A) (the law the rule applies)

“Any alien who, in the opinion of the consular officer at the time of application for a visa, or in the opinion of the Attorney General at the time of application for admission or adjustment of status, is likely at any time to become a public charge is inadmissible.”

USCIS Policy Manual, Vol. 8, Part G, Ch. 2, Receipt (current as of Oct. 2, 2026)

“While not constituting “receipt,” the alien’s own application for, or certification or approval to receive, a benefit in the future may be considered in the totality of the alien’s circumstances along with any evidence that the alien withdrew his or her application or notified the benefit granting agency that he or she wished to disenroll from a benefit he or she was receiving or was approved or certified to receive in the future.”

USCIS Policy Manual, Vol. 8, Part G, Ch. 7

“Additionally, officers will consider any evidence in the record pertaining to whether the alien has applied for any means-tested public benefits and/or whether the alien has been approved or certified to receive any means-tested public benefits on or after September 18, 2026.”

Source: Federal Register: Public Charge Ground of Inadmissibility (July 20, 2026); Cornell LII: 8 U.S.C. § 1182; USCIS Policy Manual, Vol. 8, Part G, Ch. 2: Key Concepts; USCIS Policy Manual, Vol. 8, Part G, Ch. 7: Consideration of Applications, Approvals and Receipt

4. Who is exempt

8 U.S.C. § 1157(c)(3) (refugees)

“The provisions of paragraphs (4), (5), and (7)(A) of section 1182(a) of this title shall not be applicable…”

8 U.S.C. § 1159(c) (adjustment of status for refugees and asylees)

“The provisions of paragraphs (4), (5), and (7)(A) of section 1182(a) of this title shall not be applicable to any alien seeking adjustment of status under this section…”

Form I-485 (Edition 09/18/26), Part 9, Item Number 56

“56. I am exempt from the public charge ground of inadmissibility because I am a/an (select only one box): … Asylee … Refugee … Cuban Adjustment Act …”

USCIS Policy Manual, Vol. 8, Part G, Ch. 3, Exemptions (… marks omitted text)

“The public charge ground of inadmissibility does not apply, based on statutory or regulatory authority, to the following applicants for visas, admission, and adjustment of status (or other immigration benefit requests that require admissibility): Asylees and refugees; … Applicants seeking adjustment under the Cuban Adjustment Act; … Applicants seeking temporary protected status (TPS); …”

Source: Cornell LII: 8 U.S.C. § 1157; Cornell LII: 8 U.S.C. § 1159; USCIS Form I-485; USCIS Policy Manual, Vol. 8, Part G, Ch. 3: Applicability

5. The rule is being challenged in court

Visa Lawyer Blog, Jacob Sapochnick (Oct. 5, 2026), a law-firm article, not a court record

“the new public charge policy is facing multiple federal lawsuits from states, local governments, and immigrant-rights organizations. However, as of October 2026, the policy remains in effect while the litigation continues.”

Source: Visa Lawyer Blog: Public Charge Changes Took Effect September 18, 2026

6. Who can give immigration legal advice

8 CFR § 1292.1(a)

“A person entitled to representation may be represented by any of the following:” The list includes “Any attorney as defined in § 1001.1(f) of this chapter…” and “An individual whom EOIR has authorized to represent immigration patients on…” (accredited representatives).

Federal Trade Commission consumer alert (May 18, 2023)

“notarios (also called notaries or notarios públicos) in the U.S. are not licensed attorneys. They can’t give you legal advice.” and “Some specialized lawyers and accredited representatives can help people with immigration.”

Source: Cornell LII: 8 CFR § 1292.1; FTC: Avoiding scams that target immigrants

7. Which programs may count as public

USCIS Policy Manual, Vol. 8, Part G, Ch. 2, Means-Tested Public Benefits

“A benefit is generally a “public” benefit if the payments or assistance are provided by an agency of the government or by appropriated funds of the government; Examples of public benefits that could potentially be means-tested public benefits … include but are not limited to cash assistance, public or assisted housing, financial aid for postsecondary education, food assistance, government-funded health coverage, or any other similar benefit …”

USCIS Policy Manual, Vol. 8, Part G, Ch. 2, Government

“The term “government,” for the purpose of implementing the public charge ground of inadmissibility, is generally understood to refer to any federal, state, tribal, territorial, or local government entity or entities of the United States.”

Source: USCIS Policy Manual, Vol. 8, Part G, Ch. 2: Key Concepts

Sources on public charge (9)