Maryland Medicaid Tightens in Two Waves: 4,500 Lawfully Present Immigrants Lose Coverage Oct. 1; Work Rules Hit 320,000 in January
ANNAPOLIS, Md. — Sweeping changes to Medicaid under congressional Republicans' One Big Beautiful Bill Act are hitting Maryland in two waves: about 4,500 immigrants living legally in the state lost eligibility for full Medicaid coverage on October 1, and new work and renewal requirements taking effect January 1 will affect about 320,000 low-income adults.
Signed by President Donald Trump on July 4, 2025, the law is expected to cut federal spending by more than $900 billion through 2034 for the jointly funded federal-state program that helps people with low incomes or disabilities pay for health care. The White House said at the signing that the law would strengthen the program by eliminating waste, fraud and abuse. People living in the country without authorization have long been ineligible for federally funded Medicaid; the new law, however, reaches immigrants living here legally and low-income adults, including many U.S. citizens.
"The law passed and we have to stay in compliance with the law," Maryland Health Secretary Meena Seshamani told Capital News Service. But she said she is deeply concerned: "When people lose their health insurance, they're not able to go see a doctor when they get sick… and the downstream impact of that on the lives of people in our community and their families is really, really, really concerning."
October: certain immigrants lose Medicaid. The October 1 cutoff ends full Medicaid eligibility for certain lawfully present adults: refugees, asylees, people granted temporary humanitarian permission to enter or remain in the U.S. for at least a year — including some Afghans and Ukrainians — and certain abuse or trafficking survivors, the health department said. About 4,500 enrollees received notices in August that their full coverage would end, said health department spokesperson Amanda Hils. Green card holders who meet or are exempt from a five-year waiting period, Cuban and Haitian entrants, and migrants covered by the Compacts of Free Association can still qualify. Children and pregnant women will keep their coverage, and emergency care remains unaffected.
January: work rules and twice-yearly renewals. Beginning January 1, low-income Maryland adults ages 19 to 64 who qualify for Medicaid through the Affordable Care Act expansion will face new federal work requirements and will have to renew coverage every six months instead of once a year. In Maryland, this coverage generally extends to adults earning up to 138% of the federal poverty level — about $22,000 a year for one person — a group that makes up about 22% of the state's roughly 1.5 million Medicaid enrollees.
They can meet the new rules by earning at least $580 a month, attending school at least half-time, or completing 80 hours a month of qualifying work, training or volunteering. Exemptions include pregnancy, caring for a child younger than 14 or a person with a disability, and being deemed "medically frail." The Maryland Department of Health projects about 152,000 adults could lose coverage by June 2028 — raised from an earlier projection of 115,000 after federal regulators issued an interim final rule in June. An Urban Institute analysis projects the rules could leave 102,000 to 207,000 fewer Maryland adults enrolled in an average month in 2028.
Attorney General Anthony Brown has joined a multistate lawsuit challenging parts of the federal rule, arguing the federal government unlawfully narrowed protections for medically frail people.
County officials fear the heaviest toll will fall on immigrant communities and on eligible residents who get lost in the paperwork. "I think the situation is terrible and cruel, to put it lightly," said Nina Ashford, Montgomery County's chief of public health services, noting the changes could disproportionately affect Maryland's most diverse county. Andrew Ballard, Prince George's County's chief of public health policy and innovation, said many residents have already brought Medicaid notices to the health department for review, and some disenrolled before October 1 expecting to lose coverage: "When a resident loses Medicaid, care typically shifts or in some instances stops altogether."
Vincent DeMarco, president of the Maryland Health Care for All Coalition, warned that coverage losses could raise costs for people who remain insured, as more uninsured patients turn to hospitals. His coalition's five-point plan includes a proposed 10-cent-per-drink increase in the alcohol tax, which he said could raise nearly $220 million. Seshamani said the state has a $25 million fund for federally qualified health centers so people who lose insurance will still have a place to seek care.
Impact: Another January 1 change will also cut retroactive Medicaid coverage of bills incurred before enrollment from three months to one for ACA expansion adults and two for other enrollees — a shift Ashford warned "could saddle folks who are eligible for Medicaid with massive amounts of debt." For Maryland's Chinese American community, the message from health officials is to check renewal notices carefully, use navigators and community organizations for help with the new paperwork, and seek care at federally qualified health centers if coverage lapses.
Published by GSM · USA (original Chinese edition)
Photo: P. Hughes 摄，CC BY-SA 4.0（Wikimedia Commons）
