Overview

A new U.S. law called the One Big Beautiful Bill Act (OB3) is changing some of the rules for Medicaid.

Starting October 1, 2026, the federal government will only allow certain adult non-citizens (21+) to get Medicaid.

Who Stays Eligible?

The only adult non-citizen groups who will be eligible for full federally funded Medicaid coverage will be:

1. Lawful Permanent Residents (LPRs), also known as Green Card holders. (Note: Adults may be subject to a 5-year waiting period unless they meet an exception).
2. Cuban and Haitian entrants.
3. Compact of Free Association (COFA) migrants from the Marshall Islands, Micronesia, and Palau.
4. Lawfully residing children and pregnant people.

Exceptions to the Five-Year Bar

Most adults who are LPRs must have held their Green Card for at least five years before they can get Medicaid. This is often called the “five-year bar” or waiting period. Some LPRs do not have to wait five years. You can be exempt from the waiting period if you have:

• Humanitarian Status: You transitioned to a Green Card from a refugee, asylee, Amerasian immigrant or immigrant with deportation withheld, you are exempt from the five-year waiting period. There are other humanitarian statuses that qualify. If you are unsure about your status, please contact us to check
• Military Connection: You are a veteran, on active duty, or the spouse/dependent of one.
• Significant Work History: You have 10 years (40 quarters) of work history in the U.S.

Note for Refugees and Asylees: Under these new rules, refugees and asylees who have not yet transitioned to LPR (Green Card) status will generally lose their eligibility for full federal Medicaid on October 1, 2026.

Protections for Children and Pregnant People

Children (under age 21) and pregnant individuals who are lawfully residing in the U.S. will remain eligible for Medicaid.

• No 5-Year Wait: Children and pregnant people do not have to wait five years for coverage.
• Postpartum Coverage: In the District of Columbia, coverage for pregnant individuals continues for 12 months after the pregnancy ends.

Who will no longer be eligible?

Under the new rules, the following adult non-citizen groups will generally no longer qualify for full Medicaid benefits:

Humanitarian and Special Statuses

• Refugees, Amerasian Immigrants and Asylees (if they do not yet have a Green Card).
• People paroled into the U.S. for at least one year.
• Certain Afghan and Ukrainian parolees.
• Survivors of trafficking and their qualifying family members.

Legal and Court-Ordered Statuses

• People with "Withholding of Deportation" or removal.
• People with "Conditional Entry" granted before April 1, 1980.
• Victims of battery or extreme cruelty by a U.S. citizen or Green Card-holding relative.

Other Specific Groups

• American Indians born in Canada who are members of a federally recognized tribe.
• Veterans and active-duty service members (and their families) who do not meet other new citizenship rules (if they do not yet have a Green Card).
• Most other "lawfully residing" non-citizens are not listed as eligible.

No Medicaid? You can still get Emergency Care.

The Emergency Medicaid program helps pay the cost of emergency medical services for individuals who do not qualify for Medicaid due to their citizenship/immigration status. An emergency means the sudden onset of a medical condition, such as labor and delivery, and without medical attention could result in placing your health in serious jeopardy, serious impairment of bodily functions, or serious dysfunction of any bodily organ or part. To learn more about Emergency Medicaid, visit DC Emergency Medicaid website. 

What Should You Do Next?

Please tell DC Medicaid about any changes to your immigration status. We need your most current documents to ensure your records are accurate.

Examples of what to report:

• Receiving a new Employment Authorization Document (EAD/Work Permit).
• Becoming a Lawful Permanent Resident (getting a Green Card).
• Naturalization (becoming a U.S. Citizen).
• Any change in your visa category.

Connect with Us!

Do you have questions about your Medicaid coverage or the new federal rules? Visit our community webinar page to learn more. Click here. 

• Visit us Online: Log in to District Direct at www.districtdirect.dc.gov or through the Mobile Application to check the immigration and contact information we have on file.  We encourage you to update that information if it is incorrect.
• Call Us: Contact the District Direct Call Center at 1-202-727-5355
• In-Person: Visit any service center near you.  See locations below:
  • Anacostia, 2100 Martin Luther King Ave, SE
  • Congress Heights: 4049 South Capitol Street, SW
  • Fort Davis: 3851 Alabama Avenue, SE
  • H Street: 645 H Street NE
  • Taylor Street: 1207 Taylor Street NW