H.R. 1, the bill passed by Congress in 2025, makes major changes to Medicaid, known in Washington state as Apple Health.
Two of the most talked-about changes—work requirements and more frequent eligibility checks for many adult enrollees—will not begin until January 1, 2027. But another significant change will arrive much sooner and affect one major group: non-U.S. citizens.
Beginning October 1, 2026, many immigrants who currently qualify for Apple Health may lose eligibility because of new federal restrictions. According to state officials, these changes could leave thousands of immigrants in Washington without the health insurance they rely on today.
The Washington State Health Care Authority (HCA), which oversees and administers Apple Health, estimates that roughly 20,000 enrollees could lose coverage because of the new noncitizen eligibility rules alone. The overall impact of H.R. 1 is expected to be much larger.
– Kush D., Program Manager for Immigrant and Refugee Health at Community Health Plan of Washington (CHPW)
Let’s break down what will change for immigrants and what options may be available if you’re affected.
What will happen?
Starting October 1, 2026, the federal definition used to determine Apple Health eligibility for noncitizens will change. As a result, some immigrants who currently have Apple Health may no longer qualify.
Who is affected?
People with any of the following immigration statuses will no longer be eligible for Apple Health after September 30, 2026:
- Asylees
- Refugees
- Conditional entrants
- Individuals for whom deportation or removal has been withheld
- Victims of trafficking
- Violence Against Women (VAWA) self-petitioners
- Parolees, including:
- Afghans paroled under the Afghan Allies Protection Act of 2006
- Afghans granted humanitarian parole between July 31, 2021, and Sept. 30, 2023
- Ukrainians granted humanitarian parole between Feb. 24, 2022, and Sept. 30, 2024
Who is still eligible?
The following groups are not affected by the federal change and may continue to qualify for full Apple Health coverage if they meet all other requirements:
- Green card holders (also known as lawful permanent residents) who have met, or are exempt from, the 5-year waiting period
- COFA migrants (from the Marshall Islands, Micronesia, and Palau)
- Cuban/Haitian entrants
What other coverage options do I have?
Losing full Apple Health coverage does not necessarily mean losing all health coverage. Some noncitizens will remain eligible for Apple Health programs paid for by the state, including:
- Emergency Medical (AEM)
- Apple Health for Pregnant Individuals
- After-Pregnancy Coverage (APC)
Community Health Centers (CHCs) treat everyone regardless of immigration status and offer sliding‑scale fees based on income. They can be a reliable place to get care even if your Apple Health coverage changes.
If you no longer qualify for Apple Health, you can still buy coverage through Washington Healthplanfinder. You’ll have a 60-day Special Enrollment Period from the date your coverage ends to sign up for a new plan. Several insurers, including CHPW, offer Cascade Select plans for individuals and families through Healthplanfinder. These state-approved health plans aim to provide quality coverage at a lower cost.
These plans may have monthly costs, called premiums, so they are not a one-to-one replacement for Apple Health. However, depending on your income, you may be eligible for state financial help that can significantly lower what you pay.
Any health coverage matters because medical care can be very expensive. Health insurance helps protect you and your family from large, unexpected medical bills, covers prescription medications, and makes it easier to see a doctor when you are sick. Most private health plans also cover preventive care—like yearly check-ups, vaccines, and health screenings—at no cost to you when you see a network provider.
Immigrant health care resources
- Health Care Affordability Resources for People Losing Coverage in Washington (PDF)
- ¿Perdió su cobertura médica? Recursos de asequibilidad en Washington (PDF)
Source: Northwest Health Law Advocates
What should I do now?
If you’re on an Apple Health plan—especially Apple Health for Adults—make sure your phone number, email, and mailing address in Washington Healthplanfinder are up to date. Also keep your contact information current with your health plan so they can reach you about renewals, notices, or changes to your coverage.
Also report a change or update your information in Washington Healthplanfinder by August 10, 2026, if any of the following apply to you as a noncitizen:
- Change in immigration status
- Currently pregnant
- Had a pregnancy end after October 2025
- Receiving cancer treatment, anti-rejection medication, or dialysis
- Receiving or received emergency medical services
Keeping your information current helps make sure your eligibility is calculated the right way and lowers the chance of losing coverage because of old or incorrect details.
If you or someone in your household may be affected by these noncitizen eligibility changes to Apple Health, HCA will send you a letter or email this summer explaining what’s happening and what steps you can take to explore other coverage options.
You are not alone
Navigating health coverage changes can feel overwhelming, but help is available. Your health plan, community partners, health navigators, and local resources can help you understand your options, find available coverage, and stay connected to the care you need.
For the latest official state updates on Apple Health changes, visit the Washington State Health Care Authority (HCA) website.
CHPW has a webpage on health care resources for immigrants.
Additional resources
- HCA: H.R.1 impacts for noncitizens on Apple Health (PDF)
- HCA: Noncitizen changes coming to Apple Health eligibility (PDF)
- HCA: Changes coming to Apple Health