What health insurance benefits are available to refugees and asylees arriving in the United States?

Are refugees and asylum seekers eligible for Medicaid/CHIP?

Most immigrants are ineligible for Medicaid or CHIP until they’ve been in the United States for five years. Historically, that waiting period has not applied to refugees and asylees, meaning they are eligible for Medicaid as soon as they arrive in the U.S. with asylee or refugee status.⁵

But under H.R. 1, asylees and refugees will no longer be eligible for Medicaid/CHIP as of October 1, 2026. So if a person has an asylee or refugee status, Medicaid/CHIP will not be a coverage option for them starting in October 2026.⁶ (This will apply to both new and existing asylees and refugees; those who have Medicaid coverage will be disenrolled as of October 2026, as they will no longer be eligible for Medicaid.)⁷

But before October 2026, people with asylee or refugee status can access Medicaid. Most of the states have expanded Medicaid eligibility to cover adults under age 65 with household income up to 138% of the federal poverty level (which amounts to $21,597 for a single person in 2025 in the continental U.S., and $51,957 for a household of five; the respective limits are higher in Alaska and Hawaii).⁸ The income limits for Medicaid and CHIP for children are higher and vary by state. Coverage for adult refugees and asylees with higher incomes is discussed below.

In nine states that have not expanded Medicaid, low-income adults are ineligible for Medicaid unless they have minor children, are pregnant, or are disabled. Refugees and asylees are eligible for Medicaid in these states if they fit the eligibility criteria that the states use for other applicants. But if not, these refugees and asylees may be eligible for federal Refugee Medical Assistance, or Marketplace premium tax credits. These programs are described in more detail below.

Medicaid eligibility rules are more strict for people who are 65 or older, but the Refugee Medical Assistance program or premium tax credits in the Marketplace may be available to older refugees and asylees (as explained below, Marketplace subsidies will no longer be available to people with refugee or asylee status starting with plan year 2027).⁹

What is the Refugee Medical Assistance program?

Refugee Medical Assistance (RMA) is a federal program that provides temporary medical coverage to refugees and asylees who aren’t eligible for Medicaid or CHIP but whose income and assets/resources are within the range allowed for RMA.¹⁰ The coverage itself is essentially the same as Medicaid, as outlined in the applicable federal rules. Eligible individuals can receive up to 12 months of RMA benefits (this is for people who become eligible for Office of Refugee Resettlement benefits on or after October 1, 2021; the benefit was previously capped at eight months)¹¹

The RMA eligibility rules vary from one state to another, but states can use various income and resource limits for determining eligibility:¹⁰

• States can use an income limit up to 200% of the federal poverty level, or
• The same income/resource guidelines that apply to medically needy Medicaid eligibility (in states that have medically needy programs), or
• The same income/resource guidelines that apply to the Aid to Families with Dependent Children (AFDC) program.

RMA benefits are available to anyone eligible for refugee cash assistance, assuming they're not eligible for Medicaid or CHIP.

Regardless of income, RMA coverage is available to refugees and asylees¹² who have been in the U.S. for under 12 months, were previously covered by Medicaid, and then lost Medicaid eligibility due to an increase in income. And if a refugee or asylee is receiving RMA and then begins to earn money at a job, the earnings from that job will not affect their ongoing eligibility for RMA benefits.¹⁰

CMS published a fact sheet about health coverage options for Afghan refugees arriving in the U.S., which covers the specific options available depending on refugees' immigrant visa status and state of residence. That document was published in response to the influx of Afghan refugees entering the U.S. in the fall of 2021, so it pre-dates the significant changes created by H.R. 1.

But some of the programs it outlines – including RMA coverage – will continue to be available to eligible refugees post-enactment. Although as noted above, very few refugees have been admitted to the U.S. in 2025.  (Note that after that fact sheet was published, RMA benefits were extended to 12 months, instead of eight months, for refugees who become eligible for benefits on or after October 1, 2021.¹¹)

Can you receive premium tax credits and cost-sharing reductions if you’re a refugee or have been granted asylum?

For refugees who aren’t eligible for Medicaid/CHIP or RMA – or who have exhausted their RMA benefits – premium tax credits and cost-sharing reductions (CSR) can make private health insurance coverage much more affordable than it would otherwise be (CSR benefits reduce the enrollee’s out-of-pocket costs for medical care, while premium tax credits reduce the monthly premiums that must be paid to obtain the coverage).

The premium tax credits and CSR benefits are available via the Marketplace/exchange as long as the applicant has a lawfully present immigration status (including refugees and asylees through the end of 2026), isn’t eligible for affordable, comprehensive employer-sponsored insurance, and isn’t eligible for other types of minimum essential coverage,¹³ including Medicaid/CHIP, Refugee Medical Assistance, or premium-free Medicare Part A.

But starting with the 2027 plan year, Marketplace subsidies will no longer be available to refugees or asylees, due to H.R. 1.⁹

For the 2026 plan year, however, refugee or asylee status will still allow a person to enroll in subsidized Marketplace coverage. These plans – with subsidies if the person is eligible for them – can be obtained during open enrollment or a special enrollment period. Open enrollment for 2026 coverage runs from November 1, 2025 to January 15, 2026 in most states. Most special enrollment periods are triggered by a specific qualifying life event (which includes gaining lawfully present immigration status).