Guide

Immigration status and benefits for nursing home and senior care

Updated October 15, 2026 · Reviewed against official sources

Before you start. This guide is general information to help families get their bearings. It is not legal or immigration advice. Each case depends on the person's exact status, their date of entry and the state where they live. The rules are being put into effect over these months, and some dates may still change.

Why immigration status matters for long-term care

Medicare doesn't pay for a long stay in a nursing home. For most families with limited means, Medicaid is what pays for it. So if your mom or dad is not a citizen, whether they can get Medicaid is one of the first questions to answer when you plan their care. The same goes for Medicaid programs that pay for a caregiver at home or an adult day center. Read Does Medicaid pay for a nursing home? and what Medicare covers for long-term care to see the full picture.

In this guide, when we talk about an asylee or political asylum, we mean an immigration status, not a care home.

Federal Medicaid as of October 1, 2026

Federal law P.L. 119-21, signed on July 4, 2025 (section 71109), changed who can get Medicaid and CHIP paid for with federal funds. According to CMS's letter to the states, SHO #26-001, starting October 1, 2026, only the following people qualify, as long as they also meet all the other requirements:

• U.S. citizens and nationals.
• Lawful permanent residents (LPRs, with a green card).
• Cuban and Haitian entrants.
• Migrants from the Freely Associated States (COFA): Micronesia, the Marshall Islands and Palau.

What this means in practice:

• The 5-year wait stays the same. Many permanent residents still have to wait 5 years after they get their green card before they can receive federal Medicaid. There are exceptions, for example for veterans and active-duty service members and their families.
• Some groups lose federal coverage. Refugees, asylees, people with parole, victims of trafficking and other groups that used to qualify no longer get full federal Medicaid, unless they also have one of the statuses on the list. This includes older adults: for example, a 70-year-old asylee who is not yet a permanent resident may lose federal Medicaid for a nursing home.
• States can decide. CMS said that states are not required to keep covering these groups with their own funds, but some choose to do so.
• No one loses coverage without notice. Before ending someone's coverage, the state must check whether they qualify in another way, ask for documents if needed, and send a written notice at least 10 days in advance, with the right to a fair hearing. Open and answer all mail from Medicaid and meet every deadline.
• Help with Medicare premiums counts too. Medicare Savings Programs, which help pay premiums and copays, are part of Medicaid and follow the same rules.

Emergency Medicaid

Emergency Medicaid still exists for people who meet every requirement except the immigration one, including people who are undocumented. It covers treatment for an emergency medical condition, for example care in the emergency room or a hospital stay for an emergency.

In general, it does not cover long-term care in a nursing home or home care services, because they are not considered an emergency. California is an exception, as explained below.

Medicare and immigration status

The same law (section 71201) limited Medicare to citizens and nationals, permanent residents (who must be 65 or older and have 5 years of continuous residence to buy Medicare), Cuban and Haitian entrants, and COFA migrants.

• For new applications, the restriction has applied since July 4, 2025.
• People who already had Medicare and are not in those groups (for example, some refugees, asylees, or people with TPS or parole who qualified through their work history) may lose Medicare. The law gives an 18-month period starting in July 2025, which ends in early January 2027, and directs Social Security to notify each person clearly.
• A rule proposed by CMS in July 2026 would end this coverage on February 1, 2027, with the right to appeal. It is a proposal: the final date is not confirmed yet.
• Social Security retirement benefits don't change: the person keeps receiving them even if they lose Medicare.

If your loved one gets a letter from Social Security about Medicare, read it calmly, write down the dates and get guidance soon. Your state's free Medicare counseling program (SHIP) and legal aid organizations can go over it with you.

State-funded programs

Some states use their own funds to cover people who don't qualify for federal Medicaid. The rules change often, and several programs have closed enrollment.

• California: California's restricted-scope Medi-Cal (emergency Medi-Cal) does include nursing home care, as well as emergencies and pregnancy. This is unique to California. Since January 1, 2026, adults 19 or older without satisfactory immigration status who apply for the first time qualify only for restricted-scope Medi-Cal; people who were already enrolled keep full coverage if they renew on time. According to DHCS, refugees, asylees and other groups affected by the federal law keep full state-paid Medi-Cal until June 30, 2027, with changes expected after that. See our guide to Medi-Cal and IHSS.
• Illinois: the program for people 65 or older without immigration status (HBIS) continues for people who were already enrolled, but enrollment is paused and new applications are not being accepted.
• Other states and the District of Columbia: some have or have had state programs for adults regardless of their status, often with age limits, enrollment caps or closed enrollment. Ask your state's Medicaid office directly what is available today.

Public charge

"Public charge" is a test that immigration officials apply in certain processes, such as some green card applications, to decide whether a person might depend on the government in the future.

• Benefits received before September 18, 2026: according to USCIS, only cash assistance for income maintenance (such as SSI) and long-term institutional care paid for by the government, for example a nursing home paid for by Medicaid, are considered.
• Benefits received on or after September 18, 2026: under the new Department of Homeland Security (DHS) rule, the officer may consider public benefits based on financial need, including Medicaid and SNAP, as part of a review of the person's whole situation. Getting a benefit does not, by itself, mean the application will be denied.
• The rule is being challenged in court. On September 14, 2026, the New York attorney general and 21 other states, along with the District of Columbia, filed a lawsuit to overturn it. What the courts decide could change the situation.
• Many people are not subject to this test. For example, refugees, asylees, Cuban and Haitian entrants, people applying for TPS and other groups protected by law. Most permanent residents who apply for citizenship are not subject to this test either.
• Other family members' benefits: whether benefits received by another family member (for example, a child who is a citizen) count is one of the points still being debated. Ask a lawyer about your specific case.

Before you cancel or turn down a benefit out of fear, talk with an expert. Many people are not affected, and giving up coverage for a nursing home or home care can seriously affect your loved one's health.

Where to find trustworthy legal help

• An immigration lawyer, for example at a nonprofit organization.
• An accredited representative, meaning someone accredited by the Department of Justice (DOJ). The official directory of recognized organizations and accredited representatives is on the EOIR website (justice.gov/eoir).
• Legal aid organizations and university law clinics.

A useful fact about "notarios": in the U.S., a notary public is not a lawyer and is not allowed to give immigration advice, even though in other countries the word "notario" means something different. For immigration matters, always look for a lawyer or an accredited representative from the official directory.

What your family can do today

1. Gather your loved one's immigration documents (green card, asylum approval letter, I-94, etc.) and keep copies in a safe place.
2. Open every letter from Medicaid, Medicare and Social Security, and write the deadlines on a calendar.
3. Talk with a lawyer or an accredited representative before you apply for a benefit or drop one.
4. Ask your state's Medicaid office whether there are state programs for your situation.
5. If your loved one needs care now, look for options in our directory, check the typical costs and consider home care or an adult day center.
6. If you are your loved one's caregiver, read help for family caregivers and free programs for older adults.

💬Frequently asked questions

My mom has had a green card for 3 years. Can she get Medicaid?

In general, most permanent residents must wait 5 years for federal Medicaid, with some exceptions. Some states cover people sooner with their own funds. Ask your state's Medicaid office.

If my dad is an asylee and already lives in a nursing home on Medicaid, what happens now?

It depends on the state. The state must review his case and send him a written notice before making any change, with the right to a hearing. If your dad also has a green card, he still qualifies. Answer the letters on time and get legal help.

Does using emergency Medicaid affect public charge?

According to USCIS, benefits received on or after September 18, 2026, may be considered in some immigration processes. Because the rule is being challenged in court and every case is different, talk with a lawyer before you decide. Never avoid getting care in an emergency: call 911 if there is immediate danger.

Rules vary by state and change often; this guide is not legal or immigration advice.

Sources

• CMS, SHO letter #26-001 on noncitizen eligibility: https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf (accessed October 15, 2026)
• CMS, summary of the Medicaid and CHIP provisions of P.L. 119-21: https://www.medicaid.gov/federal-policy-guidance/downloads/cib11182025.pdf (accessed October 15, 2026)
• Federal Register, proposed rule CMS-1848-P (includes Medicare and immigration status): https://www.federalregister.gov/documents/2026/07/16/2026-14327/medicare-and-medicaid-programs-cy-2027-payment-policies-under-the-physician-fee-schedule-and-other (accessed October 15, 2026)
• Federal Register, DHS final rule on public charge: https://www.federalregister.gov/documents/2026/07/20/2026-14539/public-charge-ground-of-inadmissibility (accessed October 15, 2026)
• USCIS, guidance on public charge: https://www.uscis.gov/newsroom/alerts/uscis-issues-guidance-on-making-public-charge-inadmissibility-determination (accessed October 15, 2026)
• New York Attorney General's Office, lawsuit against the public charge rule (September 14, 2026): https://ag.ny.gov/press-release/2026/attorney-general-james-leads-major-challenge-trump-administrations-attack (accessed October 15, 2026)
• California DHCS, tracking the federal impact on Medi-Cal eligibility: https://www.dhcs.ca.gov/tracking-federal-impact-medi-cal-eligibility/ (accessed October 15, 2026)
• California DHCS, frequently asked questions on immigrant eligibility: https://www.dhcs.ca.gov/medi-cal-immigrant-eligibility-faqs/ (accessed October 15, 2026)
• Illinois HFS, coverage for immigrant seniors: https://hfs.illinois.gov/medicalclients/coverageforimmigrantseniors.html (accessed October 15, 2026)
• DOJ/EOIR, roster of recognized organizations and accredited representatives: https://www.justice.gov/eoir/recognized-organizations-and-accredited-representatives-roster-state-and-city (accessed October 15, 2026)

This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.

👉Keep reading

Does Medicaid pay for care?

Yes, Medicaid pays for a nursing home if your loved one qualifies. 2026 limits, the 5-year look-back, spouse protections, waivers and how to apply.

Medi-Cal and IHSS

How Medi-Cal pays for a nursing home and how IHSS pays a caregiver at home, even a family member. The 2026 asset limit, CBAS and how to apply.

Home care

A caregiver from an agency or hired by your family, Medicare home health and Medicaid (IHSS, STAR+PLUS): typical costs and your duties as an employer.

Help for family caregivers

What the National Family Caregiver Support Program is, who qualifies, its five services and how to apply. Plus FMLA and Medicaid for family caregivers.