H.R.1 Non-Citizenship Medicaid FAQs

MO HealthNet (Missouri Medicaid)

When does the H.R.1 non-citizen Medicaid change take effect?

The H.R.1 non-citizen Medicaid change takes effect on October 1, 2026. Non-citizens who do not meet the H.R.1 citizenship or immigration status requirements may lose Medicaid eligibility on that date.

Why are some non-citizens no longer eligible for Medicaid under H.R.1?

H.R.1 created new citizenship and immigration status requirements for Medicaid. Because of these new requirements, some non-citizens may no longer be eligible for Medicaid.

Which non-citizen statuses are affected by H.R.1 Medicaid changes?

Under H.R.1, some non-citizen statuses are no longer listed as eligible for Medicaid. These include refugees, asylees, Amerasians, trafficking victims, immigration parolees, non-citizen U.S. veterans and their family members, and American Indians born in Canada. To be eligible for Medicaid under H.R.1, you must be one of the following:

  • A U.S. citizen
  • A U.S. national
  • A Cuban or Haitian Entrant
  • A Compact of Free Association (COFA) Migrant
  • A Lawful Permanent Resident, also called a green card holder, who meets or is exempt from the 5-year bar
How will I know if I no longer qualify for Medicaid because of my citizenship or immigration status?

FSD will send you a notice before ending your Medicaid coverage if you are affected by this change. To be eligible for Medicaid under H.R.1, you must be one of the following:

  • A U.S. citizen
  • A U.S. national
  • A Cuban or Haitian Entrant
  • A COFA Migrant
  • A Lawful Permanent Resident, also called a green card holder, who meets or is exempt from the 5-year bar
If I apply for Medicaid before October 1, 2026, can I get coverage until that date?

Yes, if you meet the Medicaid eligibility rules in place before H.R.1. The H.R.1 citizenship and immigration status requirements do not take effect until October 1, 2026. Applications received before that date will be reviewed using the Medicaid eligibility rules in place before H.R.1. Starting October 1, 2026, the H.R.1 requirements will apply.

Can I apply after October 1, 2026 and get coverage for months before that date?

Yes, if you were eligible under the rules in effect during those months. If you apply on or before December 31, 2026, you can get up to 3 months of retroactive coverage for months in which you met the eligibility rules that applied at that time and had unpaid medical bills. For example, a refugee who applies in December 2026 can be covered for September 2026, when refugees were still eligible—but not for October or November 2026, because the H.R.1 requirements applied in those months. December 2026 is the last month an application can reach back to September 2026. For applications made on or after January 1, 2027, retroactive coverage is limited to 1 month for the Adult Expansion Group (AEG) and 2 months for most other coverage groups.

I am a refugee or asylee. Can I still get Medicaid under H.R.1?

No. Under H.R.1, refugees and asylees are not listed as non-citizen statuses that can still get Medicaid. To be eligible for Medicaid under H.R.1, you must be one of the following:

  • A U.S. citizen
  • A U.S. national
  • A Cuban or Haitian Entrant
  • A COFA Migrant
  • A Lawful Permanent Resident, also called a green card holder, who meets or is exempt from the 5-year bar

Individuals who do not meet immigration status requirements may still qualify for Show-Me Healthy Babies (SMHB) or emergency coverage.

I am a Lawful Permanent Resident. Do I still have to wait 5 years?

Yes, but the 5-year bar may still apply. Lawful Permanent Residents, also called green card holders, may still be eligible if they have met the 5-year bar or are exempt from the 5-year bar.

I am a Lawful Permanent Resident. Who is exempt from the 5-year bar?

Lawful Permanent Residents, also called green card holders, do not have to wait 5 years if any of the following apply:

  • You had one of these statuses before becoming a Lawful Permanent Resident: refugee, asylee, Amerasian, Cuban or Haitian Entrant, trafficking victim, or a person granted withholding of removal
  • You are a veteran or active-duty member of the U.S. armed forces, or the spouse, unmarried dependent child, or unremarried surviving spouse of one
  • You are an American Indian born in Canada or a member of a federally recognized Indian tribe
  • You entered the United States before August 22, 1996

If you become a Lawful Permanent Resident after holding an exempt status, you keep the exemption.

Are refugees still eligible for Medicaid under H.R.1?

No. Under H.R.1, refugees are not listed as one of the non-citizen statuses that can still get Medicaid. To be eligible for Medicaid under H.R.1, you must be one of the following:

  • A U.S. citizen
  • A U.S. national
  • A Cuban or Haitian Entrant
  • A COFA Migrant
  • A Lawful Permanent Resident, also called a green card holder, who meets or is exempt from the 5-year bar

Individuals who do not meet immigration status requirements may still qualify for Show-Me Healthy Babies (SMHB) or emergency coverage.

Are asylees still eligible for Medicaid under H.R.1?

No. Under H.R.1, asylees are not listed as one of the non-citizen statuses that can still get Medicaid. To be eligible for Medicaid under H.R.1, you must be one of the following:

  • A U.S. citizen
  • A U.S. national
  • A Cuban or Haitian Entrant
  • A COFA Migrant
  • A Lawful Permanent Resident, also called a green card holder, who meets or is exempt from the 5-year bar

Individuals who do not meet immigration status requirements may still qualify for Show-Me Healthy Babies (SMHB) or emergency coverage.

Are Amerasians still eligible for Medicaid under H.R.1?

No. Under H.R.1, Amerasians are not listed as one of the non-citizen statuses that can still get Medicaid. To be eligible for Medicaid under H.R.1, you must be one of the following:

  • A U.S. citizen
  • A U.S. national
  • A Cuban or Haitian Entrant
  • A COFA Migrant
  • A Lawful Permanent Resident, also called a green card holder, who meets or is exempt from the 5-year bar

Individuals who do not meet immigration status requirements may still qualify for Show-Me Healthy Babies (SMHB) or emergency coverage.

Do trafficking victims still qualify for Medicaid under H.R.1?

No. Under H.R.1, trafficking victims are not listed as one of the non-citizen statuses that can still get Medicaid. To be eligible for Medicaid under H.R.1, you must be one of the following:

  • A U.S. citizen
  • A U.S. national
  • A Cuban or Haitian Entrant
  • A COFA Migrant
  • A Lawful Permanent Resident, also called a green card holder, who meets or is exempt from the 5-year bar

Individuals who do not meet immigration status requirements may still qualify for Show-Me Healthy Babies (SMHB) or emergency coverage.

Are non-citizen U.S. veterans or their family members still eligible for Medicaid under H.R.1?

No. Under H.R.1, non-citizen U.S. veterans and their family members are not listed as one of the non-citizen statuses that can still get Medicaid. To be eligible for Medicaid under H.R.1, you must be one of the following:

  • A U.S. citizen
  • A U.S. national
  • A Cuban or Haitian Entrant
  • A COFA Migrant
  • A Lawful Permanent Resident, also called a green card holder, who meets or is exempt from the 5-year bar

Individuals who do not meet immigration status requirements may still qualify for Show-Me Healthy Babies (SMHB) or emergency coverage.

Do immigration parolees still qualify for Medicaid under H.R.1?

No. Under H.R.1, immigration parolees* are not listed as one of the non-citizen statuses that can still get Medicaid.

*Immigration parole is a temporary permission granted by the U.S. government that allows someone who is not a U.S. citizen to enter or remain in the United States for a limited time, even without a visa or formal admission. It’s granted case‑by‑case for urgent humanitarian reasons or when there’s a significant public benefit.

This does not refer to U.S. citizens who are on parole through the criminal justice system. 

To be eligible for Medicaid under H.R.1, you must be one of the following:

  • A U.S. citizen
  • A U.S. national
  • A Cuban or Haitian Entrant
  • A COFA Migrant
  • A Lawful Permanent Resident, also called a green card holder, who meets or is exempt from the 5-year bar

Individuals who do not meet immigration status requirements may still qualify for Show-Me Healthy Babies (SMHB) or emergency coverage.

Do non-citizen children qualify for Medicaid under H.R.1?

No, Non-citizen children must meet the same citizenship or immigration status rules as adults.

Being a child does not create a separate exception under H.R.1.

Do Cuban or Haitian Entrants qualify for Medicaid under H.R.1?

Yes. Cuban or Haitian Entrants can receive Medicaid right away if they meet all other eligibility rules. A Cuban or Haitian Entrant generally means a national of Cuba or Haiti who was paroled into the United States, is in removal proceedings, or has a pending asylum application. See 45 CFR 401.2 for the full definition.”

Do COFA Migrants qualify for Medicaid under H.R.1?

Yes. COFA Migrants can receive Medicaid right away if they meet all other eligibility rules.

I am an American Indian born in Canada. Can I get Medicaid under H.R.1?

No. Under H.R.1, American Indians born in Canada are not listed as one of the non-citizen statuses that can still get Medicaid. You may be eligible if your status changes to Lawful Permanent Resident, also called a green card holder, and you meet or are exempt from the 5-year bar.

Individuals who do not meet immigration status requirements may still qualify for Show-Me Healthy Babies (SMHB) or emergency coverage.

Are pregnant non-citizens eligible for Medicaid under H.R.1?

Pregnant non-citizens must meet the same citizenship or immigration status rules as other adults. To be eligible for Medicaid under H.R.1, a pregnant non-citizen must be one of the following:

  • A U.S. citizen
  • A U.S. national
  • A Cuban or Haitian Entrant
  • A COFA Migrant
  • A Lawful Permanent Resident, also called a green card holder, who meets or is exempt from the 5-year bar

Pregnant individuals who do not meet immigration status requirements may still qualify for Show-Me Healthy Babies Program (SMHB) or emergency coverage.

Are undocumented immigrants eligible for Medicaid under H.R.1?

No. To be eligible for Medicaid under H.R.1, you must be one of the following:

  • A U.S. citizen
  • A U.S. national
  • A Cuban or Haitian Entrant
  • A COFA Migrant
  • A Lawful Permanent Resident, also called a green card holder, who meets or is exempt from the 5-year bar

Individuals who do not meet immigration status requirements may still qualify for Show-Me Healthy Babies (SMHB) or emergency coverage.

If I am a qualified non-citizen, can I get retroactive Medicaid coverage for past medical bills?

Yes, if you were eligible during that time. Adults in the Adult Expansion Group, also called AEG, may get up to 1 month of retroactive Medicaid coverage. People in other Medicaid coverage groups may get up to 2 months of retroactive Medicaid coverage. For applications made before January 1, 2027, up to 3 months of retroactive coverage may be available.

Do non-citizens have to meet community engagement requirements?

Certain adults enrolled in the Adult Expansion Group may be subject to Community Engagement Requirements. Some people are exempt or may otherwise not be subject to the requirements.

Are people who are blind or disabled exempt from the 5-year bar?

Yes. Lawful Permanent Residents who are blind or disabled under Supplemental Security Income (SSI) or Social Security Disability standards are exempt from the 5-year bar.

What happens if my status changes to Lawful Permanent Resident?

If your status changes to Lawful Permanent Resident, also called a green card holder, your Medicaid eligibility will be reviewed again to see if you still qualify.

How do I report a change in my citizenship or immigration status?

You may report a change online, by phone, by fax, by mail, or by visiting your local FSD office.