Here’s who does — and doesn’t — qualify for health care benefits as an immigrant in Colorado

Health care policy is changing in the United States, including for immigrants, whose eligibility for federal benefits will be restricted following the passage of congressional Republicans’ new tax and budget law. 

The so-called “big, beautiful bill,” which was signed into law on July 4 by President Donald Trump, narrows which immigrant populations can apply for Medicaid and enroll in health insurance plans through public marketplaces under the Affordable Care Act.

In Colorado, however, immigrants have more options to access health care coverage that might otherwise be unattainable after the state legislature passed laws to expand coverage to more people regardless of their immigration status. 

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Here’s a look at what is, and isn’t, changing and what it means for Colorado immigrants: 

Who currently qualifies for Medicaid?

In Colorado and across the U.S., immigrants who are “lawfully” present and meet a certain “qualified” status are eligible to receive Medicaid. 

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That can include: 

• Lawful permanent residents, commonly referred to as green card holders
• Asylees and refugees
• Victims of trafficking, torture and domestic violence 
• Parolees and other visa holders

In most cases, however, Medicaid coverage isn’t granted automatically, and immigrants usually have to wait five years before they can enroll. Immigrants who are undocumented or don’t meet the definition of having a “qualified” status, such as those with Temporary Protected Status or those enrolled in the Deferred Action for Childhood Arrivals, are generally not eligible for Medicaid. 

“The people who may not be qualified for Medicaid are not always undocumented,” said Adela Flores-Brennan, Medicaid director for the Colorado Department of Health Care Policy and Financing, “they just may not have a qualifying immigrant status that makes them eligible for Medicaid.” 

There are some exceptions for pregnant women and children. Emergency Medicaid also provides reimbursements to hospitals that provide care for undocumented immigrants during life-threatening situations. That provision accounts for a sliver of Medicaid spending, however, representing less than 1% of the program’s total costs. 

In Colorado, immigrants who are pregnant or post-partum, or under the age of 19, can receive Medicaid coverage regardless of their immigration status under the state’s new Cover All Coloradans program. 

The program was created by the legislature in 2022 and launched in 2025. As of July, enrollment exceeded 22,000 people, and the program’s costs were upwards of $51 million, according to Colorado Department of Health Care Policy spokesperson Marc Williams. 

Coverage for children comes solely from state Medicaid funds, while pregnant and postpartum coverage comes from a mix of state and matching federal dollars. Williams also emphasized that enrollment and cost estimates are still preliminary, and the state will have a better idea of the true number in November.

Because some of the program’s funding comes from matching federal dollars, it does report some individual and aggregate data on enrollees to the federal government, namely the Department of Health and Human Services. 

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Flores-Brennan said that in the past, the agency has kept that data secure, but now, under the Trump administration, it has begun to share data with Immigration and Customs Enforcement. Colorado is currently part of a multi-state lawsuit to try and stop the practice. 

Flores-Brennan said her department has not been approached by ICE, but it is under review by the federal Centers for Medicare and Medicaid Services for its spending on immigrant coverage. 

What about private health insurance? 

Immigrants who qualify for Medicaid but are subject to the five-year waiting period are currently eligible to enroll in private health insurance through the Affordable Care Act and may qualify for tax credits that can subsidize their premiums.  

People with Temporary Protected Status or who are DACA recipients are also eligible for ACA health plans, unlike Medicaid, though undocumented individuals are still ineligible. 

Colorado, however, has a state-funded program called OmniSalud that provides insurance coverage for immigrants regardless of their status. 

People who aren’t enrolled in Medicaid or Medicare, and don’t qualify for Affordable Care Act tax credits, can apply. But they must make below 150% of the Federal Poverty Level, equal to $23,475 a year for an individual.

The legislature created the program through a bill in 2020, and the OmniSalud plan launched in November 2022 with the start of that year’s open enrollment period. 

According to the Colorado Division of Insurance, the program has provided insurance to approximately 33,000 enrollees since its inception, with around 12,000 enrolled in a subsidized plan as of this year, to the tune of about $90 million. 

Funding is generated through a fee that the state levies on health insurers operating in Colorado. OmniSalud does not share information with the federal government. 

What do the federal changes mean? 

The sprawling “big, beautiful bill” passed by Congress is set to limit immigrants’ access to health care in several ways. 

Regarding Medicaid, the bill eliminates eligibility for refugees and asylees, victims of trafficking and abuse, and those who’ve been granted parole for at least one year, starting on Oct. 1, 2026. 

After that date, the only immigrants who will qualify for Medicaid will be green-card holders, Cuban and Haitian entrants and citizens of the Freely Associated States — meaning the Marshall Islands, the Federated States of Micronesia, and Palau — who are lawfully residing in the U.S..

The law still allows states like Colorado, however, to provide coverage to pregnant and postpartum women and children under the age of 19, regardless of their status. Colorado also has a separate contraceptive coverage program for undocumented immigrants that is purely funded through the state’s general fund and that will not be affected. 

But the programs could still face pressure in the future. 

The state’s general fund is projected to face a nearly $800 million deficit this fiscal year due to a loss in tax revenue as a result of the federal budget law. On top of that, the state will see losses in federal Medicaid funding that could balloon to $3 billion in future years as more federal cuts go into effect. 

Flores-Brennan, the state Medicaid director, said her department will do all that it can to ensure eligible Medicaid populations and care services aren’t being eliminated in Colorado as a result. 

“I think we’re continually surprised at the number of changes, the volume of changes that are coming at us from the federal government,” Flores-Brennan said. “There’s really no place where we aren’t looking for cost containment strategies.”

Regarding private insurance, the federal budget law makes many of those same groups that will no longer receive Medicaid also ineligible for subsidized plans under the ACA beginning on Jan. 1, 2027. 

It also bars people with Temporary Protected Status and DACA recipients from subsidized plans, and it eliminates eligibility for ACA enrollment for immigrants with incomes under 100% of the federal poverty level beginning on Jan. 1, 2026. 

Colorado will still be able to offer coverage regardless of immigration status through its OmniSalud plan. But the plan could face much greater demand once more immigrants become ineligible for ACA subsidies.

Conway, the insurance commissioner, said that it will be a challenge as the state tightens its belt in response to federal cuts. 

The loss of enhanced tax credits for health care premiums, another repercussion of the federal budget law, will mean a roughly $100 million hit to the state’s marketplace subsidy programs, according to Conway. 

That means there will be less money available to go to OmniSalud as the state looks to use state funds to stabilize measures like its reinsurance program. Conway said OmniSalud will likely have to cut its budget next year from about $90 million to $25 million, decreasing enrollment from around 12,000 to 2,700. 

“There’s going to be a lot of focus on doing as much as we can to keep as many people covered,” Conways said. “But it’s a difficult time to find funding.”