Montgomery County officials told a council committee last week that federal changes to immigrant eligibility for health coverage are already shrinking Medicaid rolls and will push more residents toward the county’s own safety-net clinics, and that a second wave arrives on Jan. 1.
At an Oct. 29 Health and Human Services Committee worksession, chaired by Councilmember Laurie-Anne Sayles with Councilmember Andrew Friedson present, council staff and Department of Health and Human Services (DHHS) officials walked through the local effects of H.R. 1, the federal budget law.
Fewer residents lost Medicaid than feared
Staff said Medicaid eligibility for many noncitizens ended Oct. 1. Early state information suggests roughly 1,100 to 1,200 county residents are affected, well below the 4,000 that officials had projected. The staff member presenting the report called it good news that is still a loss for the people involved.
Some residents may regain a path to coverage. Staff said certain humanitarian parolees and refugees who become lawful permanent residents may qualify for Medicaid immediately instead of starting a new five-year wait. The Maryland refugee medical assistance program can also help, but only for a limited time after arrival.
The bigger change comes in January
Beginning Jan. 1, 2027, holders of Temporary Protected Status (TPS) will no longer be eligible for subsidized coverage through the Affordable Care Act marketplace. Before H.R. 1, TPS holders could not get Medicaid but could buy subsidized marketplace plans.
Staff said the state has roughly 33,000 TPS holders and that most live in Montgomery and Prince George’s counties. Even if half live in Montgomery County, they said, that would be about 17,000 people. The county has large Ethiopian and Salvadoran communities affected by TPS terminations, and staff said TPS data is hard to obtain from the state. Staff suggested the county consider a TPS impact assessment and transition response, possibly starting with information from legal clinics. Lebanon’s TPS designation is set to be affected on Nov. 27, staff said.
Staff also flagged the federal public charge rule. They said it now allows a broader case-by-case review that includes Medicaid and food assistance, and that officers have wide discretion. It is unclear whether county health programs would count.
What the county is doing
DHHS officials said they are directing people who lose Medicaid or marketplace coverage to Montgomery Cares and Care for Kids, the county-funded programs for uninsured adults and children. Montgomery Cares serves adults with incomes below 250 percent of the federal poverty level. Officials said the state could not include a county flyer in its notices to people losing Medicaid, so the county is relying on community partners, hospitals and health centers to pass the information along. Sayles suggested adding libraries, wellness centers and the Community Action Board to that outreach.
Officials said the county’s health centers already see patients with Medicaid, which makes it easier to move them into Montgomery Cares if they lose eligibility.
On the marketplace side, a DHHS official said open enrollment began Nov. 1 and runs to Jan. 15, and urged residents to meet with navigators before deciding a plan is unaffordable. She also warned that people must now repay advance premium tax credits dollar for dollar, so keeping income information current matters. Residents who skip a marketplace plan can be referred to the county safety-net programs.
What to watch
The worksession did not produce a vote. Residents who lose coverage can contact DHHS or a Maryland Health Connection navigator, and the county’s Montgomery Cares and Care for Kids programs enroll uninsured residents who meet income rules.
