There are lots of federal changes to navigate this fall and winter. SignUpNow is your one-stop resource to understand what’s changing, when, who is impacted, and how you can help! 

Medicaid eligibility restrictions for certain immigrant adults went into effect October 1st.

Under the rules prior to October 1, 2026, non-pregnant adults with a wide range of immigration statues qualified if they met the other eligibility requirements: refugees, asylees, humanitarian parolees, victims of trafficking, and many more.

Under the new rules that went into effect on October 1, 2026, adults who aren’t pregnant need to have one of just three specific immigration statuses to qualify for Medicaid: they need to be a Lawful Permanent Resident, also known as a “green card holder,” a Cuban or Haitian Entrant, or a Compact of Free Association, or COFA, migrant.

Changes to public charge, which may impact certain green card and visa applications, went into effect September 18th!

The Trump Administration changed the public charge rule. This went into effect September 18, 2026.

The Virginia Poverty Law Center has an excellent resource on public charge available here that can be helpful for your clients, patients, and other stakeholders. The information below is a summary: 

A note before you read on: this is not legal advice. It's background information to help you talk with clients who have questions. If a client is worried or unsure, encourage them to talk to an immigration lawyer. Find a local immigration lawyer using this tool from Keep Your Benefits.

What is public charge? 

"Public charge" is a test immigration officials use when reviewing some green card and Visa applications. Some immigrants must pass this public charge test for their green card or Visa application to be approved. The test asks: is this person likely to depend mainly on government support in the future? To answer that question, officials look at things like income, education, family support, and public benefits received. If someone receives public benefits, it does not automatically mean they will fail the test.

Who does the public charge test apply to?

This is important: Many people do not have to worry about the public charge test at all. 

Immigration officials use the public charge test for certain green card and Visa applications. Public charge applies to:

• Family-based green card applications, including relatives of U.S. citizens, relatives of green card holders, fiancés, widows or widowers, and “Amerasian” immigrants.
• Some employer-sponsored green card applications, including EB-1 priority workers, EB-2 advanced degree/exceptional ability workers, EB-3 skilled workers and professionals, and EB-5 investors.
• Some special immigrant-based green card applications, including religious workers, U.S. government employees abroad, Panama Canal Zone employees, foreign medical school graduates, retired international organization employees, and U.S. armed forces.
• Other green card applications, including Diversity Visas, displaced diplomats, individuals born under diplomatic status, certain pre-1982 entrants, and S-Visas.
• Green card holders who are re-entering the U.S. after being abroad for more than six months.
• Visa applicants who are already physically in the U.S. and applying for their Visa with USCIS.

So, for example, if your client already has a green card and hasn’t left the U.S. for more than 6 months, public charge does not apply to them. If they're getting their green card through a humanitarian pathway, like being a refugee or asylee, public charge does not apply to them. Or, if they don’t have a pathway to getting a green card, such as being undocumented, public charge does not apply to them. For a full list of who public charge does and does not apply to, see this resource from the National Immigration Law Center.

What changed with the new rule?  

The new rule went into effect on September 18, 2026. The new rule is stricter and looks at more public benefits as part of the test.

For green card and Visa applications filed on or after September 18, 2026 with a public charge test, the new policy allows immigration officials to look at many new factors, including whether the applicant, or their dependent child, has been enrolled in government/public benefits that are based on having a low income and/or limited assets. This means that immigration officers can look at many types of benefits received, including Medicaid/CHIP (aka FAMIS), financial assistance for Virginia’s insurance Marketplace, and SNAP, when doing a public charge test.

The rule is not retroactive. This means immigration officials can generally only look at benefits received on or after September 18, 2026 when conducting the public charge test, and, again, it only applies to the groups of people outlined above. (Note: some public benefits have already been part of the public charge test for a long time, like cash assistance and when Medicaid pays for someone to receive nursing home care.)

So, in short, being enrolled in Medicaid/FAMIS, receiving financial assistance from the Marketplace, or receiving other benefits, like SNAP, could impact someone’s green card or Visa application if they are subject to the public charge test. However, immigration officials will still look at a variety of other factors when completing this test, like the person’s income, education, and family support. Receiving a public benefit does not automatically mean that someone will fail the public charge test. Other positive factors, like having a job or degrees, can help someone pass the test.

For more information and resources for your clients, please see VPLC’s public charge resource.

Reductions to the Medicaid retroactive period​​

Retroactive coverage helps Medicaid applicants pay for prior medical bills, especially for things like unexpected hospitalizations, for up to three months prior to the month of application. Starting January 1, 2027, this window shrinks. 

Note: Currently, CHIP (FAMIS) coverage does not have a retroactive coverage period with the exception of newborns, whose retroactive coverage period has been reduced to two months.

Work requirements and six-month renewals begin for certain adults on January 1st, 2027! 

Starting January 1, 2027, adults enrolled in Medicaid Expansion (that’s adults ages 19 to 64) will need to renew their coverage every 6 months instead of every 12 months. They will also need to meet a new work requirement either by being exempt, or by doing certain activities, or by having a certain household income. Adults currently enrolled in Medicaid Expansion will become subject to these requirements at their first renewal date in 2027.

Want to learn more about what’s required, who is exempt, and how all of this will be rolled out? Take our SUNLight training to understand the details and how you can help people navigate these new requirements.  

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