State Variations in the Role of the Reproductive Health Safety Net for Contraceptive Care Among Medicaid Enrollees

Published: Dec 1, 2025
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Key Takeaways

  • Medicaid is a major source of coverage for contraceptive care for millions of people. Many Medicaid patients rely on a range of safety net providers including Planned Parenthood clinics, community health centers, state and local health departments, and Indian Health Services for their contraceptive care. The composition of the safety net and the relative role of the different providers vary considerably from state to state.
  • Safety net providers served over four in ten (43%) female Medicaid enrollees seeking contraceptive care nationally, but there were considerable variations by state in the share of patients they served. While the safety net plays an important role for Medicaid enrollees, over half (54%) of female Medicaid enrollees had their last contraceptive visit at an office-based provider or outpatient clinic. 
  • Community health centers (CHC) accounted for 18% of recent contraceptive visits but the state range was sizable with 46% of female patients in DC had their last contraceptive visit of 2023 at a CHC and 38% in Rhode Island. In contrast to only 4% in Wisconsin and 6% in Utah, North Dakota, North Carolina and Minnesota were seen at a CHC.
  • Planned Parenthood was also an important source of contraceptive care for Medicaid enrollees (18%) but ranged widely by state. In California, 47% of female Medicaid enrollees had their last contraceptive visit of 2023 at a Planned Parenthood, compared to none in Arkansas, Mississippi, North Dakota, Wyoming, West Virginia and Texas.
  • Health departments (6%) and Indian Health Services (1%) often play a smaller role nationally, but these shares can mask the important role they play in some states as a major provider of contraceptive care. For example, 39% of female Medicaid enrollees in Alabama got their last contraceptive visit of 2023 at a health department and 37% of enrollees in Alaska through Indian Health Services. 
  • The relative role of safety providers is likely to change in the coming years spurred by the Federal Medicaid payment ban on Planned Parenthood, uncertainty regarding the future of Title X, growth in the uninsured projected as result of the 2025 Federal Budget Reconciliation law.

For millions of low-income people, Medicaid is a major source of coverage for their contraceptive care. It is the largest national, publicly funded program that finances family planning care and provides a key source of revenue for the vast network of safety net providers that provide reproductive and sexual health care services. Over the past year, a combination of actions by the Trump Administration, Supreme Court rulings, and new federal laws have begun to constrict the resources available to many of the providers that comprise this network. These actions have considerable implications for the future of this safety net and ultimately for access to contraceptive care for low-income people. 

The reproductive health safety net is composed of clinics that receive public funds to provide sexual and reproductive health services, and includes Community Health Centers (CHCs), health departments, Planned Parenthood clinics, Indian Health Services, and other publicly funded clinics. These sites provide family planning services including contraception, sexually transmitted infection (STI) testing and treatment, and cervical and breast cancer screening and serve large populations of low-income individuals on Medicaid billing the program for the sexual and reproductive health services they provide to enrollees. Many of these sites also receive funding support from federal programs to serve low-income uninsured individuals including the Title X family planning program, federal Health Center Program and the Indian Health Service.

The most immediate impact on funding for safety net providers has been through the Courts and Congress and has disproportionately but not exclusively affected Planned Parenthood clinics. In June 2025, the Supreme Court ruling in Medina v Planned Parenthood opened the door for states to choose to disqualify Planned Parenthood clinics from participating as a Medicaid provider. This ruling was followed by the July 2025 enactment of the 2025 Federal Budget Reconciliation Law which stripped federal Medicaid funding for one year to Planned Parenthood clinics as well as a handful of other family planning providers that also offered abortion services to their patients. The provision of the new law is being legally challenged in three separate cases making their way through federal courts, but currently, the funding ban is in effect across the country. In addition to actions directed to providers, the new law will also require certain Medicaid enrollees to meet work requirements as a condition of eligibility, a new policy that is estimated by the Congressional Budget Office to increase the number of uninsured by millions in the next ten years. 

Using the 2023 Transformed Medicaid Statistical Information System Research Files (TAF), a database of all Medicaid claims, KFF conducted an analysis to look at where reproductive age females received their last contraceptive care service by state with the goal of better understanding the role of the different types of reproductive health safety net providers in providing contraceptive care to females with Medicaid. Since people can receive contraceptive care at multiple locations in the span of a year, this analysis focused on the last location where Medicaid enrollees who received contraceptive care got their services in 2023. Since contraceptive patients can have multiple visits in the same year, this approach eliminates duplication in counting enrollees for one calendar year. This analysis specifically examines the number of Medicaid enrollees who obtained their most recent contraceptive visit at the following sites: Planned Parenthood, health centers including federally qualified health centers (FQHCs) and Look-alike health centers, state and local health departments, Indian Health Services, other sites (i.e., emergency room, retail clinics, pharmacies), and office-based providers/outpatient clinics (i.e., offices, independent clinics, outpatient hospital clinics, ambulatory surgical centers, and birthing centers). We then looked at the distribution of place of service for contraceptive care by state. Detailed methods are presented in Appendix 1. 

U.S. Profile

Nationally, Medicaid enrollees rely on a broad range of safety net providers for their contraceptive care. Over four in ten (43%) received their last contraceptive visit of 2023 at a safety net provider, including a Planned Parenthood clinic, a community health center, a state and local health department, or Indian Health Services (Figure 1).

Planned Parenthood

Planned Parenthood clinics are specialized reproductive health providers that provide the full range of contraceptive methods, STI testing, pap smears, breast exams, preventive care, and often abortion services. Despite the fact that there are fewer Planned Parenthood clinics than other safety net providers such as community health centers and state health departments, research has shown that they provide this specialized care to a high volume of patients relative to other providers. Not all states have Planned Parenthood clinics. Many states, with the support of abortion opponents, have tried to exclude Planned Parenthood clinics from their Medicaid program, largely due to opposition to including a health care provider that also provides abortion. While these efforts have been challenged by the health care provider, the Supreme Court’s June 2025 decision in Medina v Planned Parenthood South Atlantic has opened the door for states to ban Planned Parenthood from participating in their Medicaid programs. This was followed in July 2025 with the enactment of the 2025 Federal Reconciliation Bill which imposed a one year ban on Federal Medicaid funding that had a direct impact on Planned Parenthoods’ ability to participate in Medicaid for one year. In recent years, many Planned Parenthood sites have closed due to funding cuts, low Medicaid reimbursement levels, state abortion policies, and a loss of federal funds with more closures anticipated in the coming years if federal funds are not restored.

The share of female Medicaid recipients who received their last contraceptive visit of 2023 at a Planned Parenthood clinic was 18% across the U.S. and ranged from 0% in states that do not have a Planned Parenthood presence or ban Planned Parenthood from participating in their Medicaid program (Arkansas, Mississippi, North Dakota, Texas, Wyoming) to almost half (47%) of California female Medicaid recipients who received their last contraceptive visit of 2023 at a Planned Parenthood clinic (Figure 2). California has the largest Medicaid enrollment in the country and the nation’s largest Planned Parenthood clinic network but has also seen the largest number of Planned Parenthood clinic closures this year, with 6 clinics closing since the start of 2025. Some states like Louisiana have seen all of their Planned Parenthood clinics close this year. In Wisconsin, one in three (32%) female Medicaid clients received their last contraceptive care in 2023 at a Planned Parenthood clinic. Planned Parenthood clinics also provide contraceptive services to 20% Medicaid patients in Connecticut, Oregon and Washington State. As clinics have closed across the U.S. in the last several years, the share of Medicaid enrollees that rely on Planned Parenthood has likely decreased since 2023.

Share of Female Medicaid Enrollees Who Received Their Last Contraceptive Visit of 2023 at a Planned Parenthood Clinic, by State (Choropleth map)

Community Health Centers

Community health centers comprise a national network of safety net providers that receive federal grants to provide a range of primary health services as well as other services including dental and mental health care to low-income people. Community health centers as defined in this analysis include mostly federally qualified health centers (FQHCs), as well as FQHC look-alike clinics. Although the network is vast (nearly 18,000 service sites across the U.S.), not all these sites provide contraceptive care or may not provide the full range of contraceptive services to their patients. Previous research finds that only 1 in 4 community health centers offer their patients onsite access to all of the most effective family planning methods. Community health centers have historically served much smaller volumes of contraceptive clients, and it is estimated they would have to increase their contraceptive client caseloads by 56% to make up for the loss of Planned Parenthood clinics as a site of care for Medicaid enrollees.

The share of female Medicaid recipients who received their last contraceptive visit of 2023 at a community health center across the U.S. was 18% and ranged from a low of 4% in Wisconsin to a high of 46% in D.C. (Figure 3). In states where smaller shares of Medicaid patients rely on community health centers, these providers may face difficulties in ramping up the availability of services to meet a higher demand for time-sensitive services if there are fewer options for contraceptive care when other clinics close or when they are faced with an increasing number of uninsured patients due to coverage loses through ACA enrollment decreases and Medicaid disenrollment.

Share of Female Medicaid Enrollees Who Received Their Last Contraceptive Visit of 2023 at a Community Health Center, by State (Choropleth map)

State and Local Health Departments

State and local health departments comprise another important part of the reproductive health safety net in several states, and many, particularly in the South, receive Title X funding to provide family planning services to low-income and insured people in their community. Health departments have historically made up a smaller percentage of publicly supported family planning clinics and served fewer patients than Planned Parenthood clinics and federally qualified health centers (FQHCs). Of the 4.7 million women who obtained contraceptive care from publicly supported clinics in 2020, 13% received care from a health department. Similar to FQHCs, health departments are also less likely to provide the full range of contraceptive methods. However, recent research has shown that health departments perform as well or better than FQHCs on providing patient-centered contraceptive care, like prescribing at least 12 months of oral contraception at initial visit and providing same-day IUDs and implants.

This analysis finds that the role of health departments in providing contraceptive services to Medicaid enrollees nationally was 6%, it varied considerably from state to state, ranging from a high of 39% in Alabama to 0% in a number of states where health departments either do not provide or bill for health services or contraceptive care (Figure 4). Alabama’s entire Title X network is comprised of health departments, as are most of South Carolina and Louisiana’s Title X networks, which may explain the large share of Medicaid recipients who get their contraceptive care at a health department. In general, states in the Southeastern U.S. provided contraceptive care to larger shares of female Medicaid enrollees through health departments than in other parts of the country.

Share of Female Medicaid Enrollees Who Received Their Last Contraceptive Visit of 2023 at a Health Department, by State (Choropleth map)

Indian Health Services

Indian Health Services (IHS) may not play a large role in providing contraceptive care across the U.S., but in states with larger American Indian and Alaska Native populations, they play a major role. Federal regulations require IHS to cover health promotion and disease prevention services, which include family planning services and STI services with no cost-sharing to members or descendants of federally recognized Tribes who live on or near federal reservations.

In Alaska, more than one in three (37%) female Medicaid enrollees received their last contraceptive visit of 2023 at an Indian Health Services site (Figure 5). One in six (16%) female Medicaid enrollees received their last contraceptive care at Indian Health Services in South Dakota. Indian Health Services also played a larger role in Arizona, New Mexico, Wyoming, and Montana. Many of these sites bill Medicaid for services provided to Native Americans in addition to grant funding they receive through IHS. Reductions in Medicaid enrollment anticipated as a result of the Medicaid work requirements in the 2025 Federal Reconciliation law and subsequent increases in the share of patients who are uninsured means that these sites could have fewer resources to provide contraceptive services to their patients.

Share of Female Medicaid Enrollees Who Received Their Last Contraceptive Visit of 2023 at Indian Health Services, by State (Choropleth map)

Office-Based Providers/Outpatient Clinics

Given the vast proliferation of managed care in the Medicaid program, providers including those in private practice, independent clinics, outpatient or inpatient hospital departments, or ambulatory surgical centers or birthing centers provide the majority of contraceptive care to Medicaid enrollees. Most individuals with Medicaid go to an office-based provider or outpatient clinic that accepts Medicaid patients for their contraceptive care. With a weakening of the reproductive health safety net and fewer options for Medicaid enrollees to receive contraceptive care, office-based providers and outpatient clinics may see an influx of patients who can no longer go to their usual contraceptive care provider or be seen in a timely way.

The national share of female Medicaid enrollees receiving contraceptive care at an office-based provider/outpatient clinic was 54%. This ranged from a low of 25% in California, which has a large network of reproductive health safety net providers, to a high of 86% in Arkansas (Figure 6). It should be noted that office-based/outpatient providers may see a decrease in Medicaid patients in the future if enrollees start to lose Medicaid coverage due to work requirements and administrative lapses in coverage. Also, care at these sites may be unaffordable for those who are uninsured. A 2024 KFF survey found that 20% of uninsured females reported that they had to stop using a method of birth control because of cost.

Share of Female Medicaid Enrollees Who Received Their Last Contraceptive Visit of 2023 at an Office-Based Provider/Outpatient Clinic, by State (Choropleth map)

Looking Ahead

Recent policy changes under the current Trump Administration have resulted in cuts to federal funding for reproductive health safety net providers through Title X and Medicaid. This has made it challenging for some of these clinics to continue operating at full capacity, and in some cases stay open. In April 2025, 16 of the 86 Title X grantees, including all the Planned Parenthood grantees had their Title X funding withheld by the Trump Administration. While some grantees eventually received partial funding months later, many clinics went several months without any Title X funds and Planned Parenthood grantees have not received any Title X funds this year. This funding uncertainty has left some of these clinics facing difficult decisions regarding their ability to continue to operate without knowing when or if they would ever receive their Title X funding. In addition, the future of the Title X family planning program is unclear. Nearly all the staff of the federal program have been laid off during the shutdown, and the Trump administration did not include any support for the program in its FY 2026 budget proposal to Congress earlier this year. 

With the June 2025 Supreme Court ruling in Medina v. Planned Parenthood South Atlantic, the door was opened for states to disqualify Planned Parenthood from participating as providers in their Medicaid programs. While this case narrowly focused on South Carolina, it is anticipated that many states, even those where abortion is banned, will drop Planned Parenthood from their Medicaid programs because they provide abortion services in other states. Federal Medicaid funds have been prohibited from paying for abortion services for decades under the Hyde Amendment, and this case allows states to choose to block Planned Parenthood from participating in Medicaid for providing other services, including contraceptive and preventive care. This state choice was effectively nationalized by the 2025 Federal Budget Reconciliation Law which prohibits “specialized” reproductive health clinics that are classified as essential community providers, provide abortion services, and received over $850,000 in Medicaid revenues from receiving any federal Medicaid reimbursement for providing non-abortion-related family planning services to individuals with Medicaid. This includes nearly all Planned Parenthood clinics as well as Maine Family Planning and Health Imperatives in Massachusetts. While this law is currently being challenged in multiple lawsuits, federal Medicaid funding is currently blocked and no longer flows to these providers for any services they provide to Medicaid enrollees. Some states have provided funds to Planned Parenthood and other affected safety net providers, but there is no guarantee that the funding will continue in future years, and funding levels often do not fill the gap. Finally, while this is a one year ban, there are already efforts in place by abortion opponents to extend this policy next year through another reconciliation vehicle. 

The 2025 Federal Budget Reconciliation Law is also projected to increase the number of individuals without insurance by 10 million over the next 10 years, which is expected to place increased pressure on the remaining reproductive health care safety net given its role providing care to uninsured patients. Combined, these policies and cuts to funding for family planning care are expected to have a direct impact on the availability of affordable and effective contraception to those who want or need it and will likely increase the number of individuals living in contraceptive deserts and who potentially experience an undesired pregnancy. The impacts of these policies will vary considerably from state to state by provider type.

Methods

Medicaid Claims Data: This analysis used two files from the 2023 T-MSIS Analytic Files (TAF): Other Header and Other Line Files (outpatient services). The analysis was limited to outpatient services because place of service (POS_CD) is only included in the Other Header File. Some patients who received their last contraceptive care while in an inpatient setting are not captured by this analysis. 

State Exclusion Criteria: Georgia and Illinois were excluded due to data quality issues with NPI.

Identifying Contraceptive Care in Medicaid Claims Data: Contraceptive claims from the Other Line file were included if they could be linked by CLM_ID to the Other Header File. We looked for all contraceptive diagnosis and procedure codes from the Other Header and Other Line File (codes available upon request).

Defining Site of Care in Medicaid Claims Data: Then the following codes were used to define the site of care on the contraceptive claim: BLG_PRVDR_NPI, DRCTNG_PRVDR_NPI, RFRG_PRVDR_NPI, SPRVSNG_PRVDR_NPI, SRVC_PRVDR_NPI, POS_CD, PGM_TYPE_CD, and BNFT_TYPE_CD. A hierarchy of contraceptive care sites was created because a single claim can have multiple codes describing different sites. There were a number of instances where contraceptive claims had laboratory as a place of service because contraceptive counseling was provided with the lab service, such as a sexually transmitted infection test. Therefore, we applied the hierarchy to all of the claims on a service day for that individual to capture whether an individual went to another location on the same day that would have likely ordered the lab service.

Office-based providers/Outpatient clinics were classified after all other sites of care were identified. The following hierarchy and codes were used to define each site of care (see Appendix Figure 1 for distributions by state): 

  • Planned Parenthood: any Planned Parenthood NPI as identified through the NPPES Registry included in BLG_PRVDR_NPI, DRCTNG_PRVDR_NPI, RFRG_PRVDR_NPI, SPRVSNG_PRVDR_NPI, SRVC_PRVDR_NPI. 
  • Community Health Centers: POS_CD 50 (Fed Qualified Health Ctr.), PGM_TYPE_CD 04 (Federally Qualified Health Centers (FQHC)), BNFT_TYPE_CD 004 (FQHC services), BLG_PRVDR_NPPES_TXNMY_CD 261QF0400X (Clinic/Center – Federally Qualified Health Center (FQHC)), BLG_PRVDR_TXNMY_CD 261QF0400X (Clinic/Center – Federally Qualified Health Center (FQHC)), or an FQHC or FQHC look alike NPI from the HRSA Health Center Directory or NPPES Registry with taxonomy 261QF0400X (Clinic/Center – Federally Qualified Health Center (FQHC)) for BLG_PRVDR_NPI, DRCTNG_PRVDR_NPI, RFRG_PRVDR_NPI, SPRVSNG_PRVDR_NPI, SRVC_PRVDR_NPI 
  • Health Department: POS_CD 71 (Public Health Clinic) or 72 (Rural Health Clinic), PGM_TYPE_CD 03 (Rural Health Clinic (RHC)), or BNFT_TYPE_CD 003 (Rural health clinic services) 
  • Indian Health Services: POS_CD 05 (Indian Health Service – Free-standing Facility), 06 (Indian Health Service – Provider-based Facility), 07 (Tribal 638), 08 (Tribal 638 Provider-based Facility); PGM_TYPE_CD 05 (Indian Health Services (IHS)); BNFT_TYPE_CD 061 (Indian Health Services and Tribal Health Facilities); or TOS_CD 127 (Indian Health Service (IHS)) 
  • Other: Other services include places like retail clinics, pharmacies, urgent care, schools, telehealth, and laboratories. Across the states, the percentage of female Medicaid enrollees who received their last contraceptive visit in an “other” location ranged from 0% to 9%. 
  • Office-based Providers/Outpatient Clinics: POS_CD: 11 (Office), 19 (Off Campus – Outpatient Hospital), 21 (Inpatient Hospital), 22 (Outpatient Hospital), 24 (Ambulatory Surgical Center), 25 (Birthing Center), 49 (Independent Clinic)

Appendix

Place of Service for Last Contraceptive Care Encounter for Female Medicaid Enrollees Ages 15 to 49, 2023 (Stacked Bars)
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New Trump Administration Health-Related Visa Guidance Could Impact Millions of Noncitizens

Published: Nov 25, 2025

Summary

Media reports indicate that the Trump administration’s Department of State issued new guidance that directs visa officers to consider a wide range of health conditions when reviewing visa applications to enter the U.S. under the premise that these conditions could lead to people becoming a “public charge,” or reliant on the U.S. government for subsistence. KFF’s news operation, KFF Health News, examined the guidance and reported that “foreigners seeking visas to live in the U.S. might be rejected if they have certain medical conditions, including diabetes or obesity, under a Thursday directive from the Trump administration.” Further, President Trump has indicated that this policy will ban entry for “those whose poor health will overburden our health care system.”

Visa applicants already undergo medical exams and screenings, but the guidance expands the list of health conditions for visa officers to consider and provides significant discretion to officers to predict the potential long-term health and financial implications of common chronic conditions. The guidance applies to people seeking entry for permanent residence in the U.S. for work or to be with family as well as to those applying for temporary visas. The guidance extends President Trump’s broad efforts to restrict immigration into the U.S. and will likely increase barriers to family reunification and reduce the pool of available workers in the U.S., including H-1B workers, who come to the U.S. to work temporarily in specialty occupations like engineering, technology, and medicine.

Soon after this guidance was issued, the Department of Homeland Security also proposed new regulations that would rescind a 2022 Biden-era rule related to public charge determinations that apply to people seeking adjustment to lawful permanent resident (LPR or green card) status within the U.S. The guidance and proposed rule would significantly increase discretion provided to immigration officers in making public charge decisions and could allow them to consider factors that had been excluded under the 2022 rule, including use of health, nutrition, and housing programs such as Medicaid, the Children’s Health Insurance Program (CHIP), and the Supplemental Nutrition Assistance Program.

This analysis examines the share of noncitizen and citizen adults currently living in the U.S. who have one of the health conditions identified in the visa guidance. It is based on KFF analysis of the 2024 National Health Interview Survey (NHIS) sample adult file (see Methods for more details). While the analysis focuses on individuals already residing in the U.S., it provides insight into the scope of people who might be affected while seeking entry to the U.S.

The analysis shows that almost half of noncitizen immigrant adults in the U.S. have one of the health conditions listed in the guidance, dropping to about four in ten who arrived in the U.S. recently, but they are less likely to have these conditions than their citizen counterparts. Nearly half of noncitizen adults (47%) have one of the health conditions identified in the guidance compared to two in three (66%) citizen adults. Among noncitizen adults who have been residing in the U.S. for less than five years, about four in ten (39%) report having at least one of these conditions.

Findings

Under longstanding law, federal officials can deny entry to the U.S. or adjustment to lawful permanent resident (LPR) status (i.e., a “green card”) to someone they determine to be a public charge. The law specifies that officials must consider certain minimum factors when making public charge determinations, including age; health; family status; assets, resources, and financial status; and education and skills.

While immigrants seeking entry to the U.S. have long been required to undergo a health assessment as part of the visa application process, according to news reports,  the U.S. Department of State recently issued a directive to embassies and consular offices instructing visa officers to consider a broader range of health conditions when reviewing visa applications, citing these health conditions as potentially draining U.S. resources. Under longstanding policy, immigrants seeking entry to the U.S. have been required to undergo health assessments as part of the visa application process. However, the health assessment generally only considered whether an applicant had a specified communicable disease, such as tuberculosis; a serious physical or mental health condition; and proof of certain vaccinations. The new guidance directs visa officers to consider a broader set of chronic health conditions in making visa determinations, “including, but not limited to, cardiovascular diseases, respiratory diseases, cancers, diabetes, metabolic diseases, neurological diseases, and mental health conditions.” It encourages officers to consider other conditions, like obesity, which it notes can cause asthma, sleep apnea, and high blood pressure. The guidance also directs visa officers to consider the health of family members, including children or older parents.

The guidance indicates that officers should consider these health conditions to assess whether an immigrant could become a public charge and denied entry into the U.S. If an individual seeking a visa to reside in the U.S. has one of the identified chronic conditions, the guidance directs officers to consider whether the applicant has adequate financial resources to cover the costs of medical care over “his entire expected lifespan without seeking public cash assistance or long-term institutionalization at government expense.” As such, it relies on significant discretion of visa officers to make long term predictions about the health and financial implications of health conditions even though they are not trained medical professionals.

Data show that almost half of noncitizen immigrant adults in the U.S. have one of the health conditions listed in the guidance, dropping to about four in ten who arrived in the U.S. recently, but they are less likely to have these conditions than their citizen counterparts. As of 2024, nearly half (47%) of noncitizen immigrant adults in the U.S. report ever having at least one health condition that could be considered when applying for a U.S. visa under the guidance. About three in ten (29%) report being obese, 10% report ever having diabetes, 8% report ever having depression, 7% report ever having an anxiety disorder, 6% report ever having asthma, with smaller shares reporting ever having cancer, coronary heart disease, myocardial infarction (heart attack), stroke, angina, or dementia (Figure 1). Significantly higher shares of U.S. citizen adults report having these health conditions, with two in three (66%) reporting having at least one. Immigrants who have arrived in the U.S. more recently are even less likely to report one of these health conditions, with about four in ten (39%) of noncitizen immigrant adults who have been in the U.S. for less than five years reporting ever having at least one. These lower rates likely reflect them being younger and healthier than their U.S. citizen and longer-residing immigrant counterparts.

Almost Half of Noncitizen Adults Report A Health Condition that Could be Considered in Visa Determinations, But They Are Less Likely to Have These Conditions Than Citizens (Split Bars)

The new Trump administration visa guidance will further restrict immigration into the U.S., creating barriers to family reunification and limiting the pool of available workers, including H-1B workers, who come to the U.S. to work temporarily in specialty occupations like engineering, technology, and medicine. Immigrants, including noncitizen immigrants, play a significant role in the U.S. workforce in occupations such as health care, STEM, agriculture, and construction. Further, research suggests that immigrants tend to have lower health care expenditures than U.S.-born citizens and may help to subsidize the health care costs incurred by their U.S.-born counterparts. Moreover, the guidance, along with the proposed rule to remove 2022 public charge regulations, will likely make immigrant families more reluctant to access health care and health coverage due to confusion and fear about public charge rules. KFF/New York Times 2025 Survey of Immigrants data show there already has been an increase in the share of immigrant adults reporting avoiding health care and/or assistance programs for themselves or their families due to President Trump’s immigration policies.

Methods

Data source: These findings are based on KFF analysis of the 2024 National Health Interview Survey (NHIS) sample adult file. NHIS is a continuous national survey of the U.S. civilian non-institutionalized population conducted by the Centers for Disease Control and Prevention. The 2024 sample adult file contains 32,629 observations of individuals 18 years and older.

Identifying noncitizen immigrants: Noncitizen immigrants are identified as those whose citizenship status is reported as “No, not a citizen of the United States” (n=2,089) whereas U.S. citizens are identified as those whose citizenship status is reported as “Yes, a citizen of the United States” (n=29,279). Individuals who are identified as noncitizen immigrants are further broken out into those who report being in the U.S. for less than five years and those who report being in the U.S. for five or more years.

Identifying health conditions included in new visa guidance: Based on details listed in news reports, the following health conditions from NHIS were included in this analysis: ever having angina; ever having anxiety disorder; ever having asthma; ever having any cancer; ever having coronary heart disease; ever having dementia; ever having depression; ever having diabetes; ever having a heart attack (myocardial infarction); ever having a stroke; or having a body mass index of 30 or higher.

Note: Relative standard errors for shares of recent noncitizens reporting having cancer, coronary heart disease, heart attack, stroke, angina, or dementia are larger than 30% which may impact the reliability of these estimates.

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Published: Nov 25, 2025

In this JAMA Viewpoints column, KFF’s Drew Altman, Ashley Kirzinger and Mollyann Brodie explore the power of health care affordability as an economic issue, how it has played out in recent election cycles, and the implications for the 2026 midterm elections. The column notes how health care increasingly has become a dimension of voters’ economic worries rather than a stand-alone issue, which explains why the debate about whether to extend the Affordable Care Act’s expiring enhanced tax credits has so much salience now that could continue into the midterms if Congress does not strike a deal to address rising costs for consumers. It also explains why Medicaid cuts will have power as an issue even though the cuts will be phased in over time.

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KFF Dashboard: Progress Toward Global Tuberculosis Targets in USAID TB Countries

Published: Nov 25, 2025

Note: This interactive includes data from before January 2025, and therefore does not reflect the potential impact of changes implemented by the Trump administration since then. For more information, see KFF’s Overview of President Trump’s Executive Actions on Global Health and The Trump Administration’s Foreign Aid Review: Status of U.S. Global Tuberculosis Efforts.

About this Dashboard

This dashboard monitors the status of USAID’s tuberculosis (TB) priority countries’ progress toward global TB targets. It includes data for 24 countries* in which USAID’s bilateral TB program carries out TB efforts. Data are from the World Health Organization’s (WHO) Global Tuberculosis Report 2025. The data powering this dashboard are available for download here. KFF will continue to track country progress on these indicators and update the dashboard as new data become available.

Notes

* USAID TB priority countries include the following: Afghanistan, Bangladesh, Burma, Cambodia, Democratic Republic of Congo, Ethiopia, India, Indonesia, Kenya, Kyrgyz Republic, Malawi, Mozambique, Nigeria, Pakistan, Philippines, South Africa, Tajikistan, Tanzania, Uganda, Ukraine, Uzbekistan, Vietnam, Zambia, and Zimbabwe. USAID, Global Tuberculosis Countries webpage, accessed: https://www.usaid.gov/global-health/health-areas/tuberculosis/countries.

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KFF Dashboard: Progress Toward Global HIV Targets in PEPFAR Countries

Published: Nov 25, 2025

Note:  This interactive includes data from before January 2025, and therefore does not reflect the potential impact of changes implemented by the Trump administration since then. For more information, see KFF’s Overview of President Trump’s Executive Actions on Global Health and The Trump Administration’s Foreign Aid Review: Status of PEPFAR.

About This Dashboard

This dashboard monitors the status of PEPFAR countries’ progress toward global HIV targets from 2019-2024. It includes data for 54 countries required to develop a PEPFAR Country or Regional Operational Plan (COP/ROP) in FY 2024. To use the dashboard, click on any indicator and select a year to see country-level data for that year. Click on Trends Over Time to see the progress countries have made in recent years. Data are from UNAIDS AIDSinfo database and were last updated in July 2025. Data for the latest available year are for 2024. The data powering this dashboard are available for download here. KFF will continue to track PEPFAR country progress on these indicators and update the dashboard as new data become available.

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Policy Tracker: Exceptions to State Abortion Bans and Early Gestational Limits 

Last updated on November 24, 2025

19

states have abortion bans or early gestational limits in effect

6

states have no health exception

8

states have no rape or incest exception 

11

states have no fatal fetal anomaly exception 

Abortion is currently banned in 13 states and 6 states have early gestational limits between 6 weeks and 12 weeks in effect. Nearly all of these bans include exceptions, which generally fall into four categories: to prevent the death of the pregnant person, when there is risk to the health of the pregnant person, when the pregnancy is the result of rape or incest, and when there is a lethal fetal anomaly. Some states have more than one abortion ban or restriction in place. The maps below illustrate the exceptions in each state’s most restrictive gestational limit or total ban. For details hover over each state to read the rollover.  

For more information on the status of state abortion bans, please visit our Abortion in the United States Dashboard. 

Exceptions to State Abortion Bans and Early Gestational Limits in Effect, as of November 24, 2025 (Choropleth map)
Exceptions to State Abortion Bans and Gestational Limits in Effect, as of November 24, 2025 (Table)
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Mapping the Uneven Burden of Rising ACA Marketplace Premium Payments due to Enhanced Tax Credit Expiration

Published: Nov 24, 2025

Editorial Note: Originally published on November 13, this brief was revised on November 24 to provide additional analysis on the effects of enhanced premium tax credit expiration for those at 701% of poverty.

The Affordable Care Act (ACA) offers premium tax credits to help make health insurance more affordable. Under original Affordable Care Act provisions, an income cap for premium tax credits was set at 400% of the federal poverty level. Above that threshold, federal financial assistance was not available, creating a “subsidy cliff.” The American Rescue Plan Act (ARPA) and later the Inflation Reduction Act (IRA) temporarily expanded eligibility for tax credits to people with incomes over 400% of poverty, in addition to providing more generous support for people at lower incomes.

Enhanced premium tax credits expire at the end of this year. Enrollees currently receiving premium tax credits at any level of income will see their federal assistance decrease or disappear if enhanced premium tax credits expire, with an average increase of 114% to what enrollees pay in premiums net of tax credits. Since premium payments are capped based on income and family size, there is little geographic variation in the resulting increases in premium payments for enrollees with incomes below 400% of poverty. Out-of-pocket premiums for people with incomes below 400% of poverty will increase by hundreds of dollars to over $1,500 per person on average.

Among those with incomes over 400% poverty who are losing the tax credit altogether, the impact will be greatest for those whose unsubsidized premiums are highest: older Marketplace enrollees and those living in higher-premium locales. Among enrollees with incomes over 400% of poverty, just over half are between ages 50 and 64, and will therefore have high unsubsidized premiums.

The maps below show how much average premium payments would increase for 2026 benchmark silver plans with the expiration of enhanced premium tax credits at four income levels above an income cap of 400% of federal poverty for a 40-year-old and 60-year-old individual, namely 401%, 501%, 601%, and 701%..

Among these four income levels, enhanced tax credits provide the most financial assistance for those at 401% of poverty, which represents an annual salary of $62,757 for an individual in the contiguous United States. Because the cost of living is higher in Alaska and Hawaii, 401% of federal poverty is $78,396 and $72,140 for individuals there, respectively. In 46 states and the District of Columbia, a 60-year-old at 401% of poverty will see their average annual premium payment for a benchmark silver plan at least double without enhanced tax credits. In 19 states, this person would see their premium payment at least triple on average for a benchmark silver plan, consuming more than 25% of annual income. States with the highest premium payment increases due to expired enhanced tax credits for a 60-year-old at 401% of poverty purchasing a benchmark silver plan are Wyoming ($22,452 increase per year), West Virginia ($22,006), and Alaska ($19,636). The smallest increases caused by the loss of enhanced tax credits for what enrollees pay annually for the benchmark silver plan are in New York ($4,469), Massachusetts ($4,728) and New Hampshire ($4,877).

At 501% of poverty ($78,407 in the contiguous U.S., $97,946 in Alaska, $90,130 in Hawaii), expiration of enhanced premium tax credits would at least double average premium payments for a benchmark silver plan in 37 states and the District of Columbia for a 60-year-old; at 601% of poverty ($94,057 in the contiguous U.S., $117,496 in Alaska, $108,120 in Hawaii), 19 states would see the average benchmark silver premium payments at least double for a 60-year-old if enhanced tax credits expire; at 701% of poverty ($109,707 in the contiguous U.S., $137,046 in Alaska, $126,110 in Hawaii), the average benchmark silver premium payment would be at least twice as high in five states without enhanced tax credits for a 60-year-old. The impact on a 40-year-old is more modest at all income levels.

Existing premium differences lead to variation in premium payments with the expiration of the enhanced premium tax credits at the congressional district level as well. For people with incomes over 400% of poverty, there will be smaller premium payment changes for 40-year-old enrollees and larger changes for 60-year-old enrollees, for whom plans are more expensive..

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VOLUME 35

Fake AI-Generated Videos Perpetuate Stereotypes About SNAP Recipients, And New KFF Poll Looks at Belief in the False Claim That Undocumented Immigrants Are Eligible for ACA Coverage

Irving Washington , Hagere Yilma , and Joel Luther

Summary

This volume examines how AI-generated videos contributed to false narratives about Supplemental Nutrition Assistance Program (SNAP) recipients during the government shutdown, lending alleged visual evidence to decades-old stereotypes about beneficiaries of government assistance. It also highlights findings from KFF’s latest Health Tracking Poll on beliefs about undocumented immigrants’ eligibility for health insurance through the Affordable Care Act (ACA). Lastly, it shares updates on a film amplifying false vaccine claims, Louisiana officials’ delayed response to a whooping cough outbreak, efforts in medical education to address shame in clinical settings, and a survey revealing distrust of news media among U.S. teens.

AI & Emerging Technology

AI-Generated Videos Spread False SNAP Narratives During Government Shutdown

Noel Hendrickson / Getty Images

What’s happening?

  • Fake videos of public assistance beneficiaries created using artificial intelligence (AI) spread online during the government shutdown, receiving millions of views and potentially contributing to misconceptions about who uses SNAP and deepening longstanding harmful racial stereotypes. SNAP provides food assistance benefits to approximately 42 million Americans, according to data from the United States Department of Agriculture (USDA), with White people making up the largest share of beneficiaries, and many recipients either working or actively seeking employment. Eligibility for the program includes work requirements, and more than half of households with children that receive SNAP benefits also receive earned income. SNAP fraud is rare, and analysis has shown that more than 98% of those receiving benefits were eligible.
  • Despite this reality, these AI-generated videos gave new reach to decades-old myths that people who receive benefits from SNAP and other government assistance are taking advantage of these programs and choosing not to work. The AI-generated videos predominantly depicted Black women arguing with retail employees about their benefits, stealing from grocery stores, or boasting about receiving public assistance while unemployed. KFF’s monitoring of social media identified several examples of these videos posted throughout the shutdown that accumulated millions of views within days. Many of the videos contained indicators that the content was AI-generated, such as mismatched audio-visual sync. Major news outlets, including Fox News, have faced criticism for sharing this AI-generated content as authentic reactions to the Trump administration’s decision to withhold SNAP payments during the government shutdown. Fox News later corrected its coverage after online commenters pointed out that the videos were AI-generated.

Why this matters

News reports covering these videos linked them to the “welfare queen” stereotype that emerged in the 1980s because they falsely depict benefit recipients, particularly Black women, as abusing government assistance and avoiding work. AI can be used to give these myths new visual “evidence,” as the technology makes it easier to create seemingly authentic testimonials that confirm existing biases. In addition to perpetuating harmful racial stereotypes, this false narrative has historically been used to justify cuts to government assistance programs and promote policies that further limit access to assistance and make it more difficult for people who qualify to access support. Similar narratives are likely to emerge again during future policy debates about benefit programs.

Recent Developments

KFF’s Latest Health Tracking Poll Finds That Half of the Public Correctly Say Undocumented Immigrants Are Not Eligible for ACA Coverage, But Many Are Uncertain

Amid debates over the recent government shutdown, some Republican lawmakers claimed that Democrats’ efforts to reverse some provisions of H.R.1, the “One Big Beautiful Bill Act,” would allow undocumented immigrants to receive federally subsidized health insurance. Undocumented immigrants are not eligible to purchase coverage through the ACA marketplaces, or enroll in federally funded coverage, including Medicaid, CHIP, or Medicare.

Fielded during the government shutdown, KFF’s latest Health Tracking Poll finds that about half (47%) of the public correctly say that undocumented immigrants are not eligible to buy health coverage on the ACA marketplaces, while 14% incorrectly say undocumented immigrants are eligible for this coverage. Notable shares, however, express confusion, with about four in ten (39%) adults saying they are “not sure.”

Notably, similar shares of Republicans (57%) and Democrats (52%) correctly say undocumented immigrants are not eligible for this coverage.

Stacked bar chart showing the public's knowledge on whether undocumented immigrants are or are not eligible for Affordable Care Act coverage.

What We Are Watching

New Film Contributes to Misleading Vaccine Claims on Social Media

A film released in October by an advocacy group opposed to childhood vaccination that amplifies false claims about the safety of children’s vaccines was frequently cited in discussions about vaccine safety. KFF’s monitoring of social media found that the film’s title, “An Inconvenient Study,” was mentioned in over 60,000 posts, reposts, and comments across X, Reddit, and Bluesky, this year as of November 19. The film describes an unpublished study purporting to show higher rates of chronic illness among vaccinated children, suggesting that its findings were concealed from the public. Henry Ford Health System, where the study originated, has issued a cease-and-desist notice to the filmmakers, stating the research did not meet its scientific standards, and independent experts have identified methodological flaws with the study’s design. False claims about vaccine safety, like those shared in the film, may contribute to declining vaccination rates. The KFF/Washington Post Survey of Parents found that those who skipped or delayed vaccines for their children were more likely to believe vaccine myths.

Louisiana’s Delayed Response to Whooping Cough Outbreak

Louisiana is experiencing its worst outbreak of whooping cough in 35 years, with 387 cases reported as of September 20. The outbreak began in September 2024, but reporting from a partnership that includes KFF Health News and NPR showed that state health officials waited months to alert physicians or conduct public outreach. The decision to withhold outbreak information could exacerbate declining trust in state health officials. KFF polling finds that just under half of adults report having a great deal or a fair amount of trust in their state health officials to provide reliable information about vaccines.

New Efforts to Combat Shame in Healthcare Settings to Improve Trust

The provider-patient relationship can play a role in how people access and understand health information. Patients who feel shamed in clinical settings may avoid asking questions, which can limit their access to information and guidance. Recent KFF Health News reporting describes efforts in medical training to reduce the potential for patients to feel shamed. Addressing shame in clinical settings could help support people’s understanding of health information, as many people are uncertain about health information and are likely to trust their doctor. KFF’s recent Tracking Poll on Health Information and Trust shows that personal doctors continue to remain one of the most trusted sources of health guidance among the public, so how they communicate might influence whether patients feel safe discussing concerns and access accurate information.

Survey Finds Teens Hold Negative Views of News Media

A new report from the News Literacy Project found that 84% of teenagers in the U.S. expressed negative sentiment when asked to describe news media, with many believing journalists regularly engage in unethical behaviors. When asked what journalists do well, about one-third of teens offered negative feedback, saying journalists were skilled at things such as “lying and deceiving.” This widespread distrust of news media among teenagers could affect how they seek out and evaluate health information, a trend that health communicators may need to consider when developing outreach strategies.

About The Health Information and Trust Initiative: the Health Information and Trust Initiative is a KFF program aimed at tracking health misinformation in the U.S., analyzing its impact on the American people, and mobilizing media to address the problem. Our goal is to be of service to everyone working on health misinformation, strengthen efforts to counter misinformation, and build trust. 

View all KFF Monitors

The Monitor is a report from KFF’s Health Information and Trust initiative that focuses on recent developments in health information. It’s free and published twice a month.

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Support for the Health Information and Trust initiative is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed do not necessarily reflect the views of RWJF and KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities. The data shared in the Monitor is sourced through media monitoring research conducted by KFF.

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The New ACA Repeal and Replace: Health Savings Accounts

Authors: Larry Levitt and Cynthia Cox
Published: Nov 21, 2025

If enhanced premium tax credits under the Affordable Care Act (ACA) are allowed to expire at the end of the year, out-of-pocket premiums for 22 million enrollees that receive premium assistance will increase by an average of 114%, or $1,016 per person.

Democrats have pushed for the enhanced tax credits to be extended, and a vote is expected on their proposal in December. There have also been some bipartisan negotiations and proposals to extend the tax credits for up to two years, with changes like a cap on who is eligible by income and efforts to address any fraudulent signups by insurance brokers.

Meanwhile, proposals have emerged from some Republicans in Congress to effectively repeal some or all of the ACA premium tax credits and replace them with contributions to Health Savings Accounts (HSAs) or something similar. President Trump posted recently:

“THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES, WHO HAVE MADE $TRILLIONS, AND RIPPED OFF AMERICA LONG ENOUGH. THE PEOPLE WILL BE ALLOWED TO NEGOTIATE AND BUY THEIR OWN, MUCH BETTER, INSURANCE.”

(The current ACA premium tax credits do not, in fact, go to insurance companies. The tax credits go to people to help them pay their premiums for ACA Marketplace plans. People can either wait until they file their taxes the following year to receive a lump sum or qualify for advance tax credits based on estimated income so they do not need to wait until they file their taxes. Those advance tax credits are forwarded directly to the insurance company they choose to purchase, directly lowering the enrollee’s monthly premium payments.)

Senator Scott Proposal

The most expansive health account proposal was recently introduced by Senator Rick Scott of Florida. It would allow the enhanced premium tax credits to expire but keep the value of the ACA premium tax credits from the original law. States could submit a waiver to the federal government to replace the original ACA premium tax credits with contributions by the federal government to accounts similar to HSAs. These “Trump Health Freedom Accounts” could be used for out-of-pocket health care costs, or to pay health insurance premiums (unlike traditional HSAs).

Unlike ACA premium tax credits, which can only be used for ACA Marketplace plans, the accounts in the Scott proposal could be used for any type of health insurance plan, including short-term plans that can exclude people based on pre-existing conditions. States could also waive certain provisions of the ACA, including the requirement to cover certain benefits.

While ACA plans would still be required to cover people with pre-existing conditions under the Scott proposal, it is likely that the ACA Marketplace would collapse in states that seek a waiver under his approach. Healthy people would be able to buy less expensive coverage that does not cover pre-existing conditions, or forgo insurance altogether and use their health accounts to pay for health care directly (carrying over any unused balanced from year to year). People with expensive health conditions would only be able to get coverage in ACA Marketplace plans, leading to a premium “death spiral” for those plans. Insurers would likely leave the ACA Marketplaces.

Senator Cassidy Proposal

Senator Bill Cassidy of Louisiana has proposed a different, narrower approach. Under the Cassidy proposal, the original ACA premium tax credits and benefit rules would remain in place. The value of the enhanced premium tax credits would be converted to federal contributions to HSAs, which could be used for out-of-pocket health care costs (e.g., deductibles and copays), but not to pay premiums. HSA contributions would only be available for people who enroll in bronze level ACA plans.

The Cassidy proposal is not yet available in legislative language, so a number of questions remain about how it would work. For example, how big would the HSA contributions be? Enhanced ACA premium tax credits vary by income, age, and the level of premiums in the county of residence, and they range from hundreds of dollars to thousands of dollars per person.

Because the health accounts in the Cassidy proposal could not be used to pay premiums, out-of-pocket premiums for ACA enrollees would more than double on average once the enhanced tax credits expire at the end of the year. HSA contributions would cushion the effect of the premium increases by helping people pay for deductibles, if people can afford the premiums to continue purchasing coverage.

However, to qualify for the HSA, enrollees would need to select a bronze plan and most people today are in a silver or gold plan. Many low-income people could get a bronze plan with no monthly premium payment, even without the enhanced tax credits. But, the lowest-income enrollees get cost-sharing reductions that bring their deductibles down to about $80 only if they purchase a silver plan. Deductibles in bronze plans average $7,476 per person.

Additionally, some middle-income people would no longer qualify for a tax credit because their incomes exceed four times the poverty level, and may be priced out of even a bronze plan premium, meaning they would not benefit from the HSA contribution.

While healthier people could benefit from the Cassidy proposal by receiving HSA contributions that could be used for a variety of health care expenses and carry over from year to year, sicker people could be stuck with higher premiums or higher out-of-pocket health costs. Because the HSAs in the Cassidy proposal are contingent upon having ACA Marketplace coverage, it does not pose the same risks of insurance market instability as the Scott plan.

Although the proposals from Senators Scott and Cassidy are quite different, they would both present trade-offs, generally benefiting people who are currently healthy at the expense of people who have expensive health conditions.

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Refugees and Asylees: Recent Changes in Access to Health Coverage and Other Assistance 

Published: Nov 21, 2025

Introduction

Since 1980, the U.S. has had a formal system for admitting refugees and asylees—individuals and their families who are unable to return to their country of nationality due to a well-founded fear of persecution for certain protected reasons. The right to seek asylum is rooted in international law, and the system reflects the U.S.’s longstanding inclusion of humanitarian protection as a core principle of immigration law. Refugees and asylees are generally fleeing from unsafe conditions and arrive to the U.S. with few to no resources, with many facing traumatic experiences in their countries of origin and/or during their journey to the U.S. The U.S. historically provided refugees and asylees access to assistance with food, housing, and health care upon arrival to the country as well as other time-limited services to support their transition to the U.S.

Recently, President Trump has largely eliminated the entry of refugees and asylees into the U.S., and Congress passed legislation that will restrict refugees’ and asylees’ access to assistance programs. These changes could exacerbate the health and socioeconomic challenges refugees and asylees face and negatively impact the U.S. economy given that refugees and asylees have a long-term net positive impact on the U.S. economy, meaning that they contribute more through tax revenues than they cost the government.

This issue brief provides an overview of refugees and asylees in the U.S., trends in refugee and asylee admissions using data from the Department of Homeland Security (DHS), and recent changes in eligibility for assistance programs for refugees and asylees.

Overview of Refugees and Asylees

Following the passage of the Refugee Act of 1980, the U.S. established a standardized process for admitting refugees and asylees into the country through the U.S. Refugee Admissions Program. The right to seek asylum is rooted in international law, and this system reflects the longstanding inclusion of humanitarian protection as a core principle of U.S. immigration law.  Refugees and asylees are humanitarian immigrants who are unable or unwilling to return to their country of nationality due to persecution or fear of persecution based on one of five protected grounds that include race, religion, nationality, membership in a particular social group, and/or political opinion. For example, refugees living in the U.S. include young women who had to flee their lives and livelihoods in countries like Afghanistan following the departure of the U.S. military and subsequent takeover by Taliban, a fundamentalist group that is known for banning girls and women from going to school and working. Examples of asylum seekers in the U.S. include survivors of abuse, individuals from Central America who fear persecution due to identifying as Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ), and people fleeing death threats from drug cartels in Mexico. People seeking refugee status apply for their status from outside the U.S., and those seeking asylum apply for their status from within the U.S. or when seeking admission to the U.S. at a designated port of entry.

Refuges and asylees include significant shares who are children or female who mainly come from the Middle East, Central and South America, Asia, and Central Africa. In fiscal year (FY) 2023, the last year for which government data on the characteristics of refugees are available, the U.S. admitted 60,050 refugees. Nearly half (45%) were children ages 17 years and younger while 55% were adults ages 18 and older, who were primarily under age 35. They included equal shares of females and males (50%) (Figure 1). The top countries of nationality for refugees included Democratic Republic of the Congo (30%), Syria (18%), Afghanistan (11%), Burma (10%), Guatemala (3%), and Sudan (3%). In FY 2023, the last year for which government data are available, the U.S. granted asylum to 54,350 individuals. About a quarter (26%) of those receiving affirmative asylum were children ages 17 years and younger while the remaining nearly three in four were adults ages 18 and older, who were primarily under age 35. Over four in ten (44%) were female while 55% were male.1 The leading countries of nationality for asylees included Afghanistan (27%), China (9%), Venezuela (7%), El Salvador (6%), India (5%), and Guatemala (5%). However, these data are incomplete because, as of October 2024, over 90% of asylum cases filed in FY 2023 were still pending with only 2% being granted approval due to immigration backlogs. 

Refugees and Asylees Include Significant Shares Who Are Children or Female (Split Bars)

President Trump placed an indefinite pause on the U.S. Refugee Admissions Program in January 2025. The pause led to halts in the processing of refugee applications, cancelation of refugee travel to the U.S., and the termination of the Welcome Corps program, which allowed for private sponsorship of refugees. While a court partially blocked the pause in March 2025 for refugees who were conditionally approved as of January 20, 2025, it still remains in effect for new refugees who may only be admitted on an excepted, case-by-case basis.

Reflecting the pause on admissions, the Trump administration reduced the refugee admissions ceiling to an all-time low of 7,500 for FY 2026 (Figure 2). The previous all-time low of 18,000 was in FY 2020 under the first Trump administration. Further, the Trump administration has stated that the FY 2026 refugee admissions will “primarily be allocated” to Afrikaners, who are White individuals from South Africa, representing a departure from admission patterns for previous years.

The Trump Administration Reduced the Refugee Ceiling to An All-Time Low for Fiscal Year 2026 (Line chart)

While there is no annual cap for asylum filings, President Trump took executive action in January 2025 to close the border to a vast majority of migrants, including asylum seekers. Building on limits to border entries established by President Biden in 2024, President Trump took executive action aimed at increasing border security that effectively closed the U.S. border for asylum seekers when he assumed office in January 2025. President Trump also rescinded a 2021 Biden administration Executive Order that was designed to aid in the “safe and orderly processing of asylum seekers.” While data on asylum grants under the second Trump administration are not yet available, there has been considerable variation in the number of individuals granted asylum over time reflecting shifting immigration policy priorities and reductions in border entry amid the COVID-19 pandemic (Figure 3). Going forward, it is likely that asylum grants will drop substantially due to the Trump administration’s border policies.

The Number of Individuals Granted Asylum in the U.S. Has Varied Over Time (Line chart)

Refugee and Asylee Eligibility for Health Coverage and Other Assistance

Refugees and asylees are generally fleeing from unsafe conditions and arrive to the U.S. with few to no resources, with many having faced traumatic experiences in their countries of origin and/or during their journey to the U.S. Many refugees and asylees may not be able to immediately obtain jobs due to linguistic, cultural, and other barriers and, therefore, are likely to face challenges to accessing health coverage, health care, and meeting their basic needs. Research shows that refugees have significantly higher rates of food insecurity than the general U.S. population, with some refugee groups having food insecurity rates that are six times higher than the general U.S. population. Further, research shows that refugees face challenges navigating private and public health insurance and have higher uninsured rates compared to the general U.S. population. Research also shows that culturally competent and language accessible health care services for refugees can improve communication and trust between refugees and health care providers. 

Historically, the U.S. provided refugees and asylees access to health coverage and other assistance upon arrival to the U.S., with research showing that health coverage, cash assistance, and employment are important tools for helping them gain self-sufficiency. When the Refugee Act of 1980 was passed, Congress stated that part of its purpose was to help provide “humanitarian assistance” and “transitional assistance” to those fleeing persecution in their countries of nationality. While most lawfully present immigrants (including Lawful Permanent Residents or “green card holders”) have to wait five years after obtaining a “qualified” immigration status to enroll in federal public benefits, including federally funded health coverage such as Medicaid and the Children’s Health Insurance Program (CHIP), refugees and asylees historically have not been subject to this waiting period if they met income and other state-specific eligibility requirements. Refugees and asylees also have been able to enroll in subsidized Affordable Care Act (ACA) coverage and Medicare without a waiting period if they are otherwise eligible. Further, refugees and asylees could access other income-based federal assistance programs such as the Supplemental Nutrition Assistance Program (SNAP) (i.e., food stamps), Temporary Assistance for Needy Families (TANF), and Supplemental Security Income (SSI) if they met income and other eligibility requirements.

The 2025 tax and budget law, H.R.1, eliminates eligibility for health coverage and food assistance for many lawfully present immigrants, including refugees, asylees, and other humanitarian immigrants. The law restricts eligibility for Medicaid, CHIP, subsidized ACA Marketplace coverage, Medicare, and SNAP to immigrants who are Lawful Permanent Residents (LPRs or “green card” holders), certain Cuban and Haitian entrants, and citizens of the Freely Associated (COFA) nations of the Marshall Islands, Micronesia, and Palau residing in U.S. states and territories. States that have taken up an option under Medicaid and/or CHIP to cover lawfully residing children and pregnant people, who include refugees and asylees, can also maintain this coverage. Under these changes, refugees and asylees will become ineligible for these programs, except for some in states that have taken up the Medicaid and CHIP option to expand coverage for lawfully residing children and pregnant people.

Implementation dates for the eligibility restrictions vary by program. Medicaid and CHIP restrictions will take effect October 1, 2026; limits for subsidized ACA coverage will go in place January 1, 2027; Medicare coverage limits took effect July 4, 2025 (the date the law was signed), with current beneficiaries losing coverage no later than 18 months from the enactment of the legislation (January 4, 2027); and SNAP restrictions for new applicants go into effect as early as November 1, 2025, with current beneficiaries losing access at the time of their next recertification.

The U.S. also provides refugees and asylees access to certain time-limited benefits and services through the Office of Refugee Resettlement (ORR) to facilitate their transition. These include:

  • Refugee Medical Assistance (RMA): In cases where refugees and asylees are ineligible for Medicaid or CHIP, they may qualify for RMA, which had been available to refugees and asylees for up to 12 months prior to recent changes.
  • Refugee Cash Assistance (RCA): RCA provides cash assistance to refugees and asylees for basic necessities such as housing, food, and transportation. RCA had been available to refugees and asylees for up to 12 months prior to recent changes.
  • Refugee Support Services (RSS): Refugees and asylees also have access to a range of services to support employment and thereby, self-sufficiency, which include English language training, job training, childcare, and access to transportation. Access to RSS is available to refugees and asylees for up to five years.

The Trump administration has reduced access to time-limited support services that ORR provides to refugees and asylees. On March 21, 2025, the Administration for Children and Families issued a notice reducing the eligibility period for refugees and asylees to access RMA and RCA, citing budget constraints. This notice reduced access to RMA and RCA from 12 months to four months for refugees and asylees effective 45 days after the notice’s publication (i.e., May 5, 2025).

Together, these reductions are likely to exacerbate health and socioeconomic challenges faced by refugees and asylees and could also reduce their economic contributions to the U.S. Research by the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) finds that between 2005 and 2019, refugees and asylees had a net positive impact of about $124 billion on the U.S. economy, meaning that they contributed more in revenue ($581 billion) than they cost in expenditures ($457 billion) to the federal, state, and local governments. Actions to limit the assistance refugees, asylees, and other humanitarian immigrants receive when they arrive in the U.S. could create barriers to successful transition to employment and self-sufficiency and foreclose opportunities for them to make economic and workforce contributions in the future.

  1. Data on individuals granted asylum defensively in FY 2023 not available by age and sex. Affirmative asylum applies to those not in removal proceedings who apply directly to U.S. Citizenship and Immigration Services whereas defensive asylum applies to individuals already in removal proceedings. ↩︎
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