Starting Thursday, there are new restrictions on who’s eligible to receive Medicaid, part of a series of eligibility rules that will roll out over the next three months and put millions of Americans at risk of losing coverage. 

About 73 million people across the U.S. receive their health insurance through Medicaid or the Children’s Health Insurance Program, known as CHIP — roughly 20% of the population.

The changes were baked into the One Big Beautiful Bill Act that President Donald Trump signed in July 2025.

As of Thursday, immigrants who are lawfully living in the U.S. but don’t have a green card stand to lose Medicaid coverage, with some minor exceptions. On Jan. 1, many more recipients will be at risk of losing their health care if they don’t meet new work requirements.

The nonpartisan Congressional Budget Office estimates the changes will cut federal spending by roughly $1 trillion over the next 10 years, but it projects they will also push about 16% of people currently on Medicaid or CHIP off those programs.

Public health experts say it’s unlikely those people will be able to afford coverage on their own, since tax credits to purchase insurance through the Affordable Care Act expired last year.

“What we see happen is they will delay going to see care — they won’t get routine care, they won’t get preventive care,” said Katherine Hempstead, senior policy officer at the Robert Wood Johnson Foundation. “So they’ll delay until they’re very sick, and then people might turn up in an emergency room or in a setting like that, and they will need care but won’t be able to pay for it.”

The changes will hit some states harder than others. More than 30% of the population in California, Kentucky, Hawaii and New York are Medicaid recipients.

Rural communities may also struggle, given that they already operate on tight profit margins and hospitals are required by law to provide emergency care even if a patient can’t pay.

“There is definitely a concern that with these really drastic reductions in federal funding and big losses of coverage, that we’re going to see a lot of closures of rural hospitals,” Hempstead said.

White House spokesman Kush Desai told Spectrum News that financial troubles at the country’s rural healthcare facilities have been worsening for decades but added that a $50 billion federal initiative passed last year will help strengthen and modernize rural healthcare through 2030.

“The reality is that rural healthcare distress is a structural issue that the Trump administration is fixing,” Desai said.