Congress’ reconciliation bill jeopardizes North Carolina’s Medicaid expansion program and targets immigrant families with legal status

RALEIGH (June 9, 2025) – The proposed federal budget reconciliation bill revokes benefits for numerous lawfully present immigrants and threatens North Carolina’s Medicaid expansion program for more than 600,000 people.

• Medicaid expansion at risk: A poorly written provision in the bill threatens Medicaid expansion by reducing federal funding for states that provide Medicaid coverage for humanitarian parolees. This could end Medicaid expansion, destabilizing health care for over 600,000 people and threatening rural hospitals.
• Health care crisis: Non-citizens who would lose access to the Affordable Care Act (ACA), SNAP, and Medicare include refugees, human trafficking survivors, and certain victims of domestic violence, among others. DACA holders, farm workers with lawful visas, and other lawfully present immigrants would lose access to ACA health coverage, despite paying taxes and working lawfully.
• Food insecurity: 8,000 refugees, including those from Afghanistan, rely on SNAP in North Carolina, as well as thousands of other lawfully present non-citizens who would lose access to this essential support.

Medicaid expansion at risk: The reconciliation bill contains a provision that would penalize states that provide Medicaid coverage to adults with “humanitarian parole” by reducing the federal match for Medicaid expansion from 90% to 80%. Parolees who are granted parole for one year or longer are lawfully present and fully eligible for Medicaid under federal law.

This has direct implications for North Carolina, as our state has a trigger law that ends the Medicaid expansion program if the federal match falls below 90%.

Health care crisis: Programs like health insurance under the ACA and Medicare have historically been available to much broader categories of lawfully present non-citizens who work lawfully and pay into these systems through their payroll contributions or income taxes.

Due to strict Medicaid regulations, the ACA has been a pathway to health insurance for millions of lawfully present immigrants since 2014. Eligibility for ACA coverage was expanded to include DACA residents in 2024. In 2021, 15.8% of ACA enrollees nationwide were non-citizens. The reconciliation bill threatens to eliminate coverage for these programs for many lawfully present immigrants.

Food insecurity: The SNAP nutrition assistance program has always been limited to certain categories of lawfully present immigrants, but it is currently available to refugees, human trafficking survivors, and certain victims of domestic violence, as well as green card holders. In fiscal year 2023, 8,000 refugees used the SNAP program in North Carolina, as well as 9,000 other lawfully present non-citizens.

Among those refugees, 3,568 Afghans settled in North Carolina between 2021 and August 2023. Many of them had aided U.S. troops before the fall of Afghanistan in 2021.