Rosa María Carranza, 67, spent more than 30 years teaching and caring for children in Oakland, co-founding an outdoor Spanish-immersion preschool and supporting families while building a lifetime of work credits. After moving to part-time work last year she expected to retire with Medicare and Social Security — benefits she paid into for decades. Her Social Security earnings record shows tens of thousands of dollars in contributions over 24 years.
Instead, Carranza is among an estimated 100,000 lawfully present immigrants who stand to be cut off from Medicare following the One Big Beautiful Bill Act, signed by President Trump last July. The law excludes certain categories of legally present people — including those with temporary protected status (TPS), many refugees and asylum-seekers, survivors of domestic violence or human trafficking, and some visa holders — from Medicare. Officials say people already enrolled will be removed from coverage by Jan. 4.
Supporters of the change argue it reins in federal spending and discourages immigration by narrowing access to benefits. Critics note that the groups targeted by the law have legal status and, in many cases, long employment histories. Undocumented immigrants were already ineligible for Medicare and most other federal programs.
Carranza, who fled violence in El Salvador and arrived in the U.S. in 1991, eventually qualified for TPS in 2001 after earthquakes made a return unsafe. TPS, created by Congress in 1990, allows nationals of countries facing disaster or conflict to live and work in the U.S. temporarily. Carranza worked nights babysitting, substituted in classrooms, earned a degree in child development and sent support home — and planned to rely on Medicare and Social Security in retirement.
Already managing high blood pressure and a recent arthritis diagnosis after a fall, she says routine visits and urgent care were affordable with Medicare — often costing only a few dollars out-of-pocket. Losing that coverage would sharply raise her medical bills. The stress of potentially losing health insurance and facing intensified immigration enforcement has worsened her insomnia and anxiety, and she is seeking therapy.
Health-policy experts and clinicians say stripping Medicare from lawfully present groups is unprecedented and dangerous. Policy analysts at KFF and other organizations describe it as the first instance Congress has removed Medicare eligibility from an identifiable category of people, many of whom have paid into the system for years. Emergency physicians warn that older adults who lose routine care are more likely to delay treatment, suffer worsening chronic disease and end up in emergency departments with more severe conditions.
This change is only one of several federal policy shifts this year that reduce immigrants’ access to health programs. Earlier rule changes tightened eligibility for Medicaid, marketplace subsidies and other federal services; KFF estimated as many as 1.4 million lawfully present immigrants could lose coverage from the combined actions. Broader tax analyses show immigrant workers, including some undocumented people, contribute billions to Medicare and Social Security: one estimate put undocumented workers’ Medicare contributions at $6.4 billion and Social Security contributions at $25.7 billion in 2022. The Congressional Budget Office projected the Medicare restriction would lower federal spending by about $5.1 billion through 2034.
Carranza also experienced the immediate fallout of tightened enforcement and paperwork errors. The Social Security Administration once sent her a letter claiming she was no longer lawfully present, which led Medicare to stop paying for her health plan and temporarily cut off her retirement check. She missed a rent payment and had to take extra babysitting jobs until Representative Lateefah Simon’s office helped restore her benefits — but the interruption lasted months and left her financially vulnerable.
States could try to step in, but many face budget constraints. Some states had expanded coverage for immigrant residents, yet several are scaling back or freezing new enrollment amid fiscal pressures. California — home to the largest population of immigrant seniors — limited enrollment this year for adults 19 and older who are TPS holders, unauthorized or asylum-seekers. Governor Gavin Newsom’s proposed budget does not commit to replacing the federal funding for roughly 200,000 lawfully present immigrants, citing an estimated $1.1 billion annual cost and tight state finances. California officials say the state cannot absorb that expense under current conditions.
Still, some state lawmakers and advocates are pursuing fixes. California Assemblymember Mia Bonta, chair of the Assembly health committee, said she is exploring a legislative budget solution to bring affected people into Medi-Cal, the state’s Medicaid program, emphasizing the importance of preserving retirement dignity for those who have worked in the state for decades.
The debate over the federal policy is framed by competing priorities: proponents assert limiting benefits deters unauthorized immigration and saves taxpayer dollars, while opponents say the rule strips essential coverage from legally present workers who have contributed to the system. Think-tank commentary has praised the change as avoiding a so-called “welfare magnet,” while many health experts and immigrant advocates call it punitive and short-sighted.
For Carranza the consequences are immediate and personal. She keeps a box of work authorizations, ID cards and her Social Security card as proof of decades of employment. Her daughter, a green-card holder in Texas, hopes to petition to make Carranza a permanent resident — a process likely to take years. Until then, Carranza faces the real prospect of losing Medicare and Social Security benefits she paid into, and the financial and health risks that follow, along with the fear of detention or deportation.
This report was produced in collaboration with El Tímpano. KFF Health News is a national newsroom that covers health policy and is a core program of KFF.