OAKLAND, Calif. — Rosa María Carranza, 67, co-founded an outdoor Spanish immersion preschool in Oakland and has worked with children and teens for more than three decades. After transitioning to part-time work last year, she expected to receive Medicare and Social Security — benefits for workers and many lawfully present immigrants who meet work history and age requirements. Her Social Security earnings record shows she contributed tens of thousands of dollars over 24 years.
Yet Carranza and an estimated 100,000 other lawfully present immigrants will soon be cut out of Medicare. The One Big Beautiful Bill Act, signed by President Trump last July, bars certain categories of lawfully present immigrants — including temporary protected status (TPS) holders, refugees, asylum-seekers, survivors of domestic violence, trafficking victims, and people with work visas — from Medicare. Those already enrolled will be disenrolled by Jan. 4. Republican lawmakers framed the change as reining in Medicare spending and argued taxpayer dollars should not pay for care for people they describe as not authorized to be in the U.S.
The affected groups, however, do have legal status. Neither the White House nor the Department of Health and Human Services answered whether it was fair to disenroll legal residents from Medicare. Undocumented immigrants were already ineligible for Medicare and most other federal benefits.
Carranza, who arrived from El Salvador in 1991 during a civil war, overstayed a visa until she qualified for TPS in 2001 after deadly earthquakes. TPS, created by Congress in 1990, allows people from countries experiencing conflict, disaster, or other special circumstances to live and work in the U.S. when returning home would be unsafe.
She spent decades working overnight babysitting, substitute teaching, and earning a degree in child development while supporting children back home. Now, approaching retirement, she faces losing the health coverage she paid into. Last year she was diagnosed with high blood pressure and had urgent care and hospital visits she could afford because of Medicare — $10 for an urgent care visit and $5 for a primary care visit. Those costs would rise sharply without Medicare. She also woke with a swollen foot after a fall and was diagnosed with arthritis.
“This is like a horror movie, a complete nightmare,” Carranza said. The stress of potentially losing both health coverage and legal status — amid increased immigration enforcement and detentions — has affected her mental health. She is searching for therapy and other care to treat insomnia and anxiety.
Health experts say removing Medicare for lawfully present immigrants is unprecedented. Drishti Pillai, director of immigrant health policy at KFF, called it the first time Congress has taken away Medicare from any group, noting many affected people have worked and paid into the system for decades. Clinicians warn that older adults who lose coverage will delay care, increasing severe illness and pressure on emergency departments. Theresa Cheng, an emergency physician at Zuckerberg San Francisco General Hospital, said seniors can quickly deteriorate without routine care and are prone to cardiovascular and other chronic conditions.
Policy changes earlier this year also restricted immigrants’ access to Medicaid, marketplace subsidies, and federally funded services. KFF projected 1.4 million lawfully present immigrants could lose health insurance from those changes. While detailed Medicare enrollment data for lawfully present immigrants is limited, broader tax data shows immigrants — including undocumented workers — contribute substantially to federal programs. The Institute on Taxation and Economic Policy estimated undocumented immigrants paid $6.4 billion into Medicare and $25.7 billion into Social Security in 2022. The Congressional Budget Office estimated the Medicare restriction would reduce federal spending by about $5.1 billion by 2034.
Carranza already experienced a frightening bureaucratic mistake: the Social Security Administration sent a letter saying she no longer qualified for retirement benefits because she was not lawfully present, and Medicare stopped paying her health plan, which disenrolled her. Without her check she missed a rent payment and worked babysitting to cover it. Representative Lateefah Simon’s office helped restore her benefits, but the disruption took months.
Where can people like Carranza turn? Some states had bolstered coverage for immigrants, but many are scaling back amid budget pressures. California, home to the largest number of immigrant seniors, froze enrollment this year for adults 19 and older who are TPS holders, unauthorized, or asylum-seekers. Governor Gavin Newsom proposed a budget that would not backfill the federal cuts for about 200,000 lawfully present immigrants, citing a $1.1 billion annual cost and state fiscal constraints. California Department of Finance officials said the administration cannot fill the gap given fiscal pressures.
Still, some lawmakers and advocates press for state solutions. California Assembly member Mia Bonta, who chairs the Assembly’s health committee, said she is working on a legislative budget fix to bring immigrants who will lose federal coverage into Medi-Cal, the state’s Medicaid program. She emphasized the stakes for people who have lived and worked in California for decades and expect to retire with dignity.
Supporters of the federal changes say limiting benefits deters immigration and reduces federal spending, while critics argue the policy strips benefits from legally present workers who have paid into the system. Michael Cannon of the Cato Institute framed the policy as part of a broader Republican desire to avoid creating a “welfare magnet.” House Speaker spokespersons did not respond to requests for comment.
For Carranza, the threat is personal and immediate. She keeps a box of IDs, work authorization cards, driver’s licenses, and her Social Security card as a record of decades of legal authorization to work. Her daughter in Texas, a green-card holder, hopes to become a citizen so she can petition to make Carranza a permanent resident — a process that can take years. Carranza fears the worst: losing insurance, losing retirement benefits, and the possibility of detention or deportation.
This article was produced in collaboration with El Tímpano. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core programs at KFF.