A Quieter H.R. 1 Cliff: ~100,000 Lawfully Present Immigrants — Including Seniors Who Paid In for Decades — Lose Medicare on January 4, 2027, and California Has the Most

Beneath the Medi-Cal cuts sits a separate, less-discussed H.R. 1 provision: the law bars Medicare eligibility for several lawfully present immigrant categories — refugees, asylees, people with Temporary Protected Status, survivors of domestic violence and trafficking, and certain work-visa holders. KFF estimates ~100,000 people lose Medicare specifically (and ~1.4M lawfully present immigrants lose health coverage overall), with current enrollees disenrolled January 4, 2027 — squarely in the December 2026–January 2027 cliff window. California, home to the largest population of immigrant seniors, is the most exposed, and the state has proposed NOT backfilling ~200,000 affected residents with state coverage, citing a ~$1.1B annual price tag. The bitter irony: undocumented and lawfully present immigrants paid an estimated $6.4B into Medicare and $25.7B into Social Security in 2022 alone. For FQHCs this is distinct from the Medi-Cal UIS freeze and the July 1 dental cut — it converts a population of insured, often-elderly patients into uninsured/self-pay starting in January, on top of the GWU Geiger Gibson finding that ~3.4M Medicare patients already rely on community health centers (2-in-5 of them dual-eligible). FQHC finance and enrollment teams should flag affected patients now and model the Medicare-side revenue loss alongside the Medicaid cliffs.