Lawfully present vs. eligible noncitizen: what changes for Marketplace financial assistance in 2027

Beginning January 1, 2027, a provision in the Working Families Tax Cut legislation changes who can get Marketplace financial assistance. That means advance premium tax credits (APTC) and cost-sharing reductions (CSRs).

CMS released new guidance implementing this provision on October 5.

What is the difference between “lawfully present” and “eligible noncitizen”?

Lawfully present is the standard for enrolling in a Marketplace plan. Eligible noncitizen is narrower: a subset of lawfully present people who can get advance premium tax credits (APTC) and income-based cost-sharing reductions (CSRs).

Every eligible noncitizen is lawfully present, but not every lawfully present noncitizen is an eligible noncitizen. Sort of like that old bit about squares and rectangles.

Can lawfully present immigrants still buy Marketplace coverage in 2027?

Yes, if they’re otherwise eligible. Lawful presence is still a requirement to enroll in a qualified health plan through the Marketplace. A lawfully present noncitizen who isn’t an eligible noncitizen can enroll but gets no APTC or CSRs, so they pay the full price.

Who can get APTC and CSRs in 2027?

Beginning in plan year 2027, only U.S. citizens, U.S. nationals, and eligible noncitizens can get financial assistance, so long as they also meet the other requirements. Eligible noncitizens fall into one of these categories:

• Lawful permanent resident (green card holder)
• Cuban or Haitian entrant
• Individual lawfully residing under a Compact of Free Association (COFA migrant)

Does this apply to State-Based Exchanges, Medicaid, and CHIP?

This guidance covers the Federally-facilitated Exchange, including HealthCare.gov and states using it. The underlying law may also affect consumers using State-Based Exchanges, but their redetermination and notice processes may differ. Agents writing through a State-Based Exchange should check that exchange’s guidance. Medicaid and CHIP aren’t covered by this guidance, though a separate provision of the law affects federal funding for coverage of some noncitizens in those programs.

What role do agents play in conversations about immigration status?

Your job is to make sure noncitizen clients understand that the type of status they hold now determines whether they’ll get financial assistance. It isn’t to determine their status or advise on how to obtain one.

Most of us never factor immigration status into a quote. For some clients, it now changes the price. Applicants attest to their status on the application, and the Exchange verifies it through the Department of Homeland Security. They should have relevant immigration information handy, such as an alien number or passport number.

If a client isn’t sure about their status, they should check their documents or talk to an immigration attorney or other accredited representative before open enrollment.

What happens to existing noncitizen Marketplace enrollees in 2027?

CMS strongly encourages noncitizen enrollees to update their Marketplace applications. Their applications will be checked against DHS records. If the Exchange can’t confirm an attested eligible status, they enter the 95-day period below. Enrollees who don’t update are handled in one of three ways:

• Eligible status already on file, or newly verified through DHS: they keep APTC and CSRs, if otherwise eligible
• No verified eligible status: they’re re-enrolled automatically on January 1 without APTC or CSRs
• DHS shows they’re no longer lawfully present: Marketplace eligibility is lost entirely

If a household’s original subscriber is no longer eligible for coverage, the Exchange assigns a new subscriber from the remaining enrollees and age-rates everyone as of the new policy start date.

CMS will send notices to impacted enrollees. Clients whose status can’t be verified will get tailored messaging in their Marketplace Open Enrollment Notice, and then an eligibility determination notice with appeal rights before the plan year starts. But notices land in mailboxes, and your clients can miss them. Your call may be the first time they hear about it.

What is the 95-day data matching issue period?

When a client attests to eligible noncitizen status and the Exchange can’t verify it electronically through DHS, they receive a data matching issue (DMI) and 95 calendar days to submit documents. They can enroll and receive APTC and CSRs during that window, if otherwise eligible. Examples of documents consumers might submit include a Permanent Resident Card, an Employment Authorization Document, or an I-94/I-94A.

What happens next depends on paperwork. Documents showing eligible noncitizen status keep the subsidies in place. Documents showing lawful presence but not eligible status end APTC and CSRs. Documents without lawful presence end Marketplace enrollment. And failing to submit documents by day 95 can mean losing APTC and CSRs, or coverage altogether if lawful presence can’t otherwise be verified.

How do grace periods and Form 1095-A change?

Clients losing APTC also lose the three-month APTC grace period. The grace period only applies to enrollees who were receiving APTC when they fell behind, so their carrier’s own grace period applies, subject to state law.

Every lawfully present enrollee will still receive a Form 1095-A, starting in January 2028 for tax year 2027. For those losing APTC eligibility, Part III may show blanks or zeros. In a mixed-status household, the premium figures may be reduced to exclude the share tied to members who aren’t eligible noncitizens. Clients who find errors should call the Marketplace Call Center for a corrected form.

What should clients do if they can’t afford a plan without APTC?

Start by comparing lower-cost plans. If none fits the budget, clients need to understand what happens if they keep their current coverage: they may be automatically re-enrolled without APTC or CSRs, and owe the full premium. If they know they won’t qualify for financial assistance and don’t want their plan renewed, they should cancel their 2027 coverage.

Source: CMS CCIIO, "Guidance on Noncitizen Eligibility for APTC and CSRs for Plan Year 2027," released October 5, 2026. This post is educational and isn't legal or immigration advice.