Budget constraints are forcing liberal-leaning states that spend their own money on healthcare for noncitizens to scale back that aid, as they grapple with federal Medicaid cuts and the expiration of federal subsidies that helped people buy Obamacare plans.

Under federal law, immigrants who are in the country illegally are not eligible for federally funded health coverage.

But as of last month, six states — California, Colorado, Illinois, New York, Oregon and Washington — plus the District of Columbia were spending state dollars to cover some income-eligible noncitizen adults regardless of their immigration status. A total of 14 states plus the district provide state-funded coverage to noncitizen children whether they are here legally or not. And three states — Colorado, New Jersey and Vermont — cover pregnant women regardless of their immigration status.

In addition, 40 states have taken up options in Medicaid and the Children’s Health Insurance Program, known as CHIP, to provide coverage to lawfully present children and/or pregnant women who are not citizens.

But the sweeping tax and spending bill President Donald Trump signed into law last summer cuts federal spending on Medicaid, the joint federal-state health insurance program for low-income people. It also places new eligibility restrictions on lawfully present immigrants, including refugees and asylees, who are enrolled in a variety of government-subsidized health programs, including Medicaid, CHIP, Medicare and plans available on the insurance marketplaces created under the Affordable Care Act, better known as Obamacare.

And Congress at the end of last year failed to renew federal subsidies that helped people buy Obamacare plans.

With less federal money to provide health benefits, at least five states (California, Colorado, Illinois, Minnesota and Washington) plus the District of Columbia have already scaled back or announced plans to scale back state-funded health benefits for immigrants. Other states also may have to pull back as budget pressures continue.

“The federal government shifted much more of the financial burden of providing those services to states. And so states are taking a holistic view at their healthcare budgets and trying to figure out where they can cut,” said Medha Makhlouf, a law professor and the founding director of the Medical-Legal Partnership Clinic at Penn State Dickinson Law, who studies immigrants’ access to healthcare.

“Historically and currently, as we’re seeing, immigrants are going to be the first to be cut, for a variety of reasons. They don’t have political power in the same way citizens do.”

Drishti Pillai, director of immigrant health policy at KFF, a health policy research group, warned that the state cuts, combined with the federal changes, “will likely increase uninsured rates and reduce access to care among immigrants and their children, most of whom are U.S. citizens.