Medicaid is shrinking, and refugees are among the first to feel it. Starting Oct. 1, refugees are losing access to Medicaid across the country under H.R. 1, the major budget bill passed by Republicans last summer. The change affects an estimated 280,000 people, according to an analysis by KFF Health News.
Mustafa Rfat, a professor of social work at the University of Nebraska at Omaha, knows what that means. He arrived in the U.S. as a refugee from Iraq in 2011 with a chronic spinal condition. Medicaid was a lifeline while he moved from Alabama to Illinois to West Virginia. Now he is watching that safety net disappear for people like him.
“It’s a nightmare,” Rfat told NPR.
The Policy at Work
The rule is simple: refugees are among the groups losing Medicaid coverage starting Oct. 1. The cutoff applies to refugees, asylum seekers, and other legal immigrants who have not yet gained permanent residency. The analysis by KFF Health News estimates that 280,000 people will lose Medicaid in October, reflecting the first wave of the policy.
Rfat’s own experience shows why the cutoff matters. He suffers from an inflammatory condition called ankylosing spondylitis. His disability meant he needed ongoing care while he moved across the country.
He also points out that more than one third of refugees have at least one type of disability. That means a significant share of the people losing coverage have serious health conditions. And because Medicaid covers routine care, preventive care, and treatment for ongoing conditions, losing it means refugees with disabilities no longer have a way to manage their health day to day.
Who Is Losing Coverage
The group facing the cut includes refugees, asylum seekers, and other legal immigrants who have not yet gained permanent residency. These are people who have experienced violence in their own homes or on their journey, who may have physical and mental conditions, and who are fleeing persecution and war.
The KFF analysis estimates that 280,000 people will lose Medicaid in October. That number reflects the first wave of the policy. The cuts apply to people who entered the U.S. on humanitarian grounds and are waiting to be approved for a green card.
The policy also applies to pregnant women and children. Most states have opted in to allow Medicaid to continue covering those groups, but the adult population loses eligibility under the new rule.
The Cost of the Cut
The consequences of losing Medicaid are not abstract. Immigrants could still buy full-price coverage from ACA marketplaces, but that is often unaffordable. Many immigrants do not work in jobs that offer employer-sponsored coverage, including jobs in construction, agriculture, and food service.
That combination — no employer coverage and premiums that exceed what they can afford — leaves people with few options. The result is more costly care down the road, once they receive a green card and regain eligibility. By then the damage is done: untreated conditions worsen, preventive care never happened, and the system pays more to fix problems that could have been managed for less.
For refugees with disabilities, the loss is particularly severe. They often rely on Medicaid for both routine care and treatment of their chronic conditions. Without coverage, they risk letting those conditions go untreated until they become much worse — and more expensive — later on.
States Push Back
Not every state is waiting for the cuts to land. A few states are creating their own coverage options, though many have tight budgets and face even bigger Medicaid cuts in January.
The states that are opting in to protect pregnant women and children are doing so voluntarily. Their decision means those families will keep coverage even as adults around them lose it. But the protection is partial, not universal, and it leaves a gap for the affected population.
The state-by-state approach means the impact will not be uniform. Some refugees will find local coverage in states that act; others will fall through the cracks in states that do nothing.
Rfat’s Next Move
Rfat is not waiting for Congress to act. He plans to meet with refugees with disabilities at his alma mater, Washington University in St. Louis, this weekend. He wants to talk directly with people who are navigating the system right now and hear what is working and what is failing.
His hope is that Congress will reverse course on the policy.
What the Policy Protects
The Medicaid cuts apply to people who entered the U.S. as refugees or asylum seekers. The law does not extend to all immigrants; it targets a specific group whose legal status is tied to their path to permanent residency.
Here is what the policy protects, and what it does not:
- Pregnant women and children are protected in most states, thanks to the opt-in provision.
- Adults who entered the U.S. as refugees or asylum seekers are not protected; they lose coverage under the new rule.
- The ACA marketplace remains available, but full-price premiums are often unaffordable for immigrants without employer coverage.
- States that create their own coverage options can help, but many face budget constraints and larger Medicaid cuts ahead.
The policy also raises a question about how the U.S. treats people who are rebuilding their lives after war or persecution. Rfat’s story — a professor who came from Iraq with a spinal condition and relied on Medicaid to move across the country — is not unusual. It is common. And under this policy, common becomes unprotected.
The Bottom Line
The Medicaid cuts are real, and they are happening now. The Oct. 1 deadline means the first wave of people is already losing coverage. The policy was passed by Congress and is being carried out by officials implementing it.
But the law does not change the arithmetic: fewer people with coverage means more people without it.
Where the paper stands
The paper backs smaller government and is against agencies writing their own authority, including the Medicaid changes that came through H.R. 1. That means the paper supports decisions that push power back toward citizens and away from Washington, and it opposes offices gathering more power, whatever party holds it.
The Medicaid cuts under H.R. 1 remove coverage from refugees, asylum seekers, and other legal immigrants who have not yet gained permanent residency. Those cuts take effect Oct. 1 and apply to an estimated 280,000 people, according to KFF Health News. The paper sees this as an example of an agency acting beyond its proper bounds.
The cuts show an office acting on its own, removing coverage from a specific group of people rather than following a clear law written by elected representatives. The policy applies to people who entered the U.S. on humanitarian grounds and are waiting to be approved for a green card. The paper believes such decisions should come from Congress, not from an agency writing its own rules.
Source material: “'It's a nightmare.' Former refugee, professor on Trump's new Medicaid policy,” NPR.
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